ArticleBMJ open2019
Four delays of child mortality in Rwanda: a mixed methods analysis of verbal social autopsies.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 18 citations in OpenAlex.
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- Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project.Global health action · 2023Article
- Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop.Global health action · 2022Article
- A cost analysis of the diagnosis and treatment of malaria at public health facilities and communities in three districts in Rwanda.Malaria journal · 2022Article
- Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa.BMJ global health · 2022Article
- Socio-cultural barriers to the delivery and utilisation of child healthcare services in rural Ghana: a qualitative study.BMC health services research · 2022Article
- Three delays model applied to pediatric injury care seeking in Northern Tanzania: A mixed methods study.PLOS global public health · 2022Article
- Pediatric intestinal obstruction: analysis of etiologies and factors influencing short-term outcomes in Rwanda.World journal of pediatric surgery · 2022Article
- Learning to Listen.Pediatrics · 2021Article
- Community surveillance and response to maternal and child deaths in low- and middle-income countries: A scoping review.PloS one · 2021Article
- Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi-disciplinary Stakeholder Exercise.World journal of surgery · 2020Review
- Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa.BMJ global health · 2020Article
- Expectations of healthcare quality: A cross-sectional study of internet users in 12 low- and middle-income countries.PLoS medicine · 2019Article
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
objectivesWe sought to understand healthcare-seeking patterns and delays in obtaining effective treatment for rural Rwandan children aged 1-5 years by analysing verbal and social autopsies (VSA). Factors in the home, related to transport and to quality of care in the formal health sector (FHS) were thought to contribute to delays.
designWe collected quantitative and qualitative cross-sectional data using the validated 2012 WHO VSA tool. Descriptive statistics were performed. We inductively and deductively coded narratives using the three delays model, conducted thematic content analysis and used convergent mixed methods to synthesise findings.
settingThe study took place in the catchment areas of two rural district hospitals in Rwanda-Kirehe and Southern Kayonza. Participants were caregivers of children aged 1-5 years who died in our study area between March 2013 and February 2014.
resultsWe analysed 77 VSAs. Although 74% of children (n=57) had contact with the FHS before dying, most (59%, n=45) died at home. Many caregivers (44%, n=34) considered using traditional medicine and 23 (33%) actually did. Qualitative themes reflected difficulty recognising the need for care, the importance of traditional medicine, especially for 'poisoning' and poor perceived quality of care. We identified an additional delay-phase IV-which occurred after leaving formal healthcare facilities. These delays were associated with caregiver dissatisfaction or inability to adhere to care plans.
conclusionDelays in deciding to seek care (phase I) and receiving quality care in FHS (phase III) dominated these narratives; delays in reaching a facility (phase II) were rarely discussed. An unwillingness or inability toadhere to treatment plans after leaving facilities (phase IV) were an important additional delay. Improving quality of care, especially provider capacity to communicate danger signs/treatment plans and promote adherence in the presence of alternative explanatory models informed by traditional medicine, could help prevent childhood deaths.
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