Listening to Caregivers: Narratives of Health Seeking for Children Under Five with Pneumonia and Diarrhea: Insights from the NIGRAAN Trial in Pakistan
Bibliographic record
Abstract
Maryam Huda,1 Fauziah Rabbani,1,2 Leah Shipton,1,3 Wafa Aftab,1 Kausar S Khan,1 Maria Giulia Marini4 1Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; 2Brain & Mind Institute, Aga Khan University, Karachi, Pakistan; 3Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; 4Research and Health Care Director, Fondazione ISTUD per la Cultura d’Impresa e di Gestione, Milan, ItalyCorrespondence: Fauziah Rabbani, Email fauziah.rabbani@aku.eduBackground: Understanding health-seeking behaviors of caregivers is important to reduce child mortality. Several factors influence decision-making related to childhood illnesses.Objective: The objective of this study was to gather caretaker narratives to develop a comprehensive understanding of the context and process of caregiving at household level during all stages of an episode of diarrhea and pneumonia in children < 5.Methods: Using a narrative interview approach, stories from caregivers of children < 5 were collected from a rural district in Sindh Pakistan. Eleven households with children < 5 were randomly selected and purposive sampling was done to interview 20 caregivers. All data collection was conducted privately in participants’ homes and informed consent taken. Manual content analysis was carried out by three independent researchers and emerging themes drawn.Results: The role of joint family system is integral in making decisions and the child’s paternal grandmother, is an important and trusted source of information regarding child sickness in the household. They often promote home remedies with considerable authority prior to formal consultation with the health care system. Caregivers were generally dissatisfied with doctors in the public sector who were perceived to be providing free consultation with a poor quality of care and long waiting time as compared to private doctors. Financial considerations and child support were favorably addressed in households with a joint family system.Conclusion: The joint family system provides a strong support system, but also tends to reduce parental autonomy in decision-making and delay first contact with formal health providers. Prevalent home remedies, and authority of elders in the family influence management practices. Interventions for reducing improving child mortality should be cognizant of the context of decision-making and social influences at the household level.Keywords: narrative interviews, health-seeking behavior, joint family system, pneumonia, diarrhea, children < 5, caregivers
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.043 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.008 | 0.004 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.007 |
| Research integrity | 0.002 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".