Mothers' perceptions of signs and symptoms of acute respiratory infections in their children and their assessment of severity in an urban community of Ethiopia

Use of the ReSVinet Scale for parents and healthcare workers in a paediatric emergency service: a prospective study

INTRODUCTION

Most scales for acute respiratory infection (ARI) are limited to healthcare worker (HCW) use for clinical decision-making. The Respiratory Syncytial Virus network (ReSVinet) Scale offers a version for parents that could potentially help as an early warning system.

OBJECTIVE

To determine whether or not the ReSVinet Scale for ARI in infants can be reliably used by HCWs and parents in an emergency service.

METHODS

A prospective study was done of infants with ARI who were admitted to a paediatric emergency room to assess the ReSVinet Scale when used by faculty (paediatric doctor-professors), residents (doctors doing their first specialty in paediatrics) and parents. Spearman's correlation and a weighted kappa coefficient were used to measure interobserver agreement. Internal consistency was also tested by Cronbach's alpha test.

RESULTS

Overall, 188 patients, 58% male, were enrolled. A Spearman's correlation of 0.92 for faculty and resident scoring and 0.64 for faculty or resident and parent scoring was found. The weighted kappa coefficients were 0.78 for faculty versus residents, 0.41 for faculty versus parents, and 0.41 for residents versus parents. Cronbach's alpha test was 0.67 for faculty, 0.62 for residents and 0.69 for parents.

CONCLUSION

There was good correlation in the ReSVinet scores between health professionals when used in the paediatric emergency area. Agreement between parents and health professionals was found to be more variable. Future studies should focus on finding ways to improve its reliability when used by parents before the scale is used in the emergency room.

Health Beliefs and Patient Perspectives of Febrile Illness in Kilombero, Tanzania

This qualitative study assessed the knowledge and beliefs surrounding fever syndrome among adult febrile patients seeking health care in Kilombero, Tanzania. From June 11 to July 13, 2014, 10% of all adult (≥ 15 years) febrile patients enrolled in the larger syndromic study, who presented with an axillary temperature ≥ 37.5°C and symptom onset ≤ 5 days prior, were randomly selected to participate in an in-depth physician-patient interview, informed by Health Belief Model constructs. Interviews were audio recorded, translated, and transcribed. Transcripts were coded using NVivo Version 11.1, and the thematic content was analyzed by two separate researchers. Blood and nasopharyngeal/oralpharyngeal specimens were collected and analyzed using both acute febrile illness and respiratory TaqMan Array Cards for multipathogen detection of 56 potential causative agents. A total of 18 participants provided 188 discrete comments. When asked to speculate the causative agent of febrile illness, 33.3% cited malaria and the other 66.6% offered nonbiomedical responses, such as "mosquitoes" and "weather." Major themes emerging related to severity and susceptibility to health hazards included lack of bed net use, misconceptions about bed nets, and mosquito infestation. Certain barriers to treatment were cited, including dependence on traditional healers, high cost of drugs, and poor dispensary services. Overall, we demonstrate low concurrence in speculations of fever etiology according to patients, clinicians, and laboratory testing. Our findings contribute to the important, yet limited, base of knowledge surrounding patient risk perceptions of febrile illness and underscore the potential utility of community-based participatory research to inform disease control programs.

To assess the effectiveness of various communication strategies for improving childhood pneumonia case management: study protocol of a community based behavioral open labeled trial in rural Lucknow, Uttar Pradesh, India

BACKGROUND

Community Acquired Pneumonia (CAP) is the leading cause of childhood morbidity and mortality worldwide including India. Many of these deaths can be averted by creating awareness in community about early symptoms of CAP and by ensuring availability of round the clock, quality health care. The objective was to assess the effectiveness of an innovative package of orienting doctors and community health workers about community perceptions on CAP barriers to qualified health care seeking, plus infrastructural strengthening by (i) providing "Pneumonia Drug Kit" (PDK) (ii) establishing "Pneumonia Management Corner" (PMC) at additional primary health center (PHCs) and (iii) "Pneumonia Management Unit" (PMU) at Community health center (CHCs) along with one of 4 different behavior change communication interventions: 1. Organizing Childhood Pneumonia Awareness Sessions (PAS) for caregivers of children < 5 years of age during a routine immunization day at PHCs and CHCs by Auxillary Nurse Midwives (ANM) 2. Organizing PAS on Village Health and Nutrition Day only once a month in villages by Accredited Social Health Activist (ASHA) 3. Combination of both Interventions 1 & 2 4. Usual Care as measured by number of clinical pneumonia cases-treated by ANM/doctors with PDK or treated at either PMC or PMU.

