FACTORS CAUSING DELAY IN HOSPITALIZATION

OF SICK CHILDREN IN NEPAL.

(A Sociological Analysis)
Laxmi Shrestha Thakur
Tribhuvan University, Anthropology Department,
Kathmandu, NEPAL.

This study looks into the causes of delay in hospitalization of sick children (birth- 10
years of age) in Kanti Children Hospital (KCH), Kathmandu, Nepal.
The major objectives of this study are to: (i) find out the social, cultural and economic
factors which cause delay in the process of hospitalization of children,(ii)investigate
other factors such as medical system if responsible for delay in the treatment of children
and(iii) suggest measures so that an integrated approach to community health service
systems could be developed and the infant mortality as well as disability rates could be
further reduced.
The study is both descriptive and exploratory. A sample size of 300 parents (about 12
percent) of total patients admitted in the medical ward of KCH in 1992-1993 were
selected to participate in this study, and out of 300 parents 25 were selected purposively
from three districts Kathmandu, Bhaktapur and Lalitpur for the follow up study. Five
faith healers and 10 doctors of KCH were also selected purposely for interviews to
record their views on causes of delay.
The following points were developed to understand the complexity of the problems:
(i)causes of delay in hospitalization may be lack of parents knowledge in

modern scientific methods of curing disease,(ii) the parents may be

conditioned by their cultural traditions and therefore unable to understand
the need of modern medical treatment,(iii)there may be other extraneous
factors such as poor financial condition, lack of education, inadequate
health service facilities,(iv) poor response from the hospital itself to the
parents of sick children and ,(v) other social factors that may cause delay in
hospitalization process.
The study concludes that reasons for delays are: (i) inadequate
understanding about signs and symptoms of major killer diseases like
diarrhea, acute respiratory infection, malnutrition, typhoid, tuberculosis
ect, (ii) traditional beliefs and practices regarding health and illness of
people,(iii) pluralistic/alternative health care systems , (iv) glaring poverty ,
(v) poor transport and communications system,(vi) less focus on preventive
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health care systems and (vii) low literacy rate. Among major reasons
preventing parents from bringing their sick children to hospital on time
have been found: (i) financial constraints (52%),(ii) lack of time due to
household and farm work(23%), (iii) transport and communication(14%),
(iv) the management of the Kanti Children Hospital and the response of
medical doctor(11%)
Limited professional capabilities of the TFH and the health workers,
inadequate laboratory facilities in health posts and hospitals as well as
inadequate professional knowledge of sales persons at drug stores have
been found to be the main reasons for hampering proper diagnosis of
serious cases on time.
The study shows that the higher caste groups bring their sick children to
hospital earlier than other groups because (i) their mode of communication
is more effective than other groups,(ii) as their level of education is better
than others, they are more conscious and serious about the health
problems, and (iii) their income is relatively higher than other groups.
In short ,it is not any single factor that causes delay in hospitalization of
sick children for example (i) 25% of delay cases admitted to KCH were
treated by TFH before; (ii)17% of delay cases were treated by medical and
paramedical personnel before they were admitted in KCH;(iii)13% of delay
cases were under home treatment ; (iv) 13% of delay cases were due to
improper KCH management system; (v) 12% of respondents reported that
they could not provide timely treatment due to the problem of
transportation; (vi) 11% parents could not provide timely treatment to
their sick child due to economic constraints and(vii) 9% socio-cultural
constraints.
The study recommends that: (i) a national health policy for structured
cooperation is required to enhance the collaboration between indigenous
and cosmopolitan health care system; (ii) it is necessary to develop
multilevel information and communication service system to improve
parents knowledge
about modern scientific methods of curing diseases
and (iii) more emphasis should be given to preventive health care system in
order to reduce infant mortality rate and also to reduce financial
expenditure on treatment, especially in the families living below the poverty
line and suffering from major killer disease.
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