A qualitative study of factors resulting in care delays for adults with meningitis in Zambia. (2nd June 2022)

• Record Type: Journal Article
• Authors: Elafros, Melissa A; Bwalya, Chiti; Muchanga, Godfrey; Mwale, Mwangala; Namukanga, Nachizya; Birbeck, Gretchen L; Chomba, Mashina; Mugala-Mulenga, Anchindika; Kvalsund, Michelle P; Sikazwe, Izukanji; Saylor, Deanna R; Winch, Peter J
• Is Part Of: Transactions of the Royal Society of Tropical Medicine and Hygiene. Volume 116:Number 12(2022)
• Page Start: 1138
• Page End: 1144
• Publication Date: 2022-06-02
• Subjects: barriers to care -- care-seeking behavior -- health systems -- lumbar puncture -- treatment pathways -- TB; Tropical medicine -- Periodicals; 616.9883
• DOI: 10.1093/trstmh/trac049
• Languages: English
• ISSNs: 0035-9203

Abstract

Abstract: Background: Meningitis causes significant mortality in regions with high comorbid HIV and TB. Improved outcomes are hindered by limited understanding of factors that delay adequate care. Methods: In-depth interviews of patients admitted to the University Teaching Hospital with suspected meningitis, their caregivers, doctors and nurses were conducted. Patient/caregiver interviews explored meningitis understanding, treatment prior to admission and experiences since admission. Provider interviews addressed current and prior experiences with meningitis patients and hospital barriers to care. A conceptual framework based on the Three Delays Model identified factors that delayed care. Results: Twenty-six patient/caregiver, eight doctor and eight nurse interviews occurred. Four delays were identified: in-home care; transportation to a health facility; clinic/first-level hospital care; and third-level hospital. Overcrowding and costly diagnostic testing delayed outpatient care; 23% of patients began with treatment inside the home due to prior negative experiences with biomedical care. Admission occurred after multiple clinic visits, where subsequent delays occurred during testing and treatment. Conclusions: Delays in care from home to hospital impair quality meningitis care in Zambia. Interventions to improve outcomes must address patient, community and health systems factors. Patient/caregiver education regarding signs of meningitis and indications for care-seeking are warranted to reduce treatment delays.