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Dorta HG, Nandi A. Patterns of antibiotic use for acute respiratory infections in under-three-year-old children in India: A cross-sectional study. J Glob Health 2023; 13:04159. [PMID: 38131631 PMCID: PMC10740384 DOI: 10.7189/jogh.13.04159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Despite its mostly viral etiology, antibiotics are frequently used to treat acute respiratory infections (ARIs) in children. India is one of the largest global consumers of antibiotics and has one of the highest rates of resistance to antimicrobial treatments. However, the epidemiology of antibiotic treatment among young children in India is poorly understood. Methods Using nationally representative household survey data from the Indian National Family Health Surveys (NFHS) conducted between 2015 and 2016 and 2019 and 2021, we estimated the prevalence of antibiotic use among 17 472 children under the age of three who reported ARI symptoms within two weeks before their mothers were interviewed. To assess the factors associated with antibiotic use for the treatment of ARI symptoms, we used multivariable logistic regression models that included sociodemographic, child-related, household, and health care related characteristics, with results reported on the prevalence difference (PD) scale. Results We estimated that 18.7% (95% CI = 17.8-19.6) of under-three-year-old (U3) children who exhibited ARI symptoms in the two weeks prior to the survey were given antibiotics as a treatment. The highest prevalence was observed in the southern and northern geographic zones of India. Furthermore, multivariable regression models indicated that children with greater access to health services were more likely to receive antibiotics for ARI treatment, regardless of the type of health care facility (public, private or pharmacy/unregulated). Additionally, the prevalence of antibiotic consumption was higher among children from families with religious affiliations other than Muslim and Hindu backgrounds (i.e. Christian, Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi, no religion and other) (PD = 11.7 (95% CI = 6.3-16.7)) compared to Hindu families and among mothers with a secondary or higher education (PD = 5.8 (95% CI = 1.7-9.9)) compared to mothers lacking formal education. Conclusions Our findings provide an important baseline for monitoring the use of antibiotics for the treatment of acute respiratory infections, and for designing interventions to mitigate potential misuse among young children in India.
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Gosling J, Colbourn T. What is associated with reported acute respiratory infection in children under 5 and PCV vaccination in children aged 1-36 months in Malawi? A secondary data analysis using the Malawi 2014 MICS survey. PLoS One 2023; 18:e0283760. [PMID: 37000716 PMCID: PMC10065275 DOI: 10.1371/journal.pone.0283760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Acute respiratory illness (ARI) is a leading cause of mortality in children under 5 (CU5) in Malawi and can be prevented with 3-dose pneumococcal conjugate vaccine (PCV). There has been no national study in Malawi that seeks to associate social economic factors leading to PCV vaccine uptake and reported acute respiratory infections (RARI). The objectives of our study were to do this. METHODS We conducted a cross-sectional analysis of secondary data from the 2014 UNICEF Malawi Multiple Indicator Cluster Survey to construct mutlivariable logistic regression models for independent associations with PCV 1/2/3 immunisation and RARI. RESULTS 56% of CU5 in Malawi RARI in the 2 week recall period of the survey. Independent associations with reduced odds of RARI were central region living (OR 0.82, 95%CI (0.71-0.93)) middle (OR 0.84, (0.73-0.97)) fourth (OR 0.79, (0.68-0.92)) and richest wealth quintiles (OR 0.73, (0.60-0.88)). Using straw/shrubs for fuel was associated with increased RARI (OR 3.13, (1.00-9.79)). Among 1-36 month olds, in 2014, 93.3% received PCV1, 86.8% PCV2 and 77.0% PCV3. Between 2011-2014, the average age in months for a child to receive PCV1/2/3 reduced by 26.6 for PCV1, 26.4 for PCV2, and 26.1 for PCV 3. Independent predicators for increased odds of all 3 PCV doses, relative to 0-5 age group, were age group 6-11 (OR 21.8, (18.2-26.1) 12-23 (OR 27.5, (23.5-32.2) 24-36 months (OR 9.09, (7.89-10.5), mothers having a secondary (OR 1.52, (1.25-1.84)) or higher education (OR 2.68, (1.43-5.04) when compared to no education, and children in the middle (OR 1.24, (1.07-1.43)) fourth (OR 1.27, (1.09-1.48)) richest (OR 1.54, (1.27-1.88)) wealth quintiles relative to the lowest. Children living with 4-6 other children was independently associated with reduced odds of receiving all 3 PCV doses (OR 0.56, (0.33-0.96). CONCLUSION We report nationally representative social economic associations with RARI and PCV vaccine uptake and coverage estimates. We found reductions in the average age a child receives all 3 PCV vaccine doses between 2011-2014.
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Affiliation(s)
- Justine Gosling
- UCL Institute for Global Health, London, United Kingdom
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tim Colbourn
- UCL Institute for Global Health, London, United Kingdom
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Chirwa T, Malinga S, Ilukena M, Bwalya R, Chama-Chiliba CM. A cross-sectional study on factors associated with health care seeking for acute respiratory infection and fever in children under-five in Zambia. Pan Afr Med J 2023; 44:125. [PMID: 37275290 PMCID: PMC10237215 DOI: 10.11604/pamj.2023.44.125.35921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/21/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction mortality in under-five children remains a significant challenge in developing countries, including Zambia, where pneumonia and malaria account for twenty percent of under-five deaths. Poor health care seeking is one of the contributors to the high mortality rates. This study examined the predictors of health care seeking for acute respiratory infection (ARI) and fever among under-five children in Zambia. Methods the study used a population based cross-sectional survey program evaluation dataset with sample size of 12,507 households from 28 districts. Binary logistic regression was used to examine the determinants of appropriate care seeking for ARI or fever, ARI, and fever. Results the prevalence of fever or ARI in children under five was 22.9%, ARI 12.9%, and fever 13.4%. Educational status and non-participation in positive deviance hearth (PDH) were significant predictors in those with fever or ARI. Children whose household head had secondary education or higher were 4.5 times more likely to seek care than those whose household head did not have any education. Among those with ARI, educational status, women empowerment in decision-making and growth monitoring and promotion (GMP) were significant predictors while for fever only GMP was a significant predictor. Conclusion over two thirds of caregivers sought care appropriately for fever or ARI. Only educational status and GMP were associated with more than one appropriate care seeking outcome. Through GMP services, policymakers can improve healthcare seeking behavior in children under five.
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Affiliation(s)
| | | | | | - Richard Bwalya
- Institute of Economic and Social Research, Lusaka, Zambia
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Kim MK, Kim SA, Oh J, Kim CE, Arsenault C. Measuring effective coverage of maternal and child health services in Cambodia: a retrospective analysis of Demographic and Health Surveys from 2005 to 2014. BMJ Open 2022; 12:e062028. [PMID: 36691182 PMCID: PMC9454061 DOI: 10.1136/bmjopen-2022-062028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To investigate effective, quality-adjusted, coverage and inequality of maternal and child health (MCH) services to assess progress in improving quality of care in Cambodia. DESIGN A retrospective secondary analysis using the three most recent (2005, 2010 and 2014) Demographic and Health Surveys. SETTING Cambodia. PARTICIPANTS 53 155 women aged 15-49 years old and 23 242 children under 5 years old across the three surveys. OUTCOME MEASURES We estimated crude coverage, effective coverage and inequality in effective coverage for five MCH services over time: antenatal care (ANC), facility delivery and sick childcare for diarrhoea, pneumonia and fever. Quality was defined by the proportion of care seekers who received a set of interventions during healthcare visits. Effective coverage was estimated by combining crude coverage and quality. We used equiplots and risk ratios, to assess patterns in inequality in MCH effective coverage across wealth quintile, urban-rural and women's education levels and over time. RESULTS In 2014, crude and effective coverage was 80.1% and 56.4%, respectively, for maternal health services (ANC and facility delivery) and 59.1% and 26.9%, respectively, for sick childcare (diarrhoea, pneumonia and fever). Between 2005 and 2014, effective coverage improved for all services, but improvements were larger for maternal healthcare than for sick child care. In 2014, poorer children were more likely to receive oral rehydration solution for diarrhoea than children from richer households. Meanwhile, women from urban areas were more likely to receive a postnatal check before getting discharged. CONCLUSIONS Effective coverage has generally improved in Cambodia but efforts remain to improve quality for all MCH services. Our results point to substantial gaps in curative sick child care, a large share of which is provided by unregulated private providers in Cambodia. Policymakers should focus on improving effective coverage, and not only crude coverage, to achieve the health-related Sustainable Development Goals by 2030.
