Socio-Contextual Determinants of Community-Level Care Seeking for Neonatal Possible Severe Bacterial Infection (PSBI) in Amhara, Ethiopia Open Access
Asfaha, Meron (Spring 2019)
Abstract
Background: Approximately 25% of neonatal deaths occur globally due to infections. In Ethiopia, neonatal mortality accounts for 42% of under-five deaths with the majority of these deaths driven by infections. Possible Severe Bacterial Infection (PSBI) in neonates is a syndromic diagnosis that non-clinical health providers use to identify newborns with likely sepsis outside of health facilities. In low- and middle–income countries, referral to a hospital may not be feasible due to transportation, distance or finances. Growing evidence suggests health extension workers (HEWs) can identify and manage PSBI at the community level when referral to a hospital is not possible. However, community-based PSBI care strategies have not been widely scaled-up.
Methods: We conducted eleven focus group discussions (FGDs) and six in-depth interviews (IDIs) to analyze illness recognition and care seeking intentions from four rural kebeles in Amhara, Ethiopia. FGDs were conducted among mothers, fathers and households with recruitment stratified among households that have had a newborn with at least one symptom of PSBI (Symptomatic Group), and households that have had a newborn regardless of the child’s health status (Community Group). IDIs were further conducted among peripheral family members. Data were then thematically analyzed using MAXQDA software.
Results: Mothers were described as primary caretakers of the newborn and were often appreciated for making decisions for treatment, even when the father was not present. Type of care accessed was often dependent on conceptualization of the illness as simple or complex. When symptoms were not relieved with clinical care, or treatments at facilities were perceived as ineffective, alternative methods were sought. Most participants identified the health center as a reliable facility. While designed to be the first point of access for primary care, health posts were not mentioned as locations where families seek clinical treatment.
Conclusions: This study describes socio-contextual drivers for PSBI treatment at the community level. Future programming should consider the role community members have in planning interventions to increase demand for care at primary facilities. Encouragement of health post utilization could further allow for heightened accessibility-acceptability of a simplified PSBI regimen.
Table of Contents
CHAPTER 1: INTRODUCTION 1
Problem Statement 4
Theoretical Framework 5
Purpose Statement 6
Research Question(s) 6
Significance Statement 6
CHAPTER 2: LITERATURE REVIEW 8
Neonatal Mortality in Ethiopia 8
Possible Severe Bacterial Infection 9
Treatment Practices 10
Determinants of Neonatal Mortality 10
Care Seeking Behaviors 11
CHAPTER 3: STUDENT CONTRIBUTION 13
CHAPTER 4: MANUSCRIPT SUBMISSION 16
ABSTRACT 17
KEYWORDS 17
BACKGROUND 18
METHODS 20
Study setting 20
Study design 21
Recruitment 22
Data collection 23
Analysis 25
Ethics 26
RESULTS 26
Participant characteristics 26
Key themes 27
DISCUSSION 36
LIMITATIONS 38
CONCLUSIONS 39
ABBREVIATIONS 40
DECLARATIONS 40
Acknowledgements 40
Funding 40
Availability of data and materials 40
Authors’ contributions 41
Competing Interests 41
Ethics approval and consent to participate 41
Consent for publication 41
REFERENCES 41
CHAPTER 5: PUBLIC HEALTH IMPLICATIONS 44
REFERENCES 48
LIST OF APPENDICES
Appendix A. Data Collection Tools 53
Appendix B. Emory IRB Determination Letter 89
Appendix C. APHI Ethical Review Letter 91
Appendix D. Final Codebook 92
LIST OF FIGURES
Figure 1. Sampling Frame 96
Figure 2. Care Trajectory diagram 97
LIST OF TABLES
Table 1. Characteristics of Woreda and Kebele Sites 98
Table 2. Sampling Strategy per Woreda 99
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