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Bakare AA, Graham H, Agwai IC, Shittu F, King C, Colbourn T, Iuliano A, Aranda Z, McCollum ED, Isah A, Bahiru S, Valentine P, Falade AG, Burgess RA. Community and caregivers' perceptions of pneumonia and care-seeking experiences in Nigeria: A qualitative study. Pediatr Pulmonol 2020; 55 Suppl 1:S104-S112. [PMID: 31985894 DOI: 10.1002/ppul.24620] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022]
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.
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Affiliation(s)
- Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria.,Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Hamish Graham
- Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Imaria C Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | | | | | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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