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Affiliation(s)
- Min Kyung Kim
- Department of Korea, Korea Foundation for International Healthcare, Seoul, Republic of Korea
- Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Soon Ae Kim
- Department of Korea, Korea Foundation for International Healthcare, Seoul, Republic of Korea
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chae Eun Kim
- Department of Korea, Korea Foundation for International Healthcare, Seoul, Republic of Korea
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Munos MK, Maïga A, Sawadogo-Lewis T, Wilson E, Ako O, Mkuwa S, Ngalesoni F, Brenner JL, Matovelo D, Ouili I, Soura A, Bougma M, Sheffel A, Hobbs AJ, Walker N. The RADAR coverage tool: developing a toolkit for rigorous household surveys for reproductive, maternal, newborn, and child health & nutrition indicators. Glob Health Action 2022; 15:2006419. [PMID: 36098955 PMCID: PMC9481084 DOI: 10.1080/16549716.2021.2006419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Population-based intervention coverage data are used to inform the design of projects, programs, and policies and to evaluate their impact. In low- and middle-income countries (LMICs), household surveys are the primary source of coverage data. Many coverage surveys are implemented by organizations with limited experience or resources in population-based data collection. We developed a streamlined survey and set of supporting materials to facilitate rigorous survey design and implementation. The RADAR coverage survey tool aimed to 1) rigorously measure priority reproductive, maternal, newborn, child health & nutrition coverage indicators, and allow for equity and gender analyses; 2) use standard, valid questions, to the extent possible; 3) be as light as possible; 4) be flexible to address users’ needs; and 5) be compatible with the Lives Saved Tool for analysis of program impact. Early interactions with stakeholders also highlighted survey planning, implementation, and analysis as challenging areas. We therefore developed a suite of resources to support implementers in these areas. The toolkit was piloted by implementers in Tanzania and in Burkina Faso. Although the toolkit was successfully implemented in these settings and facilitated survey planning and implementation, we found that implementers must still have access to sufficient resources, time, and technical expertise in order to use the tool appropriately. This potentially limits the use of the tool to situations where high-quality surveys or evaluations have been prioritized and adequately resourced.
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Affiliation(s)
- Melinda K Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talata Sawadogo-Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Onome Ako
- Amref Health Africa, Toronto, Canada
| | - Serafina Mkuwa
- Amref Health Africa in Tanzania, Dar Es Salaam, Tanzania
| | | | - Jennifer L Brenner
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Dismas Matovelo
- Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania
| | - Idrissa Ouili
- Institut Supérieur Des Sciences de La Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Abdramane Soura
- Institut Supérieur Des Sciences de La Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Moussa Bougma
- Institut Supérieur Des Sciences de La Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy J Hobbs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rahman AE, Jabeen S, Fernandes G, Banik G, Islam J, Ameen S, Ashrafee S, Hossain AT, Alam HMS, Majid T, Saberin A, Ahmed A, A N M EK, Chisti MJ, Ahmed S, Khan M, Jackson T, Dockrell DH, Nair H, El Arifeen S, Islam MS, Campbell H. Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement. J Glob Health 2022; 12:04029. [PMID: 35486705 PMCID: PMC9079780 DOI: 10.7189/jogh.12.04029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background An estimated 7 million episodes of severe newborn infections occur annually worldwide, with half a million newborn deaths, most occurring in low- and middle-income countries. Whilst injectable antibiotics are necessary to treat the infection, supportive care is also crucial in ending preventable mortality and morbidity. This study uses multi-country data to assess gaps in coverage, quality, and documentation of supportive care, considering implications for measurement. Methods The EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Newborns with an admission diagnosis of clinically-defined infection (sepsis, meningitis, and/or pneumonia) were included. Researchers extracted data from inpatient case notes and interviews with women (usually the mothers) as the primary family caretakers after discharge. The interviews were conducted using a structured survey questionnaire. We used descriptive statistics to report coverage of newborn supportive care components such as oxygen use, phototherapy, and appropriate feeding, and we assessed the validity of measurement through survey-reports using a random-effects model to generate pooled estimates. In this study, key supportive care components were assessment and correction of hypoxaemia, hyperbilirubinemia, and hypoglycaemia. Results Among 1015 neonates who met the inclusion criteria, 89% had an admission clinical diagnosis of sepsis. Major gaps in documentation and care practices related to supportive care varied substantially across the participating hospitals. The pooled sensitivity was low for the survey-reported oxygen use (47%; 95% confidence interval (CI) = 30%-64%) and moderate for phototherapy (60%; 95% CI = 44%-75%). The pooled specificity was high for both the survey-reported oxygen use (85%; 95% CI = 80%-89%) and phototherapy (91%; 95% CI = 82%-97%). Conclusions The women's reports during the exit survey consistently underestimated the coverage of supportive care components for managing infection. We have observed high variability in the inpatient documents across facilities. A standardised ward register for inpatient small and sick newborn care may capture selected supportive care data. However, tracking the detailed care will require standardised individual-level data sets linked to newborn case notes. We recommend investments in assessing the implementation aspects of a standardised inpatient register in resource-poor settings.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sabrina Jabeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Genevie Fernandes
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Goutom Banik
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shafiqul Ameen
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Husam Md Shah Alam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Tamanna Majid
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | - Mohammod Jobayer Chisti
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | | | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - David H Dockrell
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Shams El Arifeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Harry Campbell
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
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Levine G, Bielicki J, Fink G. Cumulative Antibiotic Exposure in the First Five Years of Life: Estimates for 45 Low- and Middle-income Countries from Demographic and Health Survey Data. Clin Infect Dis 2022; 75:1537-1547. [PMID: 35325088 DOI: 10.1093/cid/ciac225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Estimates of the total cumulative exposure to antibiotics of children in low-resource settings, and the source of these treatments, are limited. METHODS We estimated the average number of antibiotic treatments children received in the first five years of life in 45 low- and middle-income countries (LMICs) using Demographic and Health Survey (DHS) data. The two-week point prevalence of fever, diarrhea or cough and antibiotic treatment for these illnesses were estimated for ages 0-59 months and aggregated to estimate cumulative illness and antibiotic treatment for each country. We estimated treatment rates and contribution to total antibiotic use attributable to medical care, informal care, and self-medication. RESULTS Forty-five countries contributed 438,140 child-observations. The proportion of illness episodes treated with antibiotics ranged from 10% (95% CI: 9-12) (Niger) to 72% (95% CI: 69-75) (Jordan). A mean of 42·7% (95% CI: 42.1-43.3) of febrile and 32.9% of non-febrile illness (95% CI: 32.4-33.5) episodes received antibiotics. In their first five years, we estimate children received 18.5 antibiotics treatments on average (IQR: 11.6-24.6) in LMICs. Cumulative antibiotic exposure ranged from 3.7 treatments in Niger (95% CI: 2.8-4.6) to 38·6 treatments in DR Congo (95% CI: 34.7-42.4). A median of 9.0% of antibiotic treatment was attributable to informal care (IQR: 5.9-21.2), and 16.9% to self-medication (IQR: 9.5-26.2). CONCLUSIONS Childhood antibiotic exposure is high in some LMICs, with considerable variability. While access to antibiotics for children is still not universal, important opportunities for reducing excess use also exist, particularly with respect to the informal care sector and self-medication.