METHODS

Prospective community based open labeled behavioral trial (2 by 2 factorial design) conducted in 8 rural blocks of Lucknow district. Community survey will be done by multistage cluster sampling to collect information on changes in types of health care providers' service utilization for ARI/CAP pre and post intervention.

DISCUSSION

CAP is one of the leading killers of childhood deaths worldwide. Studies have reported that recognition of pneumonia and its danger signs is poor among caregivers. The proposed study will assess effectiveness of various communication strategies for improving childhood pneumonia case management interventions at mother/community level, health worker and health center level. The project will generate demand and improve supply of quality of care of CAP and thus result in reduced mortality in Lucknow district. Since the work will be done in partnership with government, it can be scaled up.

TRIAL REGISTRATION

This study has been registered retrospectively in the AEARCT Registry and the registration number is: AEARCTR-0003137 .

Referral patterns, delays, and equity in access to advanced paediatric emergency care in Vietnam

BACKGROUND

Quality emergency care is a critical component of a well-functioning health system. However, severely ill children often face barriers to timely, appropriate care in less-developed health systems. Such barriers disproportionately affect poorer children, and may be particularly acute when children seek advanced emergency care. We examine predictors of increased acuity and patient outcomes at a tertiary paediatric emergency department to identify barriers to advanced emergency care among children.

METHODS

We analysed a sample of 557 children admitted to a paediatric referral hospital in Hanoi, Vietnam. We examined associations between socio-demographic and facility characteristics, referrals and transfers, and patient outcomes. We used generalized ordered logistic regression to examine predictors of increased acuity on arrival.

RESULTS

Most children accessing advanced emergency care were under two years of age (68.4%). Pneumonia was the most prevalent diagnosis (23.7%). Children referred from lower-level facilities experienced higher acuity on arrival (p = .000), were more likely to be admitted to an ICU (p = .000), and were more likely to die during hospitalization (p = .009). The poorest children [OR = 4.98, (1.82-13.61)], and children entering care at provincial hospitals [OR = 3.66, (2.39-5.63)] and other lower-level facilities [OR = 3.24, (1.78-5.88)] had significantly higher odds of increased acuity on arrival.

CONCLUSIONS

The poorest children, who were more likely to enter care at lower-level facilities, were especially disadvantaged. While delays in entry to care were not predictive of acuity, children referred to tertiary care from lower-level facilities experienced worse outcomes. Improvements in triage, stabilization, and referral linkages at all levels should reduce within-system delays, increasing timely access to advanced emergency care for all children.

"It is good to take her early to the doctor" - mothers' understanding of childhood pneumonia symptoms and health care seeking in Kilimanjaro region, Tanzania

Background

Pneumonia is among the leading causes of avoidable deaths for young children globally. The main burden of mortality falls on children from poor and rural families who are less likely to obtain the treatment they need, highlighting inequities in access to effective care and treatment. Caretakers’ illness perceptions and care-seeking practices are of major importance for children with pneumonia to receive adequate care. This study qualitatively explores the caretaker concepts of childhood pneumonia in relation to treatment seeking behaviour and health worker management in Moshi urban district, Tanzania.

Methods

In May - July 2013 data was gathered through different qualitative data collection techniques including five focus group discussions (FGDs) with mothers of children under-five years of age. The FGDs involved free listing of pneumonia symptoms and video presentations of children with respiratory symptoms done, these were triangulated with ten case narratives with mothers of children admitted with pneumonia and eleven in-depth interviews with hospital health workers. Transcripts were coded and analysed using qualitative content analysis.

