Care-Seeking Behavior of Families of North Indian Children Suffering From WHO-Defined Severe Community-Acquired Pneumonia: A Hospital-Based Prospective Study

Background Community-acquired pneumonia (CAP) is one of the leading causes of death in children under five. In developing countries, delayed treatment seeking has been associated with mortality and morbidity. There are only a few studies in India evaluating care-seeking behavior, particularly in children with CAP. Methods The present study was a hospital-based prospective semi-qualitative study. The study was conducted on parents or caregivers of consecutively hospitalized children under five (two to 59 months) with WHO-defined severe CAP along with radiological abnormalities consistent with CAP. Categorization of CAP and interpretation of chest X-rays (CXR) were done as per WHO criteria. Complicated CAP was categorized as severe pneumonia and had additional characteristics, including pleural effusion/empyema/pneumothorax requiring intercostal drainage, acute respiratory distress syndrome, or septic shock. Results After the screening of 420 consecutively hospitalized children under five with WHO-defined severe CAP along with radiological abnormalities consistent with it, 350 children were recruited in the present study. Among the recruited children, 58.6% experienced delayed care seeking, and among delayed care seekers, 94.6% presented with complications or developed complications during their hospital stay. The median delay in medical attention was three days. It also found that mothers with education levels below a high school had delayed care-seeking behavior. Mothers noticed the illness first in the majority of subjects (190, 54.3%), followed by fathers (78, 22.3%). Visiting traditional healers (46, 22.4%) and opting for home-bound remedies (44, 21.5%) were among the most common reasons for delayed care seeking. Fast breathing was the most concerning symptom among the parents and caregivers of the hospitalized children due to severe CAP followed by retractions, cough, and drowsiness. Retractions, drowsiness, and inability to feed were significantly recognized as alarming symptoms by the parents and caregivers in children with complicated CAP. Delayed care-seeking behavior was more prevalent in families from rural areas than in urban areas. If decision takers were in close relation with the sick child, chances of delayed care were less and vice versa. In urban areas, mothers can make decisions in significantly higher numbers than in rural areas, while grandmothers were more involved in decision-making in rural areas. Conclusion The delayed care-seeking behavior was significantly higher in children with complicated CAP. Delayed care-seeking behavior was more prevalent in families from rural areas than in urban areas. The most common reasons for delayed care-seeking behavior were home remedies and visiting traditional healers. Caregivers need to be more aware of the danger signs of CAP and the consequences of treatment delay.