Browsing by Author "Bwalya C"

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    A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.
    (2022-Dec-02) Elafros MA; Bwalya C; Muchanga G; Mwale M; Namukanga N; Birbeck GL; Chomba M; Mugala-Mulenga A; Kvalsund MP; Sikazwe I; Saylor DR; Winch PJ; Department of Neurology, University of Michigan, Ann Arbor, 48109 Michigan, USA.; Department of Neurology, University of Rochester, Rochester, 14642 New York, USA.; Department of Internal Medicine, University of Zambia, School of Medicine, 10101 Lusaka, Zambia.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205 Maryland, USA.; Maryland Global Initiatives Corporation (MGIC), Lusaka, Zambia.; University Teaching Hospitals Children's Hospital, 10101 Lusaka, Zambia.; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; University of Lusaka, 10101 Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, 10101 Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Meningitis causes significant mortality in regions with high comorbid HIV and TB. Improved outcomes are hindered by limited understanding of factors that delay adequate care. METHODS: In-depth interviews of patients admitted to the University Teaching Hospital with suspected meningitis, their caregivers, doctors and nurses were conducted. Patient/caregiver interviews explored meningitis understanding, treatment prior to admission and experiences since admission. Provider interviews addressed current and prior experiences with meningitis patients and hospital barriers to care. A conceptual framework based on the Three Delays Model identified factors that delayed care. RESULTS: Twenty-six patient/caregiver, eight doctor and eight nurse interviews occurred. Four delays were identified: in-home care; transportation to a health facility; clinic/first-level hospital care; and third-level hospital. Overcrowding and costly diagnostic testing delayed outpatient care; 23% of patients began with treatment inside the home due to prior negative experiences with biomedical care. Admission occurred after multiple clinic visits, where subsequent delays occurred during testing and treatment. CONCLUSIONS: Delays in care from home to hospital impair quality meningitis care in Zambia. Interventions to improve outcomes must address patient, community and health systems factors. Patient/caregiver education regarding signs of meningitis and indications for care-seeking are warranted to reduce treatment delays.