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Background <p>Our objective was to assess the role of delayed healthcare seeking and clinical care among deceased children aged &lt; 5 years enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS) in Western Kenya.</p> Methods <p>We conducted a retrospective descriptive analysis of verbal autopsies, health records, and postmortem-determined causes of death determined by an expert panel for decedent children aged &lt; 5 years enrolled in CHAMPS-Kenya (2017–2022). We used the Three Delays framework to describe delays in (1) deciding to seek care, (2) reaching healthcare facilities, and (3) receiving adequate clinical care. Proportions were compared with Chi-square testing.</p> Results <p>There were 814 enrolled cases in CHAMPS-Kenya and 611 had complete data and were included in our analysis. Nearly all cases (97.9%, <i>n</i> = 598/611) experienced at least one delay. Delayed caregivers’ decisions to seek clinical care increased by child’s age from 52.0% of &lt; 1-day old deaths (<i>n</i> = 53/102) to 70.9% of child deaths among those aged 12–59 months (<i>n</i> = 83/117, <i>p</i> &lt; 0.001), and were more common in malaria (52/63,82.5%) and malnutrition (51/64,79.7%) deaths than in deaths from other causes. Delays in receiving adequate clinical care were more common (84.9%, <i>n</i> = 519/560) than parental delays in deciding to seek care (58.9%, <i>n</i> = 366). All HIV deaths (31/31, 100.0%) and most malaria deaths (<i>n</i> = 57/63, 90.5%) experienced suboptimal or delayed clinical care.</p> Conclusions <p>Nearly all young children who died experienced delays in seeking and receiving adequate clinical care prior to their death. Reducing childhood mortality requires a multi-pronged approach including caregiver education on the detection and response to danger signs, availing a functional referral system, and providing adequate clinical care.</p>

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Understanding the role of parental decision-making and quality of clinical care in under-5 mortality in Western Kenya: an application of the Three Delays model

  • 期刊论文

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  • 发表日期：

    2026年5月21日

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  • Kitiezo Aggrey Igunza,
  • Beth A. Tippett Barr,
  • Zachary J. Madewell,
  • Dickens Onyango,
  • Dickson Gethi,
  • Joyce Were,
  • Sarah Hawi Ngere,
  • Harun Owuor,
  • Janet Agaya,
  • Peter Onyango Nyamthimba,
  • Kephas Otieno,
  • Broline S. Asuma,
  • Sammy Khagayi,
  • Florence Murila,
  • Cynthia G. Whitney,
  • Chris A. Rees,
  • Dianna M. Blau,
  • Richard Omore,
  • Victor Akelo

摘要

Background

Our objective was to assess the role of delayed healthcare seeking and clinical care among deceased children aged < 5 years enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS) in Western Kenya.

Methods

We conducted a retrospective descriptive analysis of verbal autopsies, health records, and postmortem-determined causes of death determined by an expert panel for decedent children aged < 5 years enrolled in CHAMPS-Kenya (2017–2022). We used the Three Delays framework to describe delays in (1) deciding to seek care, (2) reaching healthcare facilities, and (3) receiving adequate clinical care. Proportions were compared with Chi-square testing.

Results

There were 814 enrolled cases in CHAMPS-Kenya and 611 had complete data and were included in our analysis. Nearly all cases (97.9%, n = 598/611) experienced at least one delay. Delayed caregivers’ decisions to seek clinical care increased by child’s age from 52.0% of < 1-day old deaths (n = 53/102) to 70.9% of child deaths among those aged 12–59 months (n = 83/117, p < 0.001), and were more common in malaria (52/63,82.5%) and malnutrition (51/64,79.7%) deaths than in deaths from other causes. Delays in receiving adequate clinical care were more common (84.9%, n = 519/560) than parental delays in deciding to seek care (58.9%, n = 366). All HIV deaths (31/31, 100.0%) and most malaria deaths (n = 57/63, 90.5%) experienced suboptimal or delayed clinical care.

Conclusions

Nearly all young children who died experienced delays in seeking and receiving adequate clinical care prior to their death. Reducing childhood mortality requires a multi-pronged approach including caregiver education on the detection and response to danger signs, availing a functional referral system, and providing adequate clinical care.