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Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study
Luke B Profitt1, Graham Bresick, Liezel Rossouw
1Department of Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town; and Western Cape Government Health and Wellness, Cape Town. lukeprofitt@gmail.com.
Insights
Many child deaths in Cape Town occur out of hospital due to access barriers. Improving community services, transport, and clinic hours can help reduce under-5 mortality.
Area of Science:
- Public Health
- Paediatric Mortality
- Healthcare Access
Background:
- Under-5 mortality rate in Cape Town has plateaued at 20 per 1000 live births.
- 60% of child deaths occur out-of-hospital, with the southern subdistrict accounting for 31% of these deaths.
- High burden of out-of-hospital deaths necessitates investigation into underlying access barriers and facilitators.
Purpose of the Study:
- To uncover access barriers and facilitators contributing to out-of-hospital child deaths in Cape Town.
- To explore community perspectives on childhood mortality.
- To develop consensus-based recommendations for improving healthcare access.
Main Methods:
- Exploratory mixed-methods case study design.
- Quantitative survey with 62 community members.
- Semi-structured interviews with 11 caregivers and a nominal group technique (NGT) with 11 health workers.
Main Results:
- 74% of community members surveyed experienced barriers to accessing care.
- Key barriers identified include affordability, acceptability, household, and facility factors.
- Health workers suggested improvements in community-based services, transport, and extended service hours.
Conclusions:
- Multiple barriers to healthcare access for children were identified.
- Facilitators for addressing these barriers were explored, focusing on community-based solutions.
- Healthcare planners should address geographic-specific barriers to reduce child mortality.
Background:
In Cape Town, the under-5 mortality rate has plateaued to 20 per 1000 live births, with 60% of child deaths occurring out of hospital. The southern subdistrict has the largest paediatric population in Metro West and accounts for 31% of deaths. This study aimed to uncover the access barriers and facilitators underlying this high burden of out-of-hospital deaths.
Methods:
An exploratory mixed-methods case study design employed three data collection strategies: a quantitative survey with randomly sampled community members, semi-structured interviews with purposively sampled caregivers whose children presented critically ill or deceased (January 2017 - December 2020) and a nominal group technique (NGT) to build solution-oriented consensus among purposively sampled health workers, representing different levels of care in the local health system.
Results:
A total of 62 community members were surveyed, 11 semi-structured caregiver interviews were conducted, and 11 health workers participated in the NGT. Community members (74%) experienced barriers in accessing care. Knowledge of basic home care for common conditions was limited. Thematic analysis of interviews showed affordability, acceptability, and access, household and facility factor barriers. The NGT suggested improvement in community-based services, transport access and lengthening service hours would facilitate access.
Conclusion:
While multiple barriers to accessing care were identified, facilitators addressing these barriers were explored. Healthcare planners should examine the barriers within their geographic areas of responsibility to reduce child deaths.Contribution: This study uncovers community perspectives on childhood out-of-hospital deaths and makes consensus-based recommendations for improvement.
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