Results

Mothers demonstrated good awareness of common childhood illnesses including pneumonia, which was often associated with symptoms such as cough, flu, chest tightness, fever, and difficulty in breathing. Mothers had mixed views on causative factors and treatments options but generally preferred modern medicine for persisting and severe symptoms. However, all respondent reported access to health facilities as a barrier to care, associated with transport, personal safety and economic constraints.

Conclusion

Local illness concepts and traditional treatment options did not constitute barriers to care for pneumonia symptoms. Poor access to health facilities was the main barrier. Decentralisation of care through community health workers may improve access to care but needs to be combined with strengthened referral systems and accessible hospital care for those in need.

Predictors of Intention to Seek Medical Help by Peruvian Mothers for Children Who Have Signs of Pneumonia

The Theory of Planned Behavior was used to assess predictors of Peruvian mothers seeking medical help when they believed their child had signs of pneumonia. Open-ended interviews to identify beliefs were followed by a questionnaire administered to 500 mothers from low-income settlements in Lima in June and July 2000. Subjective norm (what important referents want) was the best predictor of intention, followed by mothers' feelings about how easy it would be to take the child to the clinic. Attitude toward taking the child to a clinic was not a significant predictor of intention. This study indicates a stronger role for subjective norm than attitudes and perceived control in similar studies done with this model in other settings. It, of course, only predicts intention to act and not behavior, important here given social-economic barriers, e.g., cost, to access to care among this study group.

CHILDHOOD RESPIRATORY MORBIDITY AND COOKING PRACTICES AMONG HOUSEHOLDS IN A PREDOMINANTLY RURAL AREA OF GHANA

Background:

Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking.

Materials and Method:

A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of respiratory symptoms and their associated risk factors. Household cooking practices were also assessed as part of the survey.

Results:

Household heads of twelve thousand, three hundred and thirty-three households were interviewed. Fifty-seven percent (7006/12333) of these households had at least one child less than five years of age. The prevalence of symptoms of acute lower respiratory infections (ALRI) was 13.7% (n= 957, 95% CI 12.8 – 15.5%). A majority (77.8%, 95% CI, 77.7 - 78.5%) of households used wood as their primary fuel. Majority of respondents who used wood as their primary fuel obtained them by gathering wood from their neighborhood (95.6%, 9177/9595) and used a 3-stone local stove for cooking (94.9%, 9101/9595). In a randomly selected subset of respondents, females were the persons who mostly gathered firewood from the fields (90.8%, 296/326) and did the cooking (94.8%, 384/406) for the household.

Conclusion:

Symptoms of ALRI reported by caregivers is high in the Kintampo area of Ghana where biomass fuel use is also high. There is the need to initiate interventions that use improved cook stoves and to test the health benefits of such interventions.

Measuring coverage in MNCH: new findings, new strategies, and recommendations for action

Considerable progress has been made in reducing maternal, newborn, and child mortality worldwide, but many more deaths could be prevented if effective interventions were available to all who could benefit from them. Timely, high-quality measurements of intervention coverage--the proportion of a population in need of a health intervention that actually receives it--are essential to support sound decisions about progress and investments in women's and children's health. The PLOS Medicine "Measuring Coverage in MNCH" Collection of research studies and reviews presents systematic assessments of the validity of health intervention coverage measurement based on household surveys, the primary method for estimating population-level intervention coverage in low- and middle-income countries. In this overview of the Collection, we discuss how and why some of the indicators now being used to track intervention coverage may not provide fully reliable coverage measurements, and how a better understanding of the systematic and random error inherent in these coverage indicators can help in their interpretation and use. We draw together strategies proposed across the Collection for improving coverage measurement, and recommend continued support for high-quality household surveys at national and sub-national levels, supplemented by surveys with lighter tools that can be implemented every 1-2 years and by complementary health-facility-based assessments of service quality. Finally, we stress the importance of learning more about coverage measurement to strengthen the foundation for assessing and improving the progress of maternal, newborn, and child health programs.

Childhood asthma in low income countries: an invisible killer?

Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing remain undiagnosed. New studies demonstrate that approximately 50% of acutely admitted under-5s diagnosed with pneumonia according to Integrated Management of Childhood Illnesses could be re-diagnosed with asthma or wheezing when using re-defined diagnostic criteria and treatment. It is hypothesised that untreated asthma may contribute to respiratory mortality since respiratory syncytial virus (RSV) is an important cause of respiratory death in childhood, and asthma in under-5s is often exacerbated by viral infections, including RSV. Furthermore, acute respiratory treatment failures were predominantly seen in under-5s without fever, which suggests the diagnosis of asthma/wheezing rather than bacterial pneumonia. Ultimately, underlying asthma may have contributed to malnutrition and fatal bacterial pneumonia. In conclusion, preschool asthma in low-income countries may be significantly under-diagnosed and misdiagnosed as pneumonia, and may be the cause of much morbidity and mortality.

Inherent illnesses and attacks: an ethnographic study of interpretations of childhood Acute Respiratory Infections (ARIs) in Manhiça, southern Mozambique

Background

Pneumonia is a leading cause of childhood hospitalisation and child mortality in Africa. This study explores local interpretations of Acute Respiratory Infections (ARIs), focusing on caretakers of children under five in the context of hospital care seeking.

Methods

The study took place in Manhiça, southern Mozambique and used Focused Ethnographic Study tools (FES) including field exercises and interviews.

Results

Understandings of terms used to describe ARIs differed between caretakers and hospital staff. Children's sicknesses that hospital staff diagnosed as ARIs were interpreted by caretakers as intermittent "attacks" of xifuva, a permanent, inherent and incurable chest illness. Caretakers thought that it was possible to manage and treat the attacks, which were caused by immediate natural factors such as food or the weather, but not the underlying illness, which was seen as having more indirect and social causes. Explanations of illness could not be neatly separated into pluralistic categories, but were characterised by syncretism, with "lay" and "biomedical" terms and concepts intermingling in practical care-seeking interactions between caretakers and health staff.

Conclusions

Health promotion should take into account the syncretism involved in explanations of ARIs in the context of practical care seeking for children. In doing so, it should draw upon lay interpretations and terminologies in order to stress the importance of seeking hospital care for all xifuva-type illnesses as well as seeking care for any subsequent attacks of an already diagnosed xifuva. However, this should be undertaken with awareness that the meanings of the terms used in practical care-seeking interactions may change over time. Health communication about ARIs should therefore be ongoing and evidence-based, even if ARIs appear to be well understood.

Community case management of pneumonia: at a tipping point?

Pneumonia is the leading cause of child mortality globally. Community case management (CCM) of pneumonia by community health workers is a feasible, effective strategy to complement facility-based management for areas that lack access to facilities. We surveyed experts in the 57 African and Asian countries with the highest levels and rates of childhood mortality to assess current policies, implementation and plans regarding CCM of pneumonia. About one-third (20/54) of countries reported policies supporting CCM for pneumonia, and another third (18/54) reported no policy against the strategy. Half (27/54) the countries reported some implementation of CCM for pneumonia, but often on a small scale. A few countries sustain a large-scale programme. Programmes, community health workers and policy parameters varied greatly among implementing countries. About half (12/26) of non-implementing countries are planning to move ahead with the strategy. Momentum is gathering for CCM for pneumonia as a strategy to address the pneumonia treatment gap and help achieve Millennium Development Goal 4. Challenges remain to: (1) introduce this strategy into policy and implement it in high pneumonia burden countries; (2) increase coverage of this strategy in countries currently implementing it; and (3) better define and monitor implementation at the country level.

Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study

OBJECTIVE

To review individual case histories of children who had died of pneumonia in rural Uganda and to investigate why these children did not survive.

METHODS

This case-series study was done in the Iganga/Mayuge demographic surveillance site, Uganda, where 67 000 people were visited once every 3 months for population-based data and vital events. Children aged 1-59 months from November 2005 to August 2007 were included. Verbal and social autopsies were done to determine likely cause of death and care-seeking actions.

