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. 2024 Feb 8;4(2):e0002494.
doi: 10.1371/journal.pgph.0002494. eCollection 2024.

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  1 , Kitiezo Aggrey Igunza  2 , Zachary J Madewell  3 , Victor Akelo  4 , Dickens Onyango  5 , Shams El Arifeen  6 , Emily S Gurley  7 , Mohammad Zahid Hossain  6 , Md Atique Iqbal Chowdhury  6 , Kazi Munisul Islam  6 , Nega Assefa  8   9   10 , J Anthony G Scott  8 , Lola Madrid  8   9   10 , Yenenesh Tilahun  9   10 , Stian Orlien  11   12 , Karen L Kotloff  13 , Milagritos D Tapia  13 , Adama Mamby Keita  14 , Ashka Mehta  13 , Amilcar Magaço  15 , David Torres-Fernandez  15   16 , Ariel Nhacolo  15 , Quique Bassat  15   16   17   18   19 , Inácio Mandomando  15   16   20 , Ikechukwu Ogbuanu  21 , Carrie Jo Cain  22 , Ronita Luke  23 , Sorie I B Kamara  21 , Hailemariam Legesse  24 , Shabir Madhi  25 , Ziyaad Dangor  25 , Sana Mahtab  25 , Amy Wise  26 , Yasmin Adam  27 , Cynthia G Whitney  28 , Portia C Mutevedzi  28 , Dianna M Blau  3 , Robert F Breiman  29 , Beth A Tippett Barr  30 , Chris A Rees  31   32 ; Child Health and Mortality Prevention Surveillance Network
Affiliations

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 et al. PLOS Glob Public Health. .

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.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: CGW received honoraria from the University of St. Andrews for speaking to alumni about CHAMPS and global health work. JAGS reports receiving funding from the Wellcome Trust, UK FCDO, European Union, and the National Institute for Health Research. SM has received grants from the Bill & Melinda Gates Foundation, GSK, Pfizer, Minervax, Novavax, Providence, Gritstone, and ImmunityBio. SM has received honoraria from GSK for lecturing. CGW and SM report serving on data safety monitoring boards for SPEAC (CGW) and PATH and CAPRISA (SM). DT-F reports having received the support of a fellowship from “La Caixa” Foundation (ID 100010434, “LCF/BQ/DR21/11880018”). All other investigators declare no competing interests.

Figures

Fig 1
Fig 1. PRISMA flow diagram for case selection.
Fig 2
Fig 2. Venn diagram of each type of delay among deceased infants and children (N = 1,326).
Fig 3
Fig 3. Proportion of deceased infants and children who experienced each delay in the “Three Delays-in-Healthcare” model.
Fig 4
Fig 4. Proportion of infants and children who experienced each delay in “Three Delays-in-Healthcare” framework by age group, country site, sex, and site of death.
Fig 5
Fig 5. Proportion of delays in the “Three Delays-in-Healthcare” model among deceased infants and children by country site.
See this image and copyright information in PMC

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