Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the
world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize
barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern
Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional
hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and
define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural
factors. Sociocultural factors were 1) interviewee’s distinctions of “traditional” versus “hospital” illnesses, which were
mutually exclusive and 2) generational conflict, where deference to one’s elders, who recommended traditional medicine,
was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting
escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness,
debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions
that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in
similarly endemic, low-resource settings.