How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia?

BMC Health Services Research

Sugy Choi¹  Jayoung Park²  Woong-Han Kim³  Jongho Heo⁴  Heesu Shin⁵  Berhanu Nega⁶  Etsegenet Gedlu⁶  Abebe Bezabih⁶  Tamirat Moges⁶ 

[1] Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA;Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea;Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;National Assembly Futures Institute, Seoul, Republic of Korea;Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;Seoul National University College of Nursing, Seoul, Republic of Korea;School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia;

关键词: Pediatric cardiac surgery;    Caregiver decision-making;    Patient experiences;    Congenital heart disease;    Child health;    Health-care seeking;    Ethiopia;    Service delivery;   

DOI  :  10.1186/s12913-021-06083-2

来源: Springer

【 摘 要 】

BackgroundSurgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery.MethodsA qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework.ResultsThe following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality.ConclusionsDelayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.

【 授权许可】

CC BY