This explorative qualitative study assesses the health-seeking behaviour for childhood ailments in caregivers of under-five children in a low-income neighbourhood in Delhi, India during July-September 2021. A total of 17 caregivers (mothers) of eight male and nine female under-five children were enrolled, with the mother being the caregiver in most (94%) cases. Caregivers consulted on common childhood ailments from multiple sources, including family, neighbours, healthcare providers (both licensed and unlicensed), frontline workers, and local pharmacists. The internet was often used as a source of child health information due to its ease of access but often "confused" caregivers due to the presence of too much information. Health-seeking behaviour of caregivers for childhood ailments could range from self-medication, local pharmacist dispensing, and private and public healthcare providers. Factors that influenced preference for the healthcare facility or provider were accessibility issues (waiting time, queuing), perceived physician competence, and associated out-of-pocket expenses. Caregivers reported dissatisfaction with government health facilities because of shorter operational hours, overcrowding, suboptimal sanitation, queuing with limited seating arrangements, and occasionally discourteous health staff. Self-medication and over-the-counter use of antibiotics was high due to a lack of awareness of the challenges of antibiotic resistance or any perceived side effects. Preference for unlicensed practitioners for medical treatment was low and based on long-term familial beliefs and acceptance. However, traditional practitioners enjoyed a high level of trust in the community from shared cultural values, enjoining attenuation of the perceived non-biological agents of childhood illnesses through non-medical supernatural interventions.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, rural and geographically isolated regions in lower-middle-income countries (LMICs) encountered major deficits in maternal and child health (MCH) care that were accentuated by pre-existing weak public health infrastructure and diversion of existing health resources for pandemic management purposes. This explorative qualitative study was conducted to assess the barriers, challenges, and facilitators in the access and utilization of essential MCH services among pregnant women during the COVID-19 pandemic in a geographically remote and rural area in India, having nearly 70% rural population.Method: The study was conducted using an ethnographic approach. Three villages were selected purposively from the Purba Medinipur district of the Eastern state of West Bengal, geographically isolated by a local river. Information on challenges of utilization was collected by in-depth interviews (IDI) with a universal sample of 25 mothers who underwent pregnancy after March 2020 and focus group discussions (FGD) with their husbands and mothers-in-laws. Thematic analysis was used to analyze the qualitative data.Results: The median (IQR) age of the mothers that delivered during pregnancy were 23 (18, 28) years and ranging from 18 to 28 years (N=25). All the mothers were married, housewives, literate, and Hindu by religion, while in the accompanying husband cohort, a majority (56 %) had completed high school. Half (52%) were primigravida with at least one living child (60 %). All the mothers had a successful birth outcome and only one had current evidence of mild depression. Low utilization of MCH services during the pandemic in the study area was recognized as an outcome of individual-level, interpersonal-level, and communitylevel barriers. Diversion of routine health staff for COVID-19 related services occasionally compelled pregnant women and children to seek care from unlicensed healthcare providers who remained accessible even during periods of stringent lockdown. Furthermore, the irregular functioning of the local primary health care system translated into missed home visits and disruption of nutritional assistance services. A dual burden of economic loss was reported in most households from loss of livelihood and wages and additional expenditure incurred in underdoing deliveries at private health facilities, thereby potentially translating into catastrophic out-of-pocket costs. The designation of a separate government health facility for delivery due to the unavailability of the local hospital did not mitigate the circumstances due to its lack of utilization by the villagers who encountered difficult access and a lack of trust in an unfamiliar environment. The functioning of a popular conditional cash transfer scheme for promoting safe motherhood was also possibly compromised during the pandemic.Conclusions: Accessibility to MCH services was severely affected during the COVID-19 pandemic, especially during the stringent lockdown periods in remote and rural a...