Funding for this project was provided by the Harvard-affiliated Emergency Medicine Residency Povinelli Research Award, as well as the Brigham and Women’s Hospital Biomedical Research Institute/Center for Faculty Development.
American Journal of Tropical Medicine and Hygiene
Malaria in children -- Treatment -- Uganda -- Qualitative studies, Malaria in children -- Social aspects, Malaria in children -- Effect of delays in treatment on
Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee’s distinctions of “traditional” versus “hospital” illnesses, which were mutually exclusive and 2) generational conflict, where deference to one’s elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.
American Society of Tropical Medicine and Hygiene
Sundararajan R, Mwanga-Amumpaire J, Adrama H, Tumuhairwe J, Mbabazi S, Mworozi K, Carroll R, Bangsberg D, Boum Y 2nd, Ware NC; Sociocultural and Structural Factors Contributing to Delays in Treatment for Children with Severe Malaria: A Qualitative Study in Southwestern Uganda. Amer J Trop Med Hyg; 2015 Mar 23 doi: 10.4269/ajtmh.14-0784