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Affiliation(s)
- Gillian Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse, Allschwil, Switzerland.,University of Basel, Petersplatz, Basel, Switzerland
| | - Julia Bielicki
- Pediatric Infectious Disease Research Group, St George's University of London, Cranmer Terrace, Tooting, London, United Kingdom.,Infection Prevention and Control, University Children's Hospital, Basel, Spitalstrasse, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse, Allschwil, Switzerland.,University of Basel, Petersplatz, Basel, Switzerland
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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. Ambient air pollution and acute respiratory infection in children aged under 5 years living in 35 developing countries. ENVIRONMENT INTERNATIONAL 2022; 159:107019. [PMID: 34875446 DOI: 10.1016/j.envint.2021.107019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence from developed countries suggests that fine particulate matter (≤2.5 µm [PM2.5]) contributes to childhood respiratory morbidity and mortality. However, few analyses have focused on resource-limited settings, where much of this burden occurs. We aimed to investigate the cross-sectional associations between annual average exposure to ambient PM2.5 and acute respiratory infection (ARI) in children aged <5 years living in low- and middle-income countries (LMICs). METHODS We combined Demographic and Health Survey (DHS) data from 35 countries with gridded global estimates of annual PM2.5 mass concentrations. We analysed the association between PM2.5 and maternal-reported ARI in the two weeks preceding the survey among children aged <5 years living in 35 LMICs. We used multivariable logistic regression models that adjusted for child, maternal, household and cluster-level factors. We also fitted multi-pollutant models (adjusted for nitrogen dioxide [NO2] and surface-level ozone [O3]), among other sensitivity analyses. We assessed whether the associations between PM2.5 and ARI were modified by sex, age and place of residence. RESULTS The analysis comprised 573,950 children, among whom the prevalence of ARI was 22,506 (3.92%). The mean (±SD) estimated annual concentration of PM2.5 to which children were exposed was 48.2 (±31.0) µg/m3. The 5th and 95th percentiles of PM2.5 were 9.8 µg/m3 and 110.9 µg/m3, respectively. A 10 µg/m3 increase in PM2.5 was associated with greater odds of having an ARI (OR: 1.06; 95% CI: 1.05-1.07). The association between PM2.5 and ARI was robust to adjustment for NO2 and O3. We observed evidence of effect modification by sex, age and place of residence, suggesting greater effects of PM2.5 on ARI in boys, in younger children, and in children living in rural areas. CONCLUSIONS Annual average ambient PM2.5, as an indicator for long-term exposure, was associated with greater odds of maternal-reported ARI in children aged <5 years living in 35 LMICs. Longitudinal studies in LMICs are required to corroborate our cross-sectional findings, to further elucidate the extent to which lowering PM2.5 may have a role in the global challenge of reducing ARI-related morbidity and mortality in children.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Centre of Excellence for Research on Clean Air, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Corvallis, OR, USA
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
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Khare S, Pathak A, Purohit MR, Sharma M, Marrone G, Tamhankar AJ, Stålsby Lundborg C, Diwan V. Determinants and pathways of healthcare-seeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing: a cohort study in rural India. BMJ Open 2021; 11:e052435. [PMID: 34862290 PMCID: PMC8647549 DOI: 10.1136/bmjopen-2021-052435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India. STUDY DESIGN Prospective cohort study. STUDY SETTING AND STUDY SAMPLE The cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses. SECONDARY OUTCOME HSB risk factors were determined using mixed-effects multinomial logistic regression. RESULTS A total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum. CONCLUSION In our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated.
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Affiliation(s)
- Shweta Khare
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Public Health and Environment, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India
| | - Ashish Pathak
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India
- Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala,SE-751 85, Sweden
| | - Manju Raj Purohit
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Pathology, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India
| | - Megha Sharma
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India
| | - Gaetano Marrone
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Ashok J Tamhankar
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Indian Initiative for Management of Antibiotic Resistance, Department of Environmental Medicine, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India
| | - Cecilia Stålsby Lundborg
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Vishal Diwan
- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR-National Institute for Research in Environmental Health, 462030 Bhopal, Madhya Pradesh, India
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10
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Rahman AE, Hossain AT, Chisti MJ, Dockrell DH, Nair H, El Arifeen S, Campbell H. Hypoxaemia prevalence and its adverse clinical outcomes among children hospitalised with WHO-defined severe pneumonia in Bangladesh. J Glob Health 2021; 11:04053. [PMID: 34552722 PMCID: PMC8442579 DOI: 10.7189/jogh.11.04053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background With an estimated 1 million cases per year, pneumonia accounts for 15% of all under-five deaths globally, and hypoxaemia is one of the strongest predictors of mortality. Most of these deaths are preventable and occur in low- and middle-income countries. Bangladesh is among the six high burden countries with an estimated 4 million pneumonia episodes annually. There is a gap in updated evidence on the prevalence of hypoxaemia among children with severe pneumonia in high burden countries, including Bangladesh. Methods We conducted a secondary analysis of data obtained from icddr,b-Dhaka Hospital, a secondary level referral hospital located in Dhaka, Bangladesh. We included 2646 children aged 2-59 months admitted with WHO-defined severe pneumonia during 2014-17. The primary outcome of interest was hypoxaemia, defined as SpO2 < 90% on admission. The secondary outcome of interest was adverse clinical outcomes defined as deaths during hospital stay or referral to higher-level facilities due to clinical deterioration. Results On admission, the prevalence of hypoxaemia among children hospitalised with severe pneumonia was 40%. The odds of hypoxaemia were higher among females (adjusted Odds ratio AOR = 1.44; 95% confidence interval CI = 1.22-1.71) and those with a history of cough or difficulty in breathing for 0-48 hours before admission (AOR = 1.61; 95% CI = 1.28-2.02). Among all children with severe pneumonia, 6% died during the hospital stay, and 9% were referred to higher-level facilities due to clinical deterioration. Hypoxaemia was the strongest predictor of mortality (AOR = 11.08; 95% CI = 7.28-16.87) and referral (AOR = 5.94; 95% CI = 4.31-17) among other factors such as age, sex, history of fever and cough or difficulty in breathing, and severe acute malnutrition. Among those who survived, the median duration of hospital stay was 7 (IQR = 4-11) days in the hypoxaemic group and 6 (IQR = 4-9) days in the non-hypoxaemic group, and the difference was significant at P < 0.001. Conclusions The high burden of hypoxaemia and its clinical outcomes call for urgent attention to promote oxygen security in low resource settings like Bangladesh. The availability of pulse oximetry for rapid identification and an effective oxygen delivery system for immediate correction should be ensured for averting many preventable deaths.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- The Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, UK.,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - David H Dockrell
- The Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- The Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Harry Campbell
- The Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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Carter ED, Leslie HH, Marchant T, Amouzou A, Munos MK. Methodological considerations for linking household and healthcare provider data for estimating effective coverage: a systematic review. BMJ Open 2021; 11:e045704. [PMID: 34446481 PMCID: PMC8395298 DOI: 10.1136/bmjopen-2020-045704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess existing knowledge related to methodological considerations for linking population-based surveys and health facility data to generate effective coverage estimates. Effective coverage estimates the proportion of individuals in need of an intervention who receive it with sufficient quality to achieve health benefit. DESIGN Systematic review of available literature. DATA SOURCES Medline, Carolina Population Health Center and Demographic and Health Survey publications and handsearch of related or referenced works of all articles included in full text review. The search included publications from 1 January 2000 to 29 March 2021. ELIGIBILITY CRITERIA Publications explicitly evaluating (1) the suitability of data, (2) the implications of the design of existing data sources and (3) the impact of choice of method for combining datasets to obtain linked coverage estimates. RESULTS Of 3805 papers reviewed, 70 publications addressed relevant issues. Limited data suggest household surveys can be used to identify sources of care, but their validity in estimating intervention need was variable. Methods for collecting provider data and constructing quality indices were diverse and presented limitations. There was little empirical data supporting an association between structural, process and outcome quality. Few studies addressed the influence of the design of common data sources on linking analyses, including imprecise household geographical information system data, provider sampling design and estimate stability. The most consistent evidence suggested under certain conditions, combining data based on geographical proximity or administrative catchment (ecological linking) produced similar estimates to linking based on the specific provider utilised (exact match linking). CONCLUSIONS Linking household and healthcare provider data can leverage existing data sources to generate more informative estimates of intervention coverage and care. However, existing evidence on methods for linking data for effective coverage estimation are variable and numerous methodological questions remain. There is need for additional research to develop evidence-based, standardised best practices for these analyses.
