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Understanding careseeking for child illness in sub-Saharan Africa: a systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria
University of Cape Town.
Liverpool School of Tropical Medicine.
University of Cape Town.
Duke University.ORCID iD: 0000-0002-4111-9708
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2013 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 86, p. 66-78, article id S0277-9536(13)00113-5Article in journal (Refereed) Published
Abstract [en]

Diarrhoea, pneumonia and malaria are the largest contributors to childhood mortality in sub-Saharan Africa. While supply side efforts to deliver effective and affordable interventions are being scaled up, ensuring timely and appropriate use by caregivers remains a challenge. This systematic review synthesises qualitative evidence on the factors that underpin household recognition and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. For this review, we searched six electronic databases, hand searched 12 journals from 1980 to 2010 using key search terms, and solicited expert review. We identified 5104 possible studies and included 112. Study quality was appraised using the Critical Appraisal Skills Program (CASP) tool. We followed a meta-ethnographic approach to synthesise findings according to three main themes: how households understand these illnesses, how social relationships affect recognition and response, and how households act to prevent and treat these illnesses. We synthesise these findings into a conceptual model for understanding household pathways to care and decision making. Factors that influence household careseeking include: cultural beliefs and illness perceptions; perceived illness severity and efficacy of treatment; rural location, gender, household income and cost of treatment. Several studies also emphasise the importance of experimentation, previous experience with health services and habit in shaping household choices. Moving beyond well-known barriers to careseeking and linear models of pathways to care, the review suggests that treatment decision making is a dynamic process characterised by uncertainty and debate, experimentation with multiple and simultaneous treatments, and shifting interpretations of the illness and treatment options, with household decision making hinging on social negotiations with a broad variety of actors and influenced by control over financial resources. The review concludes with research recommendations for tackling remaining gaps in knowledge.

Place, publisher, year, edition, pages
2013. Vol. 86, p. 66-78, article id S0277-9536(13)00113-5
Keywords [sv]
Child health, Careseeking, Infectious diseases of poverty, Community-based interventions, Systematic review, Qualitative research, Sub-Saharan Africa, Household recognition and response to illness, Community-health system interface, Cultural beliefs and social practices
National Category
Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:rkh:diva-3103DOI: 10.1016/j.socscimed.2013.02.031PubMedID: 23608095OAI: oai:DiVA.org:rkh-3103DiVA, id: diva2:1380199
Available from: 2019-12-18 Created: 2019-12-18 Last updated: 2019-12-20Bibliographically approved

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