Abstract

Introduction: Monsoon-related illnesses are major cause of morbidity and mortality in children during rainy season in Mumbai. Outcome of these illnesses largely depend on appropriate and timely care. Experience suggests delayed medical attention is a common problem in study population. Aims & Objectives: Present Study aimed to assess the prevalence, reasons and risk factors for delayed medical attention in children with monsoon-related illnesses as well as the impact on final outcome. Materials & Methods: This cross-sectional observational study included 220 children (1 month-12 years) hospitalized with monsoon-related illnesses in a tertiary hospital during two seasons (June-September) in 2019-2020. “Delayed medical attention” was pre-defined for study purpose as one or more of the following – a) More than 24 hours delay between onset of symptoms and first visit to qualified medical practitioner, or b) More than 72 hours delay between first consultation and referral to hospitalization,) c) More than 24 hours delay after referral and actual hospitalization. Results: Almost three-fourth of the study children (71.8%) received delayed medical attention with maximum delay at the level of first consultation (44.5%) followed by referral (36.5%). Delayed medical attention was more common in cases with initial self-treatment ( p 0.010; OR 38.58 with CI 2.33-638.84), Unqualified first consultations (p 0.003; OR 21.38 with CI95% 2.87-159.18) and Doctor-shopping (p0.0004; 21.38 with 95% CI 2.69 to 30.28). Older children beyond five years had significantly higher risk of delayed attention than under-five children (p 0.033; OR 1.93 with 95% CI 1.05-3.55) as also those with non-specific febrile illnesses (p 0.048, OR 2.29 with CI 95% 1.00 - 5.21). Conclusion: Delayed medical attention is widely prevalent in children with monsoon-illnesses among study population despite easy access to low-cost public health care in the city, largely due to inappropriate help-seeking behaviour. Older children, non-specific febrile illness, self- treatment, unqualified consultations and doctor-shopping are identified as significant risk factors for the delayed care.

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