Background
There are profound social meanings attached to bearing children that affect the experience
of losing a child, which is akin to the loss of a mother in the household. The objective
of this study is to comprehend the broader processes that shape household healthcare-seeking
during fatal illness episodes or reproductive health emergencies in resource-poor
communities.
Methods
The study was conducted in six purposively selected poor, rural communities in Lao
PDR, located in two districts that represent communities with different access to
health facilities and contain diverse ethnic groups. Households having experienced
fatal cases were first identified in focus group discussions with community members,
which lead to the identification of 26 deaths in eleven households through caregiver
and spouse interviews. The interviews used an open-ended anthropological approach
and followed a three-delay framework. Interpretive description was used in the data
analysis.
Results
The healthcare-seeking behavior reported by caregivers revealed a broad range of providers,
reflecting the mix of public, private, informal and traditional health services in
Lao PDR. Most caregivers had experienced multiple constraints in healthcare-seeking
prior to death. Decisions regarding care-seeking were characterized as social rather
than individual actions. They were constrained by medical costs, low expectations
of recovery and worries about normative expectations from healthcare workers on how
patients and caregivers should behave at health facilities to qualify for treatment.
Caregivers raised the difficulties in determining the severity of the state of the
child/mother. Delays in reaching care related to lack of physical access and to risks
associated with taking a sick family member out of the local community. Delays in
receiving care were affected by the perceived low quality of care provided at the
health facilities.
Conclusions
Care-seeking is influenced by family- and community-based relations, which are integrated
parts of people's everyday life. The medical and normative responses from health providers
affect the behavior of care-seekers. An anthropological approach to capture the experience
of caregivers in relation to deciding, seeking and reaching care reveals the complexity
and socio-cultural context surrounding maternal and child mortality and has implications
for how future mortality data should be developed and interpreted.