FINDINGS

Cause of death was assigned for 164 children, 27% with pneumonia. Of the pneumonia deaths, half occurred in hospital and one-third at home. Median duration of pneumonia illness was 7 days, and median time taken to seek care outside the home was 2 days. Most first received drugs at home: 52% antimalarials and 27% antibiotics. Most were taken for care outside the home, 36% of whom first went to public hospitals. One-third of those reaching the district hospital were referred to the regional hospital, and 19% reportedly improved after hospital treatment. The median treatment cost for a child with fatal pneumonia was US$ 5.8.

CONCLUSION

There was mistreatment with antimalarials, delays in seeking care and likely low quality of care for children with fatal pneumonia. To improve access to and quality of care, the feasibility and effect on mortality of training community health workers and drug vendors in pneumonia and malaria management with prepacked drugs should be tested.

Local illness concepts--implications for management of childhood pneumonia in eastern Uganda

BACKGROUND

Pneumonia is one of the major killers of children under 5 years. Prompt and appropriate management is crucial; yet, the care a sick child receives depends on caretakers' perception of illness and action taken. Hence, understanding of local illness concepts on pneumonia and caretakers' response is crucial for interventions aimed at improved management.

OBJECTIVE

To elucidate local illness concepts involving childhood fever, cough and difficult/fast breathing and how these concepts' influence management of children with potential pneumonia.

METHODS

Key informant interviews with eight health workers and eight traditional healers and five focus group discussions, including presentation of a DVD showing children suffering from respiratory problems, with mothers of children under 5 years old in Iganga/Mayuge Demographic Surveillance Site (DSS) in eastern Uganda.

RESULTS

Many terminologies were used to refer to symptoms of pneumonia. Difficult/fast breathing was considered severe but was not presented among common childhood illnesses. Mothers were likely to interpret any condition involving fever as malaria and had different preferred actions for difficult/fast breathing in their children. Although mothers mentioned using drugs at home for pneumonia related symptoms, they gave examples only of antipyretics. Health workers said mothers would use antimalarials and sometimes antibiotics to treat breathing problems.

CONCLUSIONS

There is a community knowledge gap on symptoms and biomedical treatment for pneumonia. To promote appropriate management of childhood fever, pneumonia and malaria as two separate illnesses should be highlighted, the role of antibiotics must be emphasized and local illness concepts should be addressed in behaviour change communication.

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal]

BACKGROUND

Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up.

METHODS

We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities.

RESULTS

Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second.

CONCLUSIONS

The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

Respiratory tract infections in children in developing countries

Acute respiratory infections are the main cause of morbidity worldwide, and pneumonia represents one of the main causes of death in children younger than the age of 5 years in developing countries. Several risk factors for acquiring respiratory infections in developing countries, such as poverty, restricted family income, low parental education level, low birth weight, malnutrition, and lack of breastfeeding, have been described. Another important factor in recent years that has aggravated the problem of acute respiratory infections in developing countries is the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic. In developing countries, identifying the etiology is difficult and World Health Organization recommends making the diagnosis of pneumonia based on clinical parameters. The diagnosis and suitable treatment administered by primary healthcare workers, particularly in rural areas, is part of the strategy to prevent mortality. Finally, it is important that industrialized countries support the economic growth of the developing countries to improve their healthcare system and to ensure that performed research studies will give benefits to their populations.

[Assessment of management training for low-level community health workers providing care for children with acute respiratory infections in four districts of Senegal]

BACKGROUND

Acute respiratory infections are the leading cause of death in childhood and most child deaths in Senegal occur at home without qualified health care. Despite this situation, only qualified healthcare workers are authorized to prescribe antibiotics. A competency-based training program was developed to improve and assess management of acute respiratory infections in young children aged between 2 and 59 months by low-level educated community health workers (CHWs) in four districts of Senegal.

METHODS

In accordance with the strategy developed by the World Health Organisation, educated low-level community health workers in four district of Senegal were given a three-day course on the management of acute respiratory failure. We assessed the effects of the course by comparing pre-training and post-training skills with the Students t test.

