Rwanda Huye Butare University , Rwanda
Title: Exploring the experience of caretakers of children with cardiac diseases: care-seeking pathways from home until Rwandan Teaching Hospitals
Naphtal Nyirimanzi is Lecturer at University of Rwanda, Pediatrician at University Teaching Hospital of Butare, Rwanda and her motive is to caregivers of children with cardiovascular diseases (CVDs) while seeking care for their children
Across-sectional mixed method study was conducted in the department of Pediatrics of University Teaching Hospitals: Kigali and Butare. The quantitative part included all children, ≤15 year old cardiac diseases that consulted from January to August 2016. Manual data extraction was done from their file. The qualitative part data was obtained from in-depth interviews of caregivers of children with cardiac diseases in order to explore their experiences while seeking care for their children from home until teaching hospitals. The information was filled in spreadsheet format. The data entry and analysis was performed using Microsoft Excel, Microsoft Word, and Dedoose; recording and presentation of results was done using Microsoft Excel and Microsoft Word.
Both hospitals received 368 children with cardiac diseases in 8 month period. Females were 52.9%. The majority was in heart failure (NYHA IV: 21.9%, NYHA III: 29.2). The main cardiac diseases were rheumatic heart diseases (32.3%) and ventricular septal defects (24.4%). Qualitative part included twelve caregivers of children with CVDs; 8 female and 4 male participated in-depth interviews. Their age varied between 27 and 51 years with mean of 39 years. Three main topics emerged from interviews. The first topic comprises the experience of caregivers in care seeking for the children with cardiac diseases: recognition of symptoms, access to adequate healthcare services, etc: the caretakers, the family, even the healthcare providers had difficulty to identify and interpret signs and symptoms of cardiac diseases in children, with late care seeking. The second topic concerned the challenges and barriers to seeking care through referral system: wrong and late recognition of symptoms (poisoning, malaria, etc.), limited access to optimal management (geographic and economic barrier, lack of adequate equipment and skilled personnel, poor customer care, use of traditional medicine, and family instability and violence). Finally, respondents highlighted the recommendations for improvement mainly customer care, and education of community and health professionals about cardiac diseases in order to timely recognize them and provide adequate management. Children present with different types of cardiac disease, some of which can be prevented, particularly acute rheumatic fever and rheumatic heart diseases. Their caretakers meet many challenges in seeking care for children with cardiac diseases, some of which can be managed with holistic approach including engagement of families, healthcare system, and local government.