Abstract 16550: Community Perception and Treatment of Sore Throat Among Children in a Rheumatic Heart Disease Endemic Setting

Introduction: Although Group A Streptococcal (GAS) pharyngitis (sore throat) can be treated, its complications -- acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant public health problems in low- and middle -income countries. Examining community perceptions and health seeking behavior for sore throat in these settings could translate into effective ARF/RHD prevention strategies. Objective: To develop a local explanatory model of sore throat health seeking behavior that can be used in designing ARF/RHD preventive interventions Methods: This focus group discussions-based qualitative study was conducted in 3 districts of Uganda (Lira in the north, Wakiso in central and Mbarara in the west). Overall, 50 participants were included in these discussions about sore throat in children. Thematic analysis was done on transcribed and translated audio recordings. Results: Perception of sore throat, treatment practices and challenges/barriers to seeking proper care for sore throat were major topics discussed during the focus group discussions. Across the 3 districts, sore throat was perceived to be a common and serious problem within the community. Although the majority of participants could not tell the exact cause of sore throat, they believed that poor hygiene could be a related factor. Variable methods of treatment were used across all districts. However, traditional medicine use and practices were more common in Lira and Wakiso districts while there was more trust in modern medicine in Mbarara district. Improvement in a child’s symptoms was the most common reason for stopping treatment. Individual, societal and health system factors such as distance to health facility, long waiting time and lack of medicines influenced care givers’ decisions to seek proper care for sore throat. Conclusions: Our findings show interplay between care givers’ knowledge, beliefs and preferences and the health care system as major determinants of caregivers’ behavior to seek proper care for pharyngitis. Community ARF/RHD educational programs in Uganda should emphasize the consequences of untreated or poorly treated pharyngitis and the importance of seeking proper care and treatment.