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Affiliation(s)
- Emily D Carter
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah H Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Tanya Marchant
- Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Agbessi Amouzou
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Bogler L, Weber AC, Ntambi J, Simen-Kapeu A, Zagre NM, Ekpini RE, Vollmer S. Health-care seeking for childhood diseases by parental age in Western and Central Africa between 1995 and 2017: A descriptive analysis using DHS and MICS from 23 low- and middle-income countries. J Glob Health 2021; 11:13010. [PMID: 34484717 PMCID: PMC8397328 DOI: 10.7189/jogh.11.13010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Globally, health care seeking for childhood diseases seems to be on the rise. However, progress is slow and still, many cases of infectious diseases in children remain untreated, leading to preventable child mortality. A better understanding of care seeking behaviour may help to further increase the probability that a sick child is taken to a health facility for care. METHODS We investigated whether mother's and father's age at birth of the child is associated with health care seeking behaviour for childhood diseases and how this association changed over time. For this observational study, we used repeated cross-sectional data, namely all available Demographic and Health Surveys as well as Multi-Indicator Cluster Surveys from Western and Central Africa, 1995 to 2017. We analysed care seeking behaviour for diarrhoea, acute respiratory infections (ARI), and treatment of diarrhoea with oral rehydration solution (ORS). We estimated ordinary least squares regressions, controlling for socioeconomic characteristics of the household and adding survey year- and country-fixed effects. Estimated associations are presented for the entire region and for each country separately to highlight heterogeneity. RESULTS Overall, the likelihood that care is sought for a child suffering from diarrhoea or ARI is low in Western and Central Africa. Probability of care seeking for diarrhoea ranges between 49% for mothers above 40 years and 53% for mothers between 25 and 29 years. For ARI, the rates are 60% and 62%, respectively. Treatment of diarrhoea with ORS is even lower, ranging between 23% and 26%. The probability that parents seek health care for their child does not seem to be associated with parents' age at birth. Mother's level of education and household's wealth status seem to be more important factors. There is evidence of the relationship between parents' age and care seeking changing over time, suggesting a stronger association in the past. CONCLUSIONS Parents' age at child birth does not seem to have a relevant association with care seeking for common childhood diseases. Identifying relevant factors may help in improving health care seeking behaviour of parents in low- and middle-income countries leading to reductions in child morbidity and mortality.
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Affiliation(s)
- Lisa Bogler
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Ann-Charline Weber
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - John Ntambi
- United Nations Children’s Fund (UNICEF), West and Central Africa Regional Office, Dakar, Senegal
| | - Aline Simen-Kapeu
- United Nations Children’s Fund (UNICEF), West and Central Africa Regional Office, Dakar, Senegal
| | - Noel Marie Zagre
- UNICEF Area Representative for Gabon and São Tomé and Príncipe and to the ECCAS, Libreville, Gabon
| | - Rene Ehounou Ekpini
- United Nations Children’s Fund (UNICEF), West and Central Africa Regional Office, Dakar, Senegal
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
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13
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Berhanu D, Allen E, Beaumont E, Tomlin K, Taddesse N, Dinsa G, Mekonnen Y, Hailu H, Balliet M, Lensink N, Schellenberg J, Avan BI. Coverage of antenatal, intrapartum, and newborn care in 104 districts of Ethiopia: A before and after study four years after the launch of the national Community-Based Newborn Care programme. PLoS One 2021; 16:e0251706. [PMID: 34351944 PMCID: PMC8341496 DOI: 10.1371/journal.pone.0251706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Access to health services across the continuum of care improves maternal and newborn health outcomes. Ethiopia launched the Community-Based Newborn Care programme in 2013 to increase the coverage of antenatal care, institutional delivery, postnatal care and newborn care. The programme also introduced gentamicin and amoxicillin treatment by health extension workers for young infants with possible serious bacterial infection when referral was not possible. This study aimed to assess the extent to which the coverage of health services for mothers and their young infants increased after the initiation of the programme. METHODS A baseline survey was conducted in October-December 2013 and a follow-up survey four years later in November-December 2017. At baseline, 10,224 households and 1,016 women who had a live birth in the 3-15 months prior to the survey were included. In the follow-up survey, 10,270 households and 1,057 women with a recent live birth were included. Women were asked about their experience of care during pregnancy, delivery and postpartum periods, as well as the treatment provided for their child's illness in the first 59 days of life. RESULTS Between baseline and follow-up surveys the proportion of women reporting at least one antenatal care visit increased by 15 percentage points (95% CI: 10,19), four or more antenatal care visits increased by 17 percentage points (95%CI: 13,22), and institutional delivery increased by 40 percentage points (95% CI: 35,44). In contrast, the proportion of newborns with a postnatal care visit within 48 hours of birth decreased by 6 percentage points (95% CI: -10, -3) for home deliveries and by 14 percentage points (95% CI: -21, -7) for facility deliveries. The proportion of mothers reporting that their young infant with possible serious bacterial infection received amoxicillin for seven days increased by 50 percentage points (95% CI: 37,62) and gentamicin for seven days increased by 15 percentage points (95% CI: 5,25). Concurrent use of both antibiotics increased by 12 percentage points (95% CI: 4,19). CONCLUSION The Community-Based Newborn Care programme was an ambitious initiative to enhance the access to services for pregnant women and newborns. Major improvements were seen for the number of antenatal care visits and institutional delivery, while postnatal care remained alarmingly low. Antibiotic treatment for young infants with possible serious bacterial infection increased, although most treatment did not follow national guidelines. Improving postnatal care coverage and using a simplified antibiotic regimen following recent World Health Organization guidelines could address gaps in the care provided for sick young infants.
