The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Care pathways during a child’s final illness in rural South Africa: Findings from a social autopsy study

Care pathways during a child’s final illness in rural South Africa: Findings from a social autopsy study
Care pathways during a child’s final illness in rural South Africa: Findings from a social autopsy study
Background: Half of under-5 deaths in South Africa occur at home, however the reasons remain poorly described and data on the care pathways during fatal childhood illness is limited. This study aimed to better describe care-seeking behavior in fatal childhood illness and to assess barriers to healthcare and modifiable factors that contribute to under-5 deaths in rural South Africa.

Methods: We conducted a social autopsy study on all under-5 deaths in two rural South African health and demographic surveillance system sites. Descriptive analyses based on the Pathways to Survival Framework were used to characterise how caregivers move through the stages of seeking and providing care for children during their final illness and to identify modifiable factors that contributed to death.
Findings: Of 53 deaths, 40% occurred outside health facilities. Rates of antenatal and perinatal preventative care-seeking were high: over 70% of mothers had tested for HIV, 93% received professional assistance during delivery and 79% of children were reportedly immunised appropriately for age. Of the 48 deaths tracked through the stages of the Pathways to Survival Framework, 10% died suddenly without any care, 23% received home care of whom 80% had signs of severe or possibly severe illness, and 85% sought or attempted to seek formal care outside the home. Although half of all children left the first facility alive, only 27% were referred for further care.
Conclusions: Modifiable factors for preventing deaths during a child’s final illness occur both inside and outside the home. The most important modifiable factors occurring inside the home relate to caregivers’ recognition of illness and appreciation of urgency in response to the severity of the child’s symptoms and signs. Outside the home, modifiable factors relate to inadequate referral and follow-up by health professionals. Further research should focus on identifying and overcoming barriers to referral.
1932-6203
Price, Jessica
29aaafcf-a96b-4c95-b230-e6129c46c844
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Kabudula, Chodziwadziwa
12fad217-6ba1-461b-af4d-9de40df4e8e7
Herbst, Kobus
fab67269-11ef-4c52-91bc-635b00065504
Hinton, Lisa
96d960e8-4b9f-41bf-8d2e-0bdb2864c488
Kahn, Kathleen
e8f0af52-65ce-4744-b029-688db6e12dff
Harnden, Anthony
d8494efe-3f1e-463c-9a4e-036a32d33937
Price, Jessica
29aaafcf-a96b-4c95-b230-e6129c46c844
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Kabudula, Chodziwadziwa
12fad217-6ba1-461b-af4d-9de40df4e8e7
Herbst, Kobus
fab67269-11ef-4c52-91bc-635b00065504
Hinton, Lisa
96d960e8-4b9f-41bf-8d2e-0bdb2864c488
Kahn, Kathleen
e8f0af52-65ce-4744-b029-688db6e12dff
Harnden, Anthony
d8494efe-3f1e-463c-9a4e-036a32d33937

Price, Jessica, Willcox, Merlin, Kabudula, Chodziwadziwa, Herbst, Kobus, Hinton, Lisa, Kahn, Kathleen and Harnden, Anthony (2019) Care pathways during a child’s final illness in rural South Africa: Findings from a social autopsy study. PLoS ONE, 14 (10), [e0224284]. (doi:10.1371/journal.pone.0224284).

Record type: Article

Abstract

Background: Half of under-5 deaths in South Africa occur at home, however the reasons remain poorly described and data on the care pathways during fatal childhood illness is limited. This study aimed to better describe care-seeking behavior in fatal childhood illness and to assess barriers to healthcare and modifiable factors that contribute to under-5 deaths in rural South Africa.

Methods: We conducted a social autopsy study on all under-5 deaths in two rural South African health and demographic surveillance system sites. Descriptive analyses based on the Pathways to Survival Framework were used to characterise how caregivers move through the stages of seeking and providing care for children during their final illness and to identify modifiable factors that contributed to death.
Findings: Of 53 deaths, 40% occurred outside health facilities. Rates of antenatal and perinatal preventative care-seeking were high: over 70% of mothers had tested for HIV, 93% received professional assistance during delivery and 79% of children were reportedly immunised appropriately for age. Of the 48 deaths tracked through the stages of the Pathways to Survival Framework, 10% died suddenly without any care, 23% received home care of whom 80% had signs of severe or possibly severe illness, and 85% sought or attempted to seek formal care outside the home. Although half of all children left the first facility alive, only 27% were referred for further care.
Conclusions: Modifiable factors for preventing deaths during a child’s final illness occur both inside and outside the home. The most important modifiable factors occurring inside the home relate to caregivers’ recognition of illness and appreciation of urgency in response to the severity of the child’s symptoms and signs. Outside the home, modifiable factors relate to inadequate referral and follow-up by health professionals. Further research should focus on identifying and overcoming barriers to referral.

Text
journal.pone.0224284 - Version of Record
Available under License Creative Commons Attribution.
Download (701kB)

More information

Accepted/In Press date: 9 October 2019
Published date: 22 October 2019

Identifiers

Local EPrints ID: 435420
URI: http://eprints.soton.ac.uk/id/eprint/435420
ISSN: 1932-6203
PURE UUID: a269b573-7a59-474c-b7e8-02feba3bac8d
ORCID for Merlin Willcox: ORCID iD orcid.org/0000-0002-5227-3444

Catalogue record

Date deposited: 06 Nov 2019 17:30
Last modified: 09 Jan 2022 03:56

Export record

Altmetrics

Contributors

Author: Jessica Price
Author: Merlin Willcox ORCID iD
Author: Chodziwadziwa Kabudula
Author: Kobus Herbst
Author: Lisa Hinton
Author: Kathleen Kahn
Author: Anthony Harnden

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×