Ayobami A Bakare1,2,3, Hamish Graham4,5, Imaria C Agwai6, Funmilayo Shittu7, Carina King3,8, Tim Colbourn8, Agnese Iuliano8, Zeus Aranda8, Eric D McCollum9, Adamu Isah10, Solomon Bahiru10, Paula Valentine11, Adegoke G Falade5,12, Rochelle A Burgess8. 1. Department of Community Medicine, University College Hospital, Ibadan, Nigeria. 2. Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. 3. Department of Global Public Health, Karolinska Institute, Stockholm, Sweden. 4. Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia. 5. Department of Paediatrics, University College Hospital, Ibadan, Nigeria. 6. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. 7. Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. 8. Institute for Global Health, University College London, London, UK. 9. Eudowood Division of Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. 10. Save the Children International, Abuja, Nigeria. 11. Save the Children UK, London, UK. 12. Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Abstract
BACKGROUND: Appropriate and timely care seeking can reduce pneumonia deaths, but are influenced by caregivers and community norms of health and illness. We explore caregiver and community perceptions, and care-seeking experience, of childhood pneumonia, to understand contexts that drive pediatric service uptake in Nigeria. METHODS: Community group discussions and qualitative interviews with caregivers in Lagos and Jigawa states were completed between 1 November 2018 and 31 May 2019. Participants were recruited from purposively sampled health facility catchment areas with assistance from facility staff. We used episodic interviews, asking caregivers (Jigawa = 20; Lagos = 15) to recount specific events linked to quests for therapy. Community group discussions (n = 3) used four vignettes from real pneumonia cases to frame a discussion around community priorities for healthcare and community-led activities to improve child survival. Data were analyzed using the framework method. RESULTS: We found poor knowledge of pneumonia-specific symptoms and risk factors among caregivers and community members, with many attributing pneumonia to cold air exposure. Interviews highlighted that care-seeking decision making involved both husbands and wives, but men often made final decisions. In Lagos, older female relatives also shaped quests for therapy. Cost was a major consideration. In both states, there were accounts of dissatisfaction with health workers' attitudes and a general acceptance of vaccination services. CONCLUSION: There is a need for community-based approaches to improve caregiver knowledge and care seeking for under-five children with pneumonia. Messaging should attend to knowledge of symptoms, risk factors, family dynamics, and community responsibilities in healthcare service delivery and utilization.
BACKGROUND: Appropriate and timely care seeking can reduce pneumonia deaths, but are influenced by caregivers and community norms of health and illness. We explore caregiver and community perceptions, and care-seeking experience, of childhood pneumonia, to understand contexts that drive pediatric service uptake in Nigeria. METHODS: Community group discussions and qualitative interviews with caregivers in Lagos and Jigawa states were completed between 1 November 2018 and 31 May 2019. Participants were recruited from purposively sampled health facility catchment areas with assistance from facility staff. We used episodic interviews, asking caregivers (Jigawa = 20; Lagos = 15) to recount specific events linked to quests for therapy. Community group discussions (n = 3) used four vignettes from real pneumonia cases to frame a discussion around community priorities for healthcare and community-led activities to improve child survival. Data were analyzed using the framework method. RESULTS: We found poor knowledge of pneumonia-specific symptoms and risk factors among caregivers and community members, with many attributing pneumonia to cold air exposure. Interviews highlighted that care-seeking decision making involved both husbands and wives, but men often made final decisions. In Lagos, older female relatives also shaped quests for therapy. Cost was a major consideration. In both states, there were accounts of dissatisfaction with health workers' attitudes and a general acceptance of vaccination services. CONCLUSION: There is a need for community-based approaches to improve caregiver knowledge and care seeking for under-five children with pneumonia. Messaging should attend to knowledge of symptoms, risk factors, family dynamics, and community responsibilities in healthcare service delivery and utilization.
Authors: Hamish R Graham; Omotayo E Olojede; Ayobami Adebayo A Bakare; Eric D McCollum; Agnese Iuliano; Adamu Isah; Adams Osebi; Ibrahim Seriki; Tahlil Ahmed; Samy Ahmar; Christine Cassar; Paula Valentine; Temitayo Folorunso Olowookere; Matt MacCalla; Obioma Uchendu; Rochelle Ann Burgess; Timothy Colbourn; Carina King; Adegoke G Falade Journal: BMJ Open Date: 2022-05-02 Impact factor: 3.006
Authors: Carina King; Rochelle Ann Burgess; Ayobami A Bakare; Funmilayo Shittu; Julius Salako; Damola Bakare; Obioma C Uchendu; Agnese Iuliano; Adamu Isah; Osebi Adams; Ibrahim Haruna; Abdullahi Magama; Tahlil Ahmed; Samy Ahmar; Christine Cassar; Paula Valentine; Temitayo Folorunso Olowookere; Matthew MacCalla; Hamish R Graham; Eric D McCollum; Adegoke G Falade; Tim Colbourn Journal: Trials Date: 2022-01-31 Impact factor: 2.279