ArticlePloS one2013
Recognising and treatment seeking for acute bacterial meningitis in adults and children in resource-poor settings: a qualitative study.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Experiences and service-uptake factors of receiving and providing care for meningitis and its sequelae: a qualitative systematic review.BMC medicine · 2026Pooled it
- Epidemiological distribution of bacterial meningitis infections in South Africa: a systematic review and meta-analysis.BMC infectious diseases · 2025Pooled it
- Diagnostic Performance of Complementary Serum and Cerebrospinal Fluid Multiplex PCR for Acute Bacterial Meningitis.Diagnostics (Basel, Switzerland) · 2026Article
- Molecular Diagnosis of Bacterial Meningitis in Ethiopia: A Narrative Review of Current Evidence and Implementation Gaps.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2026Review
- Improving care pathways for children with severe illness through implementation of the ASPIRE mHealth primary ETAT package in Malawi.PLOS global public health · 2024Article
- A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2022Article
- Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status.Bulletin of the World Health Organization · 2022Article
- Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda.BMJ global health · 2022Observational
- Article
- Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study.Journal of pharmaceutical health care and sciences · 2021Article
- Modeling Optimal Laboratory Testing Strategies for Bacterial Meningitis Surveillance in Africa.The Journal of infectious diseases · 2021Article
- Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study.BMC health services research · 2021Observational
- Determinants of healthcare seeking and out-of-pocket expenditures in a "free" healthcare system: evidence from rural Malawi.Health economics review · 2020Article
- Antimicrobial sensitivity profile and bacterial isolates among suspected pyogenic meningitis patients attending at Hawassa University Hospital: Cross-sectional study.BMC microbiology · 2020Article
- Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.The Lancet. Neurology · 2018Article
- Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011-2013.The American journal of tropical medicine and hygiene · 2018Article
- Public engagement in Malawi through a health-talk radio programme ' Umoyo nkukambirana': A mixed-methods evaluation.Public understanding of science (Bristol, England) · 2018Article
- Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: A prospective study.PloS one · 2018Article
- Empiric Treatment of Acute Meningitis Syndrome in a Resource-Limited Setting: Clinical Outcomes and Predictors of Survival or Death.Ethiopian journal of health sciences · 2017Article
- Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
objectiveHigh mortality burden from Acute Bacterial Meningitis (ABM) in resource-poor settings has been frequently blamed on delays in treatment seeking. We explored treatment-seeking pathways from household to primary health care and referral for ABM in Malawi.
designA cross-sectional qualitative study using narrative in-depth interviews, semi-structured interviews and focus group discussions.
participantsAdults and children with proven and probable acute bacterial meningitis and/or their carers; adults from urban and peri-urban communities; and primary health care workers (HCW).
settingQueen Elizabeth Central Hospital (QECH), urban and peri-urban private and government primary health centres and communities in Blantyre District, Malawi.
resultsWhilst communities associated meningitis with a stiff neck, in practice responses focused on ability to recognise severe illness. Misdiagnosis of meningitis as malaria was common. Subsequent action by families depended on the extent to which normal social life was disrupted by the illness and depended on the age and social position of the sufferer. Seizures and convulsions were considered severe symptoms but were often thought to be malaria. Presumptive malaria treatment at home often delayed formal treatment seeking. Further delays in treatment seeking were caused by economic barriers and perceptions of inefficient or inadequate primary health services.
conclusionsGiven the difficulties in diagnosis of meningitis where malaria is common, any intervention for ABM at primary level must focus on recognising severe illness, and encouraging action at the household, community and primary health levels. Overcoming barriers to recognition and social constraints at community level require broad community-based strategies and may provide a route to addressing poor clinical outcomes.
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