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Careseeking for illness in young infants in an urban slum in India
I de Zoysa1, N Bhandari, N Akhtari
1Rose Farm, New Delhi, India. isabelle@pcindia.org
Insights
Mothers promptly seek care for sick infants, but often choose unqualified practitioners. Critical failures in care assessment and management by practitioners hinder effective treatment, impacting infant survival rates.
Area of Science:
- Public Health
- Pediatrics
- Medical Anthropology
Background:
- Infant illness in the first two months of life can rapidly become life-threatening, necessitating prompt medical attention.
- Effective assessment and management are crucial for severe illness in young infants.
- Understanding care-seeking behaviors is vital for reducing infant mortality.
Purpose of the Study:
- To investigate constraints in accessing effective care for severe illness in young infants.
- To analyze care-seeking practices within an urban slum in New Delhi, India.
- To identify barriers to timely and appropriate medical assessment and management.
Main Methods:
- Focused ethnographic study design.
- Observation and analysis of illness recognition and care-seeking behaviors in mothers of young infants.
- Evaluation of healthcare provider practices in assessing and managing sick infants.
Main Results:
- Maternal recognition of infant illness signs (e.g., changes in sleep/feeding) is not a barrier to seeking care.
- Mothers struggle to differentiate healthcare sources, often preferring unqualified local practitioners.
- Both qualified and unqualified practitioners exhibit significant failures in assessing and managing sick young infants.
- Care continuity is disrupted by expectations of rapid cure, leading to frequent practitioner changes and reluctance towards hospital care.
Conclusions:
- Current healthcare-seeking practices and practitioner capabilities present significant challenges to reducing young infant mortality.
- Existing hospital referral programs may face feasibility and acceptability issues due to caretaker expectations and reluctance.
- Interventions must address practitioner training and improve the integration of healthcare services for sick young infants.
Abstract:
Illness in infants in the first two months of life can take a precipitous life-threatening course, and requires timely and appropriate medical assessment and management. We conducted a focused ethnographic study of illness in young infants and associated careseeking practices in an urban slum in New Delhi, India, in order to identify the constraints in securing effective care for severe illness in this age group. The findings suggest that maternal recognition of illness is not a limiting factor in the use of health care services for sick young infants in this setting. Mothers respond to a number of important signs of illness, including changes in the young infant's sleeping or feeding behavior, and they are usually prompt in seeking care outside the home. They are not able, however, to discriminate among the many sources of health care available in this setting, and give preference to local unqualified private practitioners. Most practitioners, including qualified medical practitioners, display critical failures in the assessment and management of sick young infants. The continuity and effectiveness of care is further compromised by the caretakers' expectations of rapid cure, which result in discontinued treatment courses and frequent changes in practitioners, and by their reluctance to seek hospital care. The implications of these findings for the design of programs to reduce young infant mortality are discussed. In particular, the feasibility and acceptability of hospital referrals according to current program guidelines are called into question.
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