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Affiliation(s)
- Della Berhanu
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma Beaumont
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Keith Tomlin
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | | | - Girmaye Dinsa
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States of America
- Department of Public Health and Health Policy, College of Health and Medical Sciences Haramaya University, Ethiopia
| | | | | | - Manuela Balliet
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bilal Iqbal Avan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Rahman AE, Hossain AT, Zaman SB, Salim N, K C A, Day LT, Ameen S, Ruysen H, Kija E, Peven K, Tahsina T, Ahmed A, Rahman QSU, Khan J, Kong S, Campbell H, Hailegebriel TD, Ram PK, Qazi SA, El Arifeen S, Lawn JE. Antibiotic use for inpatient newborn care with suspected infection: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:229. [PMID: 33765948 PMCID: PMC7995687 DOI: 10.1186/s12884-020-03424-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND An estimated 30 million neonates require inpatient care annually, many with life-threatening infections. Appropriate antibiotic management is crucial, yet there is no routine measurement of coverage. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aimed to validate maternal and newborn indicators to inform measurement of coverage and quality of care. This paper reports validation of reported antibiotic coverage by exit survey of mothers for hospitalized newborns with clinically-defined infections, including sepsis, meningitis, and pneumonia. METHODS EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Neonates were included based on case definitions to focus on term/near-term, clinically-defined infection syndromes (sepsis, meningitis, and pneumonia), excluding major congenital abnormalities. Clinical management was abstracted from hospital inpatient case notes (verification) which was considered as the gold standard against which to validate accuracy of women's report. Exit surveys were conducted using questions similar to The Demographic and Health Surveys (DHS) approach for coverage of childhood pneumonia treatment. We compared survey-report to case note verified, pooled across the five sites using random effects meta-analysis. RESULTS A total of 1015 inpatient neonates admitted in the five hospitals met inclusion criteria with clinically-defined infection syndromes. According to case note verification, 96.7% received an injectable antibiotic, although only 14.5% of them received the recommended course of at least 7 days. Among women surveyed (n = 910), 98.8% (95% CI: 97.8-99.5%) correctly reported their baby was admitted to a neonatal ward. Only 47.1% (30.1-64.5%) reported their baby's diagnosis in terms of sepsis, meningitis, or pneumonia. Around three-quarters of women reported their baby received an injection whilst in hospital, but 12.3% reported the correct antibiotic name. Only 10.6% of the babies had a blood culture and less than 1% had a lumbar puncture. CONCLUSIONS Women's report during exit survey consistently underestimated the denominator (reporting the baby had an infection), and even more so the numerator (reporting known injectable antibiotics). Admission to the neonatal ward was accurately reported and may have potential as a contact point indicator for use in household surveys, similar to institutional births. Strengthening capacity and use of laboratory diagnostics including blood culture are essential to promote appropriate use of antibiotics. To track quality of neonatal infection management, we recommend using inpatient records to measure specifics, requiring more research on standardised inpatient records.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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15
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Odo DB, Yang IA, Knibbs LD. A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1411. [PMID: 33546363 PMCID: PMC7913474 DOI: 10.3390/ijerph18041411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
The domestic combustion of polluting fuels is associated with an estimated 3 million premature deaths each year and contributes to climate change. In many low- and middle-income countries (LMICs), valid and representative estimates of people exposed to household air pollution (HAP) are scarce. The Demographic and Health Survey (DHS) is an important and consistent source of data on household fuel use for cooking and has facilitated studies of health effects. However, the body of research based on DHS data has not been systematically identified, nor its strengths and limitations critically assessed as a whole. We aimed to systematically review epidemiological studies using DHS data that considered cooking fuel type as the main exposure, including the assessment of the extent and key drivers of bias. Following PRISMA guidelines, we searched PubMed, Web of Science, Scopus and the DHS publication portal. We assessed the quality and risk of bias (RoB) of studies using a novel tool. Of 2748 records remaining after removing duplicates, 63 were read in full. A total of 45 out of 63 studies were included in our review, spanning 11 different health outcomes and representing 50 unique analyses. In total, 41 of 45 (91%) studies analysed health outcomes in children <5 years of age, including respiratory infections (n = 17), death (all-cause) (n = 14), low birthweight (n = 5), stunting and anaemia (n = 5). Inconsistencies were observed between studies in how cooking fuels were classified into relatively high- and low-polluting. Overall, 36/50 (80%) studies reported statistically significant adverse associations between polluting fuels and health outcomes. In total, 18/50 (36%) of the analyses were scored as having moderate RoB, while 16/50 (32%) analyses were scored as having serious or critical RoB. Although HAP exposure assessment is not the main focus of the DHS, it is the main, often only, source of information in many LMICs. An appreciable proportion of studies using it to analyse the association between cooking fuel use and health have potential for high RoB, mostly related to confounder control, exposure assessment and misclassification, and outcome ascertainment. Based on our findings, we provide some suggestions for ways in which revising the information collected by the DHS could make it even more amenable to studies of household fuel use and health, and reduce the RoB, without being onerous to collect and analyse.
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Affiliation(s)
- Daniel B. Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- College of Health Sciences, Arsi University, Oromia, Asella P.O. Box 193, Ethiopia
| | - Ian A. Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, QLD 4032, Australia;
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane QLD 4032, Australia
| | - Luke D. Knibbs
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
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16
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Berhanu D, Okwaraji YB, Defar A, Bekele A, Lemango ET, Medhanyie AA, Wordofa MA, Yitayal M, W/Gebriel F, Desta A, Gebregizabher FA, Daka DW, Hunduma A, Beyene H, Getahun T, Getachew T, Woldemariam AT, Wolassa D, Persson LÅ, Schellenberg J. Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia. BMJ Open 2020; 10:e040868. [PMID: 32933966 PMCID: PMC7493123 DOI: 10.1136/bmjopen-2020-040868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention's effectiveness on care utilisation for common childhood illnesses. METHODS We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses. RESULTS There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2-59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences -4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services. CONCLUSION We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period. TRIAL REGISTRATION NUMBER ISRCTN12040912.
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Affiliation(s)
- Della Berhanu
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Health Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yemisrach Behailu Okwaraji
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Atkure Defar
- Health Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Bekele
- Health Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ephrem Tekle Lemango
- Maternal and Child Health Directorate, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Muluemebet Abera Wordofa
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fitsum W/Gebriel
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Alem Desta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fisseha Ashebir Gebregizabher
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Tigray Regional Health Bureau, Mekelle, Ethiopia
| | - Dawit Wolde Daka
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Alemayehu Hunduma
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Habtamu Beyene
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Southern Nations, Nationalities & Peoples Regional Health Bureau, Hawassa, Ethiopia
| | - Tigist Getahun
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Amhara Regional Health Bureau, Baher Dar, Ethiopia
| | - Theodros Getachew
- Health Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku Woldemariam
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desta Wolassa
- Health Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lars Åke Persson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Health Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Joanna Schellenberg
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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17
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Allwell-Brown G, Hussain-Alkhateeb L, Kitutu FE, Strömdahl S, Mårtensson A, Johansson EW. Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005-17: a systematic analysis of 132 national surveys from 73 countries. LANCET GLOBAL HEALTH 2020; 8:e799-e807. [PMID: 32446345 DOI: 10.1016/s2214-109x(20)30079-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/22/2020] [Accepted: 02/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Global assessments of antibiotic consumption have relied on pharmaceutical sales data that do not measure individual-level use, and are often unreliable or unavailable for low-income and middle-income countries (LMICs). To help fill this evidence gap, we compiled data from national surveys in LMICs in 2005-17 reporting antibiotic use for sick children under the age of 5 years. METHODS Based on 132 Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 73 LMICs, we analysed trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing by WHO region, World Bank income classification, and symptom complaint. A logit transformation was used to estimate the outcome using a linear Bayesian regression model. The model included country-level socioeconomic, disease incidence, and health system covariates to generate estimates for country-years with missing values. FINDINGS Across LMICs, reported antibiotic use among sick children under 5 years of age increased from 36·8% (uncertainty interval [UI] 28·8-44·7) in 2005 to 43·1% (33·2-50·5) in 2017. Low-income countries had the greatest relative increase; in these countries, reported antibiotic use for sick children under 5 years of age rose 34% during the study period, from 29·6% (21·2-41·1) in 2005 to 39·5% (32·9-47·6) in 2017, although it remained the lowest of any income group throughout the study period. INTERPRETATION We found a limited but steady increase in reported antibiotic use for sick children under 5 years of age across LMICs in 2005-17, although overlapping UIs complicate interpretation. The increase was largely driven by gains in low-income countries. Our study expands the evidence base from LMICs, where strengthening antibiotic consumption and resistance surveillance is a global health priority. FUNDING Uppsala Antibiotic Centre, Uppsala University, Uppsala University Hospital, Makerere University, Gothenburg University.
