Why was it important?
Presenting late at hospital is common in cases of acute bacterial meningitis in sub-Saharan African countries such as Malawi and results in high rates of death and disability.
Recognition of illness is the first stage in seeking care. In contexts where illness is common and 70% of treatment is carried out in the home, it is important that carers are able to recognise particularly severe illness such as meningitis and act on it.
Recognition in the community
• Community plays a big part in making the decision to seek treatment. It is rare for only one individual to make the decision to go to hospital or the local clinic.
o Respected elders or other family
• Symptoms associated with severe illness included
o Inability to eat
o Inability to work
o Failure in mobility (failure to sit in infants or stand in adults)
o Some are associated with meningitis while others aren’t.
Recognition at primary health clinics
• Many cases of meningitis are misdiagnosed and treated as malaria (7/9 infant cases, 5/8 adult cases)
• Other factors affected timely diagnosis
o Diagnosis without examination
o Lack of follow up
o Lack of drugs
o Long waiting times
Barriers to action
• Male reluctance to seek healthcare (concepts of wellness and masculinity)
• Perceptions of health services (patients were worried about inconsistent availability of medical professionals and long waiting times)
• Financial constraints
• Gender and social positioning (e.g. mother needing husband’s advice)
• Priority focus on maternal health at clinics (follow up maternal deaths but not others, nurses and ambulance drivers prioritise complications during birth)
• Individual case studies in this research are drawn from those meningitis cases who made it to QECH and it is difficult to estimate how many people don’t actually get that far.