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How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia?

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Authors
Choi, Sugy; Shin, Heesu; Heo, Jongho; Gedlu, Etsegenet; Nega, Berhanu; Moges, Tamirat; Bezabih, Abebe; Park, Jayoung; Kim, Woong-Han
Issue Date
2021-02-01
Publisher
BMC
Citation
BMC Health Services Research. 2021 Feb 01;21(1):110
Keywords
Pediatric cardiac surgeryCaregiver decision-makingPatient experiencesCongenital heart diseaseChild healthHealth-care seekingEthiopiaService delivery
Abstract
Background
Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery.

Methods
A qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework.

Results
The following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality.

Conclusions
Delayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.
ISSN
1472-6963
Language
English
URI
https://hdl.handle.net/10371/174229
DOI
https://doi.org/10.1186/s12913-021-06083-2
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College of Medicine/School of Medicine (의과대학/대학원)Thoracic Surgery (흉부외과학전공)Journal Papers (저널논문_흉부외과학전공)
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