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Affiliation(s)
- Gbemisola Allwell-Brown
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Freddy Eric Kitutu
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden; Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda
| | - Susanne Strömdahl
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Emily White Johansson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
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18
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Marsh A, Hirve S, Lele P, Chavan U, Bhattacharjee T, Nair H, Juvekar S, Campbell H. Determinants and patterns of care-seeking for childhood illness in rural Pune District, India. J Glob Health 2020; 10:010601. [PMID: 32082546 PMCID: PMC7020658 DOI: 10.7189/jogh.10.010601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India. METHODS Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics. RESULTS We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking. CONCLUSIONS This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness.
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Affiliation(s)
- Andrew Marsh
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- KEM Hospital Research Centre, Rasta Peth, Pune, India
| | | | - Pallavi Lele
- KEM Hospital Research Centre, Rasta Peth, Pune, India
| | | | - Tathagata Bhattacharjee
- KEM Hospital Research Centre, Rasta Peth, Pune, India
- INDEPTH Network, East Legon, Accra, Ghana
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Rasta Peth, Pune, India
- INDEPTH Network, East Legon, Accra, Ghana
- Joint last author with equal contributions
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK
- Joint last author with equal contributions
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19
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Anaba U, Hutchinson PL, Abegunde D, White Johansson E. Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria. Pediatr Pulmonol 2020; 55 Suppl 1:S91-S103. [PMID: 31990144 DOI: 10.1002/ppul.24644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. METHODS A two-stage cluster-sample cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years ("under-twos") for inclusion. Respondents were asked about pediatric pneumonia and other health-related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care-seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under-twos were calculated using mixed-effects Poisson regression models with robust error variance. RESULTS Among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. CONCLUSIONS Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care-seeking and treatment rates and should expand to address perceived and actual poor-quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility.
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Affiliation(s)
- Udochisom Anaba
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Paul L Hutchinson
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Dele Abegunde
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Population Council, Washington, District of Columbia
| | - Emily White Johansson
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
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20
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Berhanu D, Okwaraji YB, Belayneh AB, Lemango ET, Agonafer N, Birhanu BG, Abera K, Betemariam W, Medhanyie AA, Abera M, Yitayal M, Belay FW, Persson LÅ, Schellenberg J. Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas. BMC Health Serv Res 2020; 20:339. [PMID: 32316969 PMCID: PMC7171736 DOI: 10.1186/s12913-020-05151-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/24/2020] [Indexed: 12/29/2022] Open
Abstract
Background By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. “Optimizing the Health Extension Program” is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities. Methods Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components. Discussion This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond. Trial registration Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017.
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Affiliation(s)
- Della Berhanu
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.,Ethiopian Public Health Institute, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Yemisrach B Okwaraji
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.,Ethiopian Public Health Institute, P.O.Box 1242, Addis Ababa, Ethiopia
| | | | | | - Nesibu Agonafer
- PATH, Ethiopia Country Program Office, Addis Ababa, Ethiopia
| | | | - Kurabachew Abera
- Save the Children, Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Lars Åke Persson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.,Ethiopian Public Health Institute, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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21
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Choufani J, Kim SS, Nguyen PH, Heidkamp R, Grummer-Strawn L, Saha KK, Hayashi C, Mehra V, Alayon S, Menon P. Measuring coverage of infant and young child feeding counselling interventions: A framework and empirical considerations for survey question design. MATERNAL AND CHILD NUTRITION 2020; 16:e13001. [PMID: 32297479 PMCID: PMC7507318 DOI: 10.1111/mcn.13001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/05/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
Most countries implement nutrition counselling interventions as part of programmes to support breastfeeding and complementary feeding. However, data to track coverage of counselling interventions are rarely available. As a result, little is known about the coverage of counselling on infant and young child feeding (IYCF). Survey-based data collection systems generally collect data on IYCF practices but do not collect data on coverage of interventions to support IYCF, and those surveys that do collect this information do not do so consistently. We present a framework to guide the design of survey questions to measure IYCF counselling coverage. We provide examples of how large-scale surveys for programme evaluation and national monitoring have included survey questions to address these data gaps. Our review suggests that elements relevant to designing survey questions to capture coverage of counselling interventions include timing of contact, target behaviour and message content, place of contact, type of service provider, frequency of contact and mode of intervention. Application of this framework may help strengthen harmonized measurement of IYCF counselling coverage to enable better tracking of programme investments, document progress in scaling up nutrition services and allow for cross-country comparisons. Thus, improving measurement of counselling coverage may lead to improved reach of programmes to support optimal IYCF practices.
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Affiliation(s)
- Jowel Choufani
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Sunny S Kim
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Rebecca Heidkamp
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kuntal Kumar Saha
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | | | - Silvia Alayon
- Save the Children, Washington, District of Columbia, USA
| | - Purnima Menon
- International Food Policy Research Institute, Washington, District of Columbia, USA
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22
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Amouzou A, Leslie HH, Ram M, Fox M, Jiwani SS, Requejo J, Marchant T, Munos MK, Vaz LME, Weiss W, Hayashi C, Boerma T. Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage. BMJ Glob Health 2019; 4:e001297. [PMID: 31297252 PMCID: PMC6590972 DOI: 10.1136/bmjgh-2018-001297] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 04/06/2019] [Indexed: 11/17/2022] Open
Abstract
Current methods for measuring intervention coverage for reproductive, maternal, newborn, and child health and nutrition (RMNCH+N) do not adequately capture the quality of services delivered. Without information on the quality of care, it is difficult to assess whether services provided will result in expected health improvements. We propose a six-step coverage framework, starting from a target population to (1) service contact, (2) likelihood of services, (3) crude coverage, (4) quality-adjusted coverage, (5) user-adherence-adjusted coverage and (6) outcome-adjusted coverage. We support our framework with a comprehensive review of published literature on effective coverage for RMNCH+N interventions since 2000. We screened 8103 articles and selected 36 from which we summarised current methods for measuring effective coverage and computed the gaps between ‘crude’ coverage measures and quality-adjusted measures. Our review showed considerable variability in data sources, indicator definitions and analytical approaches for effective coverage measurement. Large gaps between crude coverage and quality-adjusted coverage levels were evident, ranging from an average of 10 to 38 percentage points across the RMNCH+N interventions assessed. We define effective coverage as the proportion of individuals experiencing health gains from a service among those who need the service, and distinguish this from other indicators along a coverage cascade that make quality adjustments. We propose a systematic approach for analysis along six steps in the cascade. Research to date shows substantial drops in effective delivery of care across these steps, but variation in methods limits comparability of the results. Advancement in coverage measurement will require standardisation of effective coverage terminology and improvements in data collection and methodological approaches.
