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Barriers to seeking timely treatment for severe childhood pneumonia in rural Bangladesh
  1. Kamal Ibne Amin Chowdhury1,
  2. Ishrat Jabeen1,
  3. Mahfuzur Rahman1,
  4. Abu Syed Golam Faruque1,
  5. Nur H Alam1,
  6. Shahjahan Ali1,
  7. Tahmeed Ahmed1,
  8. George J Fuchs2,
  9. Trevor Duke3,4,5,
  10. Niklaus Gyr6,
  11. Haribondhu Sarma1,7
  1. 1Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
  2. 2Department of Paediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
  3. 3Department of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
  4. 4Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
  5. 5Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
  6. 6Department of Internal Medicine, University of Basel, Basel, Switzerland
  7. 7Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Kamal Ibne Amin Chowdhury, Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh; kiachowdhury{at}


Objective Delays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh.

Methods We conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically.

Results We found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors.

Conclusions This study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.

  • qualitative research
  • health services research
  • mortality
  • paediatrics
  • child health services

Data availability statement

Data are available on reasonable request.

Statistics from

Data availability statement

Data are available on reasonable request.

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  • Contributors KIAC, ASGF, NHA, and HS contributed to the conception and design of the study, carried out the data collection, analysis, drafted the manuscript and proofed the final manuscript as submitted. IJ and MR mainly contributed to data collection and analysis and drafted the manuscript. Contributions to input on initial data analysis and substantial guidance and input for developing the manuscript were given by SA, TA, GJF, TD and NG.

  • Funding This work was supported by UBS Optimus Foundation, Switzerland and UNICEF, Switzerland grant numbers (GR-01269 and GR-01083).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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