Care delays for adults with meningitis in Zambia

2 January, 2023

Citation, abstract and a comment from me below.

Dear HIFA and HIFA-Zambia colleagues,

CITATION: Trans R Soc Trop Med Hyg

2022 Dec 2;116(12):1138-1144. doi: 10.1093/trstmh/trac049.

A qualitative study of factors resulting in care delays for adults with meningitis in Zambia

Melissa A Elafros et al.

PMID: 35653707 PMCID: PMC9717355 (available on 2023-06-02) DOI: 10.1093/trstmh/trac049


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.

COMMENT (NPW): In almost every area of healthcare, from infectious diseases to cancer, lack of availability of basic reliable healthcare information - including awareness of the signs of meningitis - contribute to delays and deaths. Access to, and use of, a book such as Where there is no doctor, could make all the difference. Mobile health can and should mean universal access to reliable healthcare information, as proposed by HIFA members: Some of us have argued for such information to be preloaded onto all phones before, or at, point of sale (or, at least, for buyers to have that option). The reality is that the vast majority of people do not have basic healthcare information on their phones. The Red Cross First Aid app is freely available, but is not widely known. I would like to invite HIFA members to comment on next steps. What apps/content currently exists that could serve this purpose (basic offline healthcare information for patients and caregivers across health conditions, with a focus on recognition of danger signs)? How can apps/content be made more available and accessible to all?

Join HIFA:

Join HIFA-Zambia:

Dr Neil Pakenham-Walsh, HIFA Coordinator

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