Prevalence and factors associated with delay in seeking healthcare by caregivers of children less than five years with severe pneumonia at Mulago National Referral Hospital
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Background: Globally, pneumonia is the leading infectious cause of under-five mortality In Uganda, pneumonia accounts for 16% of childhood deaths. Child mortality and complications from pneumonia can be reduced by prompt healthcare seeking. Evidence to guide interventions to reduce delay in seeking healthcare for children less than five years with pneumonia is crucial. Objectives: The study aimed to determine the prevalence and factors associated with delay in seeking healthcare by caregivers of children under five years with severe pneumonia attending Mulago National Referral Hospital (MNRH). Methods: It was a mixed methods cross sectional study conducted among 384 caregivers of children under-five with severe pneumonia at MNRH from December 2020 to May 2021. The participants were consecutively enrolled. They were identified from a patient register at admission and the children screened to confirm they met the WHO case definition of severe pneumonia before enrolling their caregivers. Quantitative data was collected using interviewer administered structured questionnaires. The qualitative data was collected through focus group discussions with caregivers. All data was collected after seeking written informed consent from the caregivers. Quantitative data was entered in epidata version 4.2 and exported to STATA version 14 for analysis. Descriptive statistics was used to determine the prevalence of delay in care seeking. Logistic regression analysis was used to determine the factors that were independently associated with delay in seeking healthcare among caregivers of children under five years with severe pneumonia. Content thematic analysis was used to analyse the qualitative data for barriers and facilitators to health care seeking. Results: Of the 384 caregivers enrolled, majority (97.4%) were female, the median age was 27 years (IQR 24-33) and 82.8% had sought care from other sources including drug shops, pharmacies and herbalists before going to a hospital or health center. The prevalence of delay in seeking healthcare among care givers of children under five with severe pneumonia was 53.6% (95% CI: 48.6-58.6). Long distance to hospital AOR = 1.94 (95% CI 1.24–3.01) p-value=0.003, first seeking care from other sources such as drug shops before going to a hospital or health center AOR = 3.33 (95% CI 1.85–6.01) p-value=0.001), and monthly income ≤100,000 UGX AOR = 2.27 (95% CI 1.33–3.86) p-value=0.003) were significantly associated with delay in seeking healthcare. Limited knowledge of symptoms, delayed referrals and low level of education were some of the identified barriers to prompt health care seeking. Conclusion This study showed that more than half of the caregivers delayed seeking healthcare for their children with severe pneumonia. With majority of mothers seeking healthcare from drug shops and pharmacies, where the providers are not primarily trained to diagnose and treat pneumonia, more than half of the children with severe pneumonia continue to receive the much needed treatment late. As such, many children remain at risk of suffering complications of severe pneumonia or even death. Therefore, there is need for the ministry of health and other stakeholders to engage in increasing community awareness on the need and importance of prompt healthcare seeking for children with pneumonia symptoms.