RESULTS

The results showed that the educated low-level community health workers were capable of acquiring the skills needed to effectively manage children with acute respiratory failure.

CONCLUSION

Further evaluation is needed to determine the mid- and long-term effects of the course and supervised post-training activities.

Acute respiratory infections control in the context of the IMCI strategy in the Americas

Acute respiratory infections (ARI) are an important cause of morbidiyty and mortality in children all over the World, particularly in developing countries. Contrasts in mortality can be observed among the countries in America, and also within the countries. Contrasts are also observed in morbidity, associated with differences in nutritional status, absence of breast-feeding and characteristics of care given for ill chidren. Parents perception of disease, patterns and habits of care administered to child during the illness, level of concern about decision to seek assistence, manner in wich care is sought and extent to wich recommendations are followed have great influence in the course and outcome of the disease. Bacterial resistance to antibiotics is an increasing problem in America, with an average of 26,1% resistance of Streptococcus pneumonia to penicilin. Antibiotics are frequently used in irrational way, and up to 70% of ARI receive antibiotics unnecessarily. Controlling IRA has become a priority. Preventive interventions with vaccines, specially current conjugate vaccines against Haemophilus influenzae and Streptococcus pneumoniae, and standardized case management, as proposed by Integrated Management of Childhood Ilness (IMCI) seems to be the most important steps for this public health problem.

Quality assurance of the knowledge exchange process: a factor in the success of child health programs in developing countries

This article views the many national and international programs concerned with child survival in developing countries as sharing one important objective, i.e. the exchange of specialized knowledge to mothers who are the primary caretakers of children under age five. If mothers do not possess the knowledge required to develop proper care‐seeking practices, then return on investments in infrastructure, drugs, and human resources development, as these relate to child‐killer diseases such as diarrhea and acute respiratory infection, may not be optimal. Cognizant of reports of the limited impact of health promotion programs, in spite of the investments made, the article models the knowledge exchange process to pinpoint possible sources of problems. Pertinent issues of quality assurance are raised and the consequences of neglecting them pointed out. Some empirical evidence is offered in support of these predicted consequences. Proposes a value analysis framework, to make the point that paying attention to quality assurance concerns is more about optimizing the fit between available resources and ideal outcomes, rather than always being about additional resources.

Factors contributing to high mortality due to pneumonia among under-fives in Kalabo District, Zambia

OBJECTIVE

To determine factors contributing to high mortality caused by pneumonia among children under 5 years of age in Kalabo District.

METHODS

In a cross-sectional descriptive study 78 mothers and 16 health workers were interviewed using structured questionnaires. Focus group discussions were held with groups of women who did not take part in the survey. Registers, patient records, drug stock control cards, drug stores and equipment were reviewed or checked.

RESULTS

Pneumonia is an important public health problem in Kalabo District. Knowledge about the disease and its treatment is inadequate, both in health workers and in mothers. Low birth weight and distance contribute to high mortality. Mother and Child Health (MCH) clinic visits protect against mortality.

CONCLUSION

The community should be educated to recognize the signs and symptoms of pneumonia and to understand the importance of early and adequate treatment. As MCH clinics can play an important role, health workers, especially at rural health centre level, should be re-trained in case definition, case management and the use of available protocols. Strategies to fight the impact of pneumonia in the district should be part of an integrated package of care focusing on all prevalent childhood diseases, as they overlap in many cases.

Integrating prevention of acute respiratory infections with micro-credit programme: experience of BRAC, Bangladesh

The contribution of acute respiratory infection control project within the framework of micro-credit-based development intervention in promoting maternal knowledge of ARIs in children was assessed. Data came from a cross-sectional survey of 2814 mothers of under 5-y-old children residing in 200 randomly selected villages in five districts in Bangladesh. Findings revealed that the ARI control project had significant positive effects in raising knowledge of clinical signs and preventive measures. When ARI control project activities were integrated with the credit-based development initiative, maternal knowledge improved even further. The study concludes that the micro-credit programme can be a catalytic agent in raising health knowledge among poor women in developing countries.