Transcript PowerPoint-presentation

Community health worker and caretaker
recognition of pneumonia in children
Karin Källander1, Göran Tomson1, Xavier Nsabagasani2, Jesca Nsungwa Sabiiti1,3,4, George Pariyo3 and Stefan Peterson1,3
Conclusions and policy implications
Community health workers (CHWs), in Uganda ”drug distributors” or DDs, could
successfully assess rapid breathing in children with pneumonia. Also caretakers
were aware of ARI symptoms but linked them to fever and malaria treatment. To
avoid over-treatment and failure-to-treat, highly focused training and context
specific education messages are required. A standard set of both qualitative and
quantitative methods are proposed as a toolkit. With such a standardised toolkit,
the full-scale feasibility of integrated home and community management of both
malaria and pneumonia should be tested.
Figure 1. Drug Distributors counting breathing rate on a child with pneumonia
Introduction
Results
Acute respiratory infections (ARI) are
leading killers of children worldwide.
Case management of ARI using
CHWs has halved ARI mortality in
children in Asia. WHO and UNICEF
recommend integrating pneumonia
care with Home Management of
Malaria. However, in sub-Saharan
Africa, performance of CHWs to
assess rapid breathing has rarely
been demonstrated.
Of all CHW assessments 71% of were
within ±5 breaths/minute from gold
standard. Sensitivity of CHW
classification was 87% and specificity
84%. Many local terms existed for
respiratory illness, such as ‘Quick
breathing’ and ‘Groaning breathing’.
There was consistency in the
interpretation of severity, cause and
treatment of ARI - most being related
to fever and treated with antimalarials.
To assess antimalarial drug
distributors (DDs) ability to assess
rapid breathing in children under-five
and to explore caretaker recognition
and interpretation of pneumonia
symptoms in western Uganda.
Quantitative and qualitative methods
were used. Ninety-six DDs were
trained in recognition of pneumonia
symptoms and their skills evaluated
on in-patient children in the paediatric
ward. Respiratory illness concepts
and actions were obtained from a
triangulation of 4 focus group
discussions using video probing and
feedback interviews with 2 key
informants.
Percent of DD assessments
50%
40%
30%
20%
10%
0%
0%
20%
Wrongly
classified
compared to
gold standard
n=119 (21%)
60%
80%
100%
* Data deduced from Kolstad et al. (1997) Bull WHO, 75
Suppl 1:77-85 & Weber et al. (1997) Bull WHO, 75
Suppl 1:25-32
Figure 2. Schematic presentation of DDs’ ability
to classify children according to breathing rate.
Table 1. Biomedical illness symptoms and ARI illness concepts among mothers in Western Uganda
Biomedical symptom
Respiratory illness concept
Ekihahayiro Erihihira Ekihumira Erihumayira Ekyikenyero Akafundi Obukoni
Quick
Shivering
Heavy
Unorganised
Groaning
Narrow
Abrupt
breathing
breathing
attack
breathing
breathing
space
attack
Hot body
√
Cough
Fast breathing
√
Difficult breathing
√
√
√
(√)
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Grunting
√
Chest indrawing
√
2) Uganda Program for Human and
Holistic Development (UPHOLD)
Kampala Uganda
Ekikuba
Chest
√
Stridor
1) Division of International Health (IHCAR)
Karolinska Institutet
Stockholm, Sweden
[email protected]
40%
Figure 3. The relationship between pneumonia
prevalence and projected over treatment and
failure to treat. Lines indicate the range resulting
from sensitivity analysis for values of sensitivity
(76-81 %)* and specificity (60-89%)*.
12 missing values
Correctly
classified
compared to
gold standard
n=445 (79%)
Failure-to-treat
Prevalence of pneumonia
All observations
n=576 (100 %)
Study objectives
Methods
Over treatment
3) Institute of Public Health
Makerere University
Kampala Uganda
√
4) Child Health Division
Ministry of Health
Kampala, Uganda