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Affiliation(s)
- Agbessi Amouzou
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Hogan Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Malathi Ram
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Monica Fox
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Safia S Jiwani
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Requejo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Data and Analytics Section, Division of Data, Research and Policy, UNICEF USA, New York, New York, USA
| | - Tanya Marchant
- Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Melinda Kay Munos
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lara M E Vaz
- Global Health, Save the Children, Fairfield, Connecticut, USA
| | - William Weiss
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chika Hayashi
- Data and Analytics Section, Division of Data, Research and Policy, UNICEF USA, New York, New York, USA
| | - Ties Boerma
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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23
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Adegbosin AE, Zhou H, Wang S, Stantic B, Sun J. Systematic review and meta-analysis of the association between dimensions of inequality and a selection of indicators of Reproductive, Maternal, Newborn and Child Health (RMNCH). J Glob Health 2019; 9:010429. [PMID: 31131102 PMCID: PMC6513502 DOI: 10.7189/jogh.09.010429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Globally, progress in Maternal and Child Health (MCH) has been inconsistent, with several evidence showing both between and within country disparities in several RMNCH outcome measures. In this study, we aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators. METHODS We searched PubMed, Embase, Scopus databases and grey literatures from the WHO, UNICEF and World Bank publications. Using the PRISMA guidelines, we identified and reviewed studies from low and middle-income countries, that explored the effects of inequalities on RMNCH, with focus on studies that utilised data from a nationally representative survey. The review protocol was registered at the PROSPERO international prospective register of systematic reviews. RESULTS A total of 28 studies were included in the meta-analysis. Results revealed the existence of marked inequality based on income levels, education and place of residence. The most significant level of disparity was with regards to unmet need for contraception and antenatal coverage. For both respective indicators, those with secondary or higher education were 6 times more likely to have better coverage, than those with lesser level of education; (odds ratio (OR) = 6.25 (95% confidence interval (CI) = 1.68-23.23; I2 = 98%, P = 0.006) and (OR = 6.17 (95% CI = 3.03-12.56; I2 = 97%, P < 0.00001) respectively. In contrast, the lowest inequality was in the completion of 3 doses of diphtheria, pertussis and tetanus vaccines (DPT3), those with primary or no education, were equally as likely as those with secondary or higher education to have received DPT3; (OR = 1.21, 95% CI = 0.34-4.27; I2 = 96%, P = 0.77). CONCLUSIONS In developing countries, maternal and child health coverage remains highly inequitable and assess to maternal and child health services are governed by factors such as income, level of education, and place of residence.
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Affiliation(s)
| | | | - Sen Wang
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - Bela Stantic
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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24
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Kirolos A, Ayede AI, Williams LJ, Fowobaje KR, Nair H, Bakare AA, Oyewole OB, Qazi SA, Campbell H, Falade AG. Care seeking behaviour and aspects of quality of care by caregivers for children under five with and without pneumonia in Ibadan, Nigeria. J Glob Health 2018; 8:020805. [PMID: 30254743 PMCID: PMC6150609 DOI: 10.7189/jogh.08.020805] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to investigate the differences in reported care seeking behaviour and treatment between children with pneumonia and children without pneumonia with cough and/or difficult breathing. METHODS Three hundred and two children aged 0-59 months with fast breathing pneumonia were matched with 302 children seeking care for cough and/or difficult breathing at four outpatient clinics in Ibadan, Nigeria. After follow up at home, Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questionnaires were administered in the community by trained field workers to gather information around care seeking delay, patterns of care seeking, appropriateness of care seeking and treatment provided once care was sought. Multivariable analysis was carried out to determine significant factors associated with care seeking delay. RESULTS Children with pneumonia had a significantly longer delay (median = 3d) before seeking care than those without pneumonia (median = 2d; P = 0.001). The length of the delay was 21% (95% confidence interval (CI) = 1%-42%) greater in those aged 0-1 month and 11% (95% CI = 5%-42%) greater in those aged 2-11 months compared to those aged 12-59 months. The length of delay was 17% (95% CI = 5%-30%) greater in rural locations than urban ones, and 33% (95% CI = 7%-51%) shorter in fathers with only primary education compared to higher education, adjusted for covariates. The range of places where care was sought showed the same distribution in those with and without pneumonia. Twenty two per cent of those with pneumonia sought care first from inappropriate providers. The number of children for whom caregivers reported having received antibiotic treatment was 92% for those with pneumonia and 84% for those without pneumonia. CONCLUSIONS Given that children with pneumonia and cough/cold had similar patterns of reported care seeking information gathered on care seeking (type of provider visited) from DHS and MICS surveys on those with 'symptoms of acute respiratory infection' in this setting provide a reasonably valid indication of care seeking behaviours in children with pneumonia. There are high levels of antibiotic overuse for children with cough/cold in this setting which risks worsening antibiotic resistance.
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Affiliation(s)
- Amir Kirolos
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
- Joint first authorship
| | - Adejumoke I Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Joint first authorship
| | - Linda J Williams
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
- Joint first authorship
| | | | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | | | | | - Shamim A Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
- Joint senior authorship
| | - Adegoke G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Joint senior authorship
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25
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Hirve S, Marsh A, Lele P, Chavan U, Bhattacharjee T, Nair H, Campbell H, Juvekar S. Concordance between GPS-based smartphone app for continuous location tracking and mother's recall of care-seeking for child illness in India. J Glob Health 2018; 8:020802. [PMID: 30410742 PMCID: PMC6209739 DOI: 10.7189/jogh.08.020802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Traditionally, health care-seeking behaviour for child illness is assessed through population-based national demographic and health surveys. GPS-based technologies are increasingly used in human behavioural research including tracking human mobility and spatial behaviour. This paper assesses how well a care-seeking event to a health care facility for child illness, as recalled by the mother in a survey setting using questions sourced from Demographic and Health Surveys, concurs with one that is identified by TrackCare, a GPS-based location-aware smartphone application. Methods Mothers residing in the Vadu HDSS area in Pune district, India having at least one young child were randomly assigned to receive a GPS-enabled smartphone with a pre-installed TrackCare app configured to record the device location data at one-minute intervals over a 6-month period. Spatio-temporal parameters were derived from the location data and used to detect a care-seeking event to any of the health care facilities in the area. Mothers were asked to recall a child illness and if, where and when care was sought, using a questionnaire during monthly visits over a 6-month period. Concordance between the mother's recall and the TrackCare app to identify a care-seeking event was estimated according to percent positive agreement. Results Mean concordance for a care-seeking event between the two methods (mother's recall and TrackCare location data) ranged up to 45%, was significantly higher (P-value <0.001) for care-seeking at a hospital as compared to a clinic and for a health care facility in the private sector compared to that in the public sector. Overall, the proportion of disagreement for a care-seeking event not detected by TrackCare but reported by mother ranged up to 77% and was significantly higher (P-value <0.001) compared to those not reported by mother but detected by TrackCare. Conclusions Given the uncertainty and limitations in use of continuous location tracking data in a field setting and the complexity of classifying human activity patterns, additional research is needed before continuous location tracking can serve as a gold standard substitute for other methods to determine health care-seeking behaviour. Future performance may be improved by incorporating other smartphone-based sensors, such as Wi-Fi and Bluetooth, to obtain more precise location estimates in areas where GPS signal is weakest.
