Sociocultural and structural factors contributing to delays in treatment for children with severe malaria: A qualitative study in Southwestern Uganda

Radhika Sundararajan, Juliet Mwanga-Amumpaire, Harriet Adrama, Jackline Tumuhairwe, Sheilla Mbabazi, Kenneth Mworozi, Ryan Carroll, David Bangsberg, Yap Boum, Norma C. Ware

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of "traditional" versus "hospital" illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.

Original languageEnglish (US)
Pages (from-to)933-940
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume92
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

Fingerprint

Uganda
Malaria
Hospitalized Child
Mortality
Health Resources
Structural Models
Traditional Medicine
Poverty
Child Care
Violence
Therapeutics
Interviews
Pediatrics
Morbidity
Delivery of Health Care
Incidence

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology
  • Medicine(all)

Cite this

Sociocultural and structural factors contributing to delays in treatment for children with severe malaria : A qualitative study in Southwestern Uganda. / Sundararajan, Radhika; Mwanga-Amumpaire, Juliet; Adrama, Harriet; Tumuhairwe, Jackline; Mbabazi, Sheilla; Mworozi, Kenneth; Carroll, Ryan; Bangsberg, David; Boum, Yap; Ware, Norma C.

In: American Journal of Tropical Medicine and Hygiene, Vol. 92, No. 5, 01.05.2015, p. 933-940.

Research output: Contribution to journalArticle

Sundararajan, Radhika ; Mwanga-Amumpaire, Juliet ; Adrama, Harriet ; Tumuhairwe, Jackline ; Mbabazi, Sheilla ; Mworozi, Kenneth ; Carroll, Ryan ; Bangsberg, David ; Boum, Yap ; Ware, Norma C. / Sociocultural and structural factors contributing to delays in treatment for children with severe malaria : A qualitative study in Southwestern Uganda. In: American Journal of Tropical Medicine and Hygiene. 2015 ; Vol. 92, No. 5. pp. 933-940.
@article{2724b40340e441a189fb6fccf363a550,
title = "Sociocultural and structural factors contributing to delays in treatment for children with severe malaria: A qualitative study in Southwestern Uganda",
abstract = "Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of {"}traditional{"} versus {"}hospital{"} illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.",
author = "Radhika Sundararajan and Juliet Mwanga-Amumpaire and Harriet Adrama and Jackline Tumuhairwe and Sheilla Mbabazi and Kenneth Mworozi and Ryan Carroll and David Bangsberg and Yap Boum and Ware, {Norma C.}",
year = "2015",
month = "5",
day = "1",
doi = "10.4269/ajtmh.14-0784",
language = "English (US)",
volume = "92",
pages = "933--940",
journal = "American Journal of Tropical Medicine and Hygiene",
issn = "0002-9637",
publisher = "American Society of Tropical Medicine and Hygiene",
number = "5",

}

TY - JOUR

T1 - Sociocultural and structural factors contributing to delays in treatment for children with severe malaria

T2 - A qualitative study in Southwestern Uganda

AU - Sundararajan, Radhika

AU - Mwanga-Amumpaire, Juliet

AU - Adrama, Harriet

AU - Tumuhairwe, Jackline

AU - Mbabazi, Sheilla

AU - Mworozi, Kenneth

AU - Carroll, Ryan

AU - Bangsberg, David

AU - Boum, Yap

AU - Ware, Norma C.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of "traditional" versus "hospital" illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.

AB - Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of "traditional" versus "hospital" illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.

UR - http://www.scopus.com/inward/record.url?scp=84929095468&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929095468&partnerID=8YFLogxK

U2 - 10.4269/ajtmh.14-0784

DO - 10.4269/ajtmh.14-0784

M3 - Article

C2 - 25802438

AN - SCOPUS:84929095468

VL - 92

SP - 933

EP - 940

JO - American Journal of Tropical Medicine and Hygiene

JF - American Journal of Tropical Medicine and Hygiene

SN - 0002-9637

IS - 5

ER -