ArticleBMJ open2021
Care-seeking during fatal childhood illness in rural South Africa: a qualitative study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 14 citations in OpenAlex.
- Understanding the role of parental decision-making and quality of clinical care in under-5 mortality in Western Kenya: an application of the Three Delays model.BMC health services research · 2026Article
- Assessing the validity of post-discharge readmission and mortality as a composite outcome among newborns in Uganda.PloS one · 2026Article
- Caregivers' lived experiences of childhood probable pneumonia through a gendered lens in western Kenya.African journal of primary health care & family medicine · 2025Article
- A methodological review of patient healthcare-seeking journeys from symptom onset to receipt of care.BMJ global health · 2025Review
- Navigating the Lay Referral System for Treatment-Seeking Decisions During Illness in the Digital Age: A Qualitative Study of Adults Living in Slums in Nigeria.Sociology of health & illness · 2025Article
- Cardiac Surgery to Manage Rheumatic Heart Disease in Africa Is Complex - a Geographic Perspective.Global heart · 2025Article
- Estimating Congenital Cardiac Surgical Need in Africa Using Geographic Distribution of Surgeons.Annals of global health · 2025Article
- Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months.PLOS global public health · 2024Article
- Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2023Article
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Authors and funding
9 authors at 6 institutions in 2 countries.
Funding
Abstract
objectivesThis study aimed to better understand reasons why children in South Africa die at home, including caregivers' care-seeking experiences, decision-making, choice of treatment provider and barriers to accessing care during a child's final illness.
designThis qualitative study included semi-structured in-depth interviews and focus group discussions with caregivers of children who died below the age of 5 years. Data were thematically analysed, and key findings compared with the Pathways to Survival Framework-a model frequently used in the study of child mortality. An adapted model was developed.
settingTwo rural health and demographic surveillance system (HDSS) sites in South Africa-the Agincourt HDSS and the Africa Health Research Institute.
participantsThirty-eight caregivers of deceased children (29 participated in in-depth interviews and 9 were participants in two focus group discussions). Caregivers were purposively sampled to ensure maximum variation across place of death, child age at death, household socioeconomic status, maternal migration status and maternal HIV status.
findingsAlthough caregivers faced barriers in providing care to children (including insufficient knowledge and poor transport), almost all did seek care from the formal health system. Negative experiences in health facilities did not deter care-seeking, but most respondents still received poor quality care and were not given adequate safety-netting advice. Traditional healers were only consulted as a last resort when other approaches had failed.
conclusionBarriers to accessing healthcare disrupt the workings of previously accepted care-seeking models. The adapted model presented in this paper more realistically reflects care-seeking experiences and decision-making during severe childhood illness in rural South Africa and helps explain both the persistence of home deaths despite seeking healthcare, and the impact of a child's death on care-seeking in future childhood illness. This model can be used as the basis for developing interventions to reduce under-5 mortality.
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