Assessing Impediments to Healthcare Access for Children Under Five in Larkana, Pakistan Using the Three Delays Model
Three Delays Model in Action: Unveiling Child Healthcare Obstacles in Larkana
DOI:
https://doi.org/10.62807/jowach.v2i1.2024.14-20Keywords:
child health, access to care, Pakistan, delays, childrenAbstract
Abstract:
Background: Despite national improvements, Larkana district in Pakistan suffers from high under-five child mortality. This study employs the Three Delays Model (TDM) to identify impediments to healthcare access for children under five in Larkana, informing interventions to combat preventable deaths.
Methods: A cross-sectional survey (January-April 2021) in Larkana hospitals recruited 390 parents/guardians via simple random sampling. Semi-structured interviews explored sociodemographics, care-seeking behaviors, and barriers across the TDM's three delays: 1) recognizing and acting on illness, 2) reaching care, and 3) receiving adequate care. Data was analyzed in SPSS v22 using frequencies, percentages, and chi-square tests for associations between sociodemographic factors and care-seeking patterns.
Results: 47% of mothers and 29% of fathers lacked formal education. 49.7% of children were born at home. Delay 1 barriers included preference for traditional healers (36%). Delay 2 barriers included lack of transportation (17%) and long travel times (>3 hours for 84%). Delay 3 barriers included high healthcare costs (43% spending >1000 rupees). Illiterate mothers predominantly gave birth at home (44% vs. 13% matriculate mothers, p<0.001) and were less likely to recognize danger signs (61% vs. 89%, p<0.001). Rickshaws were the primary mode of transport (86%).
Discussion: This TDM-based study reveals multiple intertwined barriers hindering child healthcare access in Larkana. Maternal education significantly influences care-seeking behavior and danger sign recognition, highlighting the need for targeted community education programs. High prevalence of home births necessitates interventions promoting institutional deliveries. Lack of transportation and high costs demand affordable options like government-subsidized transport or expanded health insurance coverage.
Keywords: child health, access to care, Pakistan
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