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Health seeking and access to care for children with suspected dengue in Cambodia: an ethnographic study.

Khun S, Manderson L - BMC Public Health (2007)

Bottom Line: The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care.While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so.Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Psychology, Psychiatry and Psychological Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Caulfield East, Victoria, 3145, Australia. khunsokrin@hotmail.com

ABSTRACT

Background: The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care. It is important to identify the reasons that influence these delays, in order to develop appropriate interventions to redress the impact of dengue.

Methods: Data on health seeking were collected during an ethnographic study conducted in two villages in the eastern province of Kampong Cham, Cambodia in 2004. Interviews were conducted with mothers whose children had been infected with suspected dengue fever, or who had been sick for other reasons, in 2003 and 2004.

Results: Women selected a therapeutic option based on perceptions of the severity of the child's condition, confidence in the particular modality, service or practitioner, and affordability of the therapy. While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so. Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness.

Conclusion: The lack of availability of financial resources for poor people and their continuing lack of confidence in the care provided by government centres combine to delay help seeking and inappropriate treatment of children sick with dengue.

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Patterns of help seeking by women with children with dengue.
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Figure 1: Patterns of help seeking by women with children with dengue.

Mentions: These patterns of treatment and help-seeking were replicated for children who were diagnosed subsequently with dengue fever – krun chiem (krun = fever; chiem = blood) – as illustrated in Figure 1. The majority of women used drugs purchased over the counter (18/28) as the first course of treatment of their child's illness, at times borrowing money for this purpose: "I buy drugs in the village to treat coughs, cold, fever, a little at a time ... I cant go to the health centre because I'm too busy to wait for the health workers, even if I were to go to the health centre at 7 o'clock in the morning I'd be late for farming ... there's no-one else to do the work." Few women used only traditional home practices such as herbs, cold presses or coining, although five women used pharmaceuticals and traditional therapies concurrently. One child was taken to Kantha Bopha Hospital in Phnom Penh as the first action, not because of perceptions of appropriate care, however, but because the parents were working in a garment factory in the city when the child became sick.


Health seeking and access to care for children with suspected dengue in Cambodia: an ethnographic study.

Khun S, Manderson L - BMC Public Health (2007)

Patterns of help seeking by women with children with dengue.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2164964&req=5

Figure 1: Patterns of help seeking by women with children with dengue.
Mentions: These patterns of treatment and help-seeking were replicated for children who were diagnosed subsequently with dengue fever – krun chiem (krun = fever; chiem = blood) – as illustrated in Figure 1. The majority of women used drugs purchased over the counter (18/28) as the first course of treatment of their child's illness, at times borrowing money for this purpose: "I buy drugs in the village to treat coughs, cold, fever, a little at a time ... I cant go to the health centre because I'm too busy to wait for the health workers, even if I were to go to the health centre at 7 o'clock in the morning I'd be late for farming ... there's no-one else to do the work." Few women used only traditional home practices such as herbs, cold presses or coining, although five women used pharmaceuticals and traditional therapies concurrently. One child was taken to Kantha Bopha Hospital in Phnom Penh as the first action, not because of perceptions of appropriate care, however, but because the parents were working in a garment factory in the city when the child became sick.

Bottom Line: The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care.While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so.Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Psychology, Psychiatry and Psychological Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Caulfield East, Victoria, 3145, Australia. khunsokrin@hotmail.com

ABSTRACT

Background: The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care. It is important to identify the reasons that influence these delays, in order to develop appropriate interventions to redress the impact of dengue.

Methods: Data on health seeking were collected during an ethnographic study conducted in two villages in the eastern province of Kampong Cham, Cambodia in 2004. Interviews were conducted with mothers whose children had been infected with suspected dengue fever, or who had been sick for other reasons, in 2003 and 2004.

Results: Women selected a therapeutic option based on perceptions of the severity of the child's condition, confidence in the particular modality, service or practitioner, and affordability of the therapy. While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so. Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness.

Conclusion: The lack of availability of financial resources for poor people and their continuing lack of confidence in the care provided by government centres combine to delay help seeking and inappropriate treatment of children sick with dengue.

Show MeSH
Related in: MedlinePlus