223 - Family caregiver perspectives on barriers and facilitators in the care of pediatric injury patients at two primary health facilities in Northern Tanzania: a qualitative study

Publication Number: 1212.223

Sarmishta Kannan, Primary Children's Hospital, Midvale, UT, United States; Getrude M. Nkini, KCMC-Duke Collaboration, Moshi mjini, Kilimanjaro, Tanzania; Deusdedith Evarist. Marandu, Hai Hospital, Moshi, Kilimanjaro, Tanzania; Itikija Edward. Msuya, Hai District Council, Kilimanjaro, Kilimanjaro, Tanzania; Nancy Stewart. Mmary, Mwenge Catholic university, Kilimanjaro, Kilimanjaro, Tanzania; Rosalia E. Njau, Kilimanjaro Christian Medical Centre, Kilimanjaro, Kilimanjaro, Tanzania; Matti Koenig, University of Utah, Rootstown, OH, United States; Sharla Rent, Duke University School of Medicine, Chapel Hill, NC, United States; Heather Keenan, University of Utah School of Medicine, Salt Lake City, UT, United States; Jennie L. Hill, University of Utah School of Medicine, Salt Lake City, UT, United States; Joao Ricardo Nickenig Vissoci, Duke University School of Medicine, Durham, NC, United States; Catherine Staton, Duke University School of Medicine, Durham, NC, United States; Melissa H. Watt, University of Utah, School of Medicine, Population Health Sciences, Salt Lake City, UT, United States; Elizabeth M. Keating, University of Utah, Salt Lake City, UT, United States; Blandina Mmbaga, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Francis Gwasma,Pasua Health Centre, Moshi, Tanzania; Emmanuel Minja, Hai District Hospital, Hai, Tanzania

Background: The vast majority of injury related childhood deaths occur in low-and-middle income countries and children in sub-Saharan Africa are disproportionately impacted. In Tanzania, patients often require referral from the first site of care, a primary health facility, to receive definitive care at a tertiary hospital. Prior studies have identified numerous barriers at the first site of care contributing to care delays. Family caregivers have unique insights into the care of their injured children and their perspectives are valuable in finding solutions to optimize pediatric injury care.

Objective: This study aims to understand the barriers and facilitators to pediatric injury triage, care and referral from the family caregiver perspective at two primary health facilities in Northern Tanzania.

Design/Methods: This was a qualitative study using semi-structured in-depth interviews to identify system-level barriers and facilitators to pediatric injury care in Northern Tanzania from the family caregiver perspective. We completed in-depth interviews with family caregivers of 30 pediatric injury patients who were seen initially at a primary health facility and subsequently referred to definitive care. Interview questions focused on injury occurrence, presentation to a health facility, care received, and referral to definitive care. Interview transcripts were thematically coded using Dedoose.

Results: Most family caregivers reported seeking care for their injured child on the day of injury. The selection of the particular health facility was reported to be due to proximity and cost. Nobody reported seeking care from traditional healers. A facilitator to triage was timely service. Facilitators to care included social and financial support from loved ones. Barriers to care included insufficient finances, no access to transportation, and delay in provision of first aid care. Facilitators to referral included early identification of advanced imaging or need for subspecialty care. Barriers to timely referral included imaging delays, delayed ambulance transport between facilities, and delayed recognition of disease severity (Table 1).

Conclusion(s): Family caregiver perspectives highlighted the facilitators and barriers to pediatric injury triage, care, and referral to definitive care. These findings will help develop targeted, sustainable solutions at the primary health facilities that will improve care and timely referral of pediatric injury patients in Northern Tanzania.

Table 1: Family caregiver perspectives on barriers and facilitators to pediatric injury triage, care, and referral to definitive care.
Pasua Health Centre and Hai District Hospital are primary health facilities in Northern Tanzania.