Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1–59 months
Elisa Garcia Gomez, Kitiezo Aggrey Igunza, Zachary J. Madewell, Victor Akelo, Dickens Onyango, Shams El Arifeen, Emily S. Gurley, Mohammad Zahid Hossain, Md Atique Iqbal Chowdhury, Kazi Munisul Islam, Nega Assefa, J. Anthony G. Scott, Lola Madrid, Yenenesh Tilahun, Stian Magnus Staurung Orlien, Karen L. Kotloff, Milagritos D. Tapia, Adama Mamby Keita, Ashka Mehta, Amílcar Magaço, David Torres-Fernández, Ariel Nhacolo, Quique Bassat, Inácio Mandomando, Ikechukwu U. Ogbuanu, Carrie Jo Cain, Ronita Luke, Sorie Ibrahim Kamara, Hailemariam Legesse, Shabir A. Madhi, Ziyaad Dangor, Sana Mahtab, Amy Wise, Yasmin Adam, Cynthia G. Whitney, Portia Mutevedzi, Dianna M. Blau, Robert F. Breiman, Beth A. Tippett Barr, Chris A. Rees, Child Health and Mortality Prevention Surveillance Network
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.