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Affiliation(s)
- Siddhivinayak Hirve
- KEM Hospital Research Centre, Pune, India.,Joint first author with equal contributions
| | - Andrew Marsh
- KEM Hospital Research Centre, Pune, India.,Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Joint first author with equal contributions
| | | | | | | | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.,Joint last author with equal contributions
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, India.,INDEPTH Network, East Legon, Accra, Ghana.,Joint last author with equal contributions
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Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, Albertson SB, Deshpande A, Farag T, Abebe Z, Adetifa IMO, Adhikari TB, Akibu M, Al Lami FH, Al-Eyadhy A, Alvis-Guzman N, Amare AT, Amoako YA, Antonio CAT, Aremu O, Asfaw ET, Asgedom SW, Atey TM, Attia EF, Avokpaho EFGA, Ayele HT, Ayuk TB, Balakrishnan K, Barac A, Bassat Q, Behzadifar M, Behzadifar M, Bhaumik S, Bhutta ZA, Bijani A, Brauer M, Brown A, Camargos PAM, Castañeda-Orjuela CA, Colombara D, Conti S, Dadi AF, Dandona L, Dandona R, Do HP, Dubljanin E, Edessa D, Elkout H, Endries AY, Fijabi DO, Foreman KJ, Forouzanfar MH, Fullman N, Garcia-Basteiro AL, Gessner BD, Gething PW, Gupta R, Gupta T, Hailu GB, Hassen HY, Hedayati MT, Heidari M, Hibstu DT, Horita N, Ilesanmi OS, Jakovljevic MB, Jamal AA, Kahsay A, Kasaeian A, Kassa DH, Khader YS, Khan EA, Khan MN, Khang YH, Kim YJ, Kissoon N, Knibbs LD, Kochhar S, Koul PA, Kumar GA, Lodha R, Magdy Abd El Razek H, Malta DC, Mathew JL, Mengistu DT, Mezgebe HB, Mohammad KA, Mohammed MA, Momeniha F, Murthy S, Nguyen CT, Nielsen KR, Ningrum DNA, Nirayo YL, Oren E, Ortiz JR, PA M, Postma MJ, Qorbani M, Quansah R, Rai RK, Rana SM, Ranabhat CL, Ray SE, Rezai MS, Ruhago GM, Safiri S, Salomon JA, Sartorius B, Savic M, Sawhney M, She J, Sheikh A, Shiferaw MS, Shigematsu M, Singh JA, Somayaji R, Stanaway JD, Sufiyan MB, Taffere GR, Temsah MH, Thompson MJ, Tobe-Gai R, Topor-Madry R, Tran BX, Tran TT, Tuem KB, Ukwaja KN, Vollset SE, Walson JL, Weldegebreal F, Werdecker A, West TE, Yonemoto N, Zaki MES, Zhou L, Zodpey S, Vos T, Naghavi M, Lim SS, Mokdad AH, Murray CJL, Hay SI, Reiner RC. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. THE LANCET. INFECTIOUS DISEASES 2018; 18:1191-1210. [PMID: 30243584 PMCID: PMC6202443 DOI: 10.1016/s1473-3099(18)30310-4] [Citation(s) in RCA: 971] [Impact Index Per Article: 161.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages. METHODS We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000-16 using the risk factors associated with LRI in GBD 2016. FINDINGS In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475-720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749-1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584-2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445-1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7-69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden. INTERPRETATION Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations. FUNDING Bill & Melinda Gates Foundation.
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27
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Cousens S, Head R. The legitimacy of modelling the impact of an intervention based on important intermediate outcomes in a trial. BMJ Glob Health 2018; 3:e001222. [PMID: 30483410 PMCID: PMC6231108 DOI: 10.1136/bmjgh-2018-001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Simon Cousens
- Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Roy Head
- Development Media International, London, UK
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28
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Ayede AI, Kirolos A, Fowobaje KR, Williams LJ, Bakare AA, Oyewole OB, Olorunfemi OB, Kuna O, Iwuala NT, Oguntoye A, Kusoro SO, Okunlola ME, Qazi SA, Nair H, Falade AG, Campbell H. A prospective validation study in South-West Nigeria on caregiver report of childhood pneumonia and antibiotic treatment using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questions. J Glob Health 2018; 8:020806. [PMID: 30254744 DOI: 10.7189/jogh.08.020806] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Childhood pneumonia is the single largest infectious cause of death in children under five worldwide. Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) provide health information on care sought for sick children in resource poor settings. Despite not being primarily designed to identify childhood pneumonia, there are concerns that reported episodes of "symptoms of acute respiratory infection" in DHS and MICS are often interpreted by other groups as a "proxy" for childhood pneumonia. Using DHS5 and MICS5 survey tools, this study aimed to assess how accurately caregivers report of "symptoms of acute respiratory infection" reflect pneumonia episodes and antibiotic use in children under five. Methods Children aged 0 to 59 months presenting with cough and/or difficult breathing were recruited from four study hospitals in Ibadan, Nigeria from August 2015 to March 2017. Children were assessed using World Health Organization (WHO) standard criteria by study physicians to identify whether they had pneumonia. Three hundred and two matched children in each category of 'pneumonia' and "no pneumonia" were followed up at home, either two or eight weeks later, using questions from DHS5 and MICS5 surveys to assess the accuracy of caregiver recall of pneumonia. Results The specificity of DHS5 and MICS5 questions for identifying childhood pneumonia were 87.4 (95% confidence interval (CI) = 83.1-91.0) and 86.1 (95% CI = 81.7-89.8) respectively and the sensitivity of questions were 37.1 (95% CI = 31.6-42.8) and 37.1 (95% CI = 31.6-42.8). Correct recall of antibiotic treatment was poor (kappa statistic = 0.064) but improved with the use of medicine pill boards (kappa statistic = 0.235). Conclusions DHS5 and MICS5 survey questions are not designed to identify childhood pneumonia and this study confirms that they do not accurately discern episodes of childhood pneumonia from cough/cold in children under five. The proportion of pneumonia episodes appropriately treated with antibiotics cannot be accurately assessed using current DHS and MICS surveys. If these results are used to guide programmatic decisions, it is likely to encourage overuse and inappropriate prescribing of antibiotics for episodes of cough/cold. International agencies who continue to use these household data to monitor the proportion of children with pneumonia who receive antibiotic treatment should be discouraged from doing this as these data are likely to mislead national and global programmes. Medicine pill boards are used in a number of DHS surveys and should be promoted for wider use in national population surveys to improve the accuracy of antibiotic recall.
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Affiliation(s)
- Adejumoke I Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria.,Joint first authorships
| | - Amir Kirolos
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.,Joint first authorships
| | | | - Linda J Williams
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | | | | | | | | | | | | | | | | | - Shamim A Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Adegoke G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria.,Joint last authorships
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.,Joint last authorships
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29
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Ayede AI, Kirolos A, Fowobaje KR, Williams LJ, Bakare AA, Oyewole OB, Olorunfemi OB, Kuna O, Iwuala NT, Oguntoye A, Kusoro SO, Okunlola ME, Qazi SA, Nair H, Falade AG, Campbell H. A prospective validation study in South-West Nigeria on caregiver report of childhood pneumonia and antibiotic treatment using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questions. J Glob Health 2018. [PMID: 30254744 PMCID: PMC6150611 DOI: 10.7189/jogh.08-020806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Childhood pneumonia is the single largest infectious cause of death in children under five worldwide. Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) provide health information on care sought for sick children in resource poor settings. Despite not being primarily designed to identify childhood pneumonia, there are concerns that reported episodes of “symptoms of acute respiratory infection” in DHS and MICS are often interpreted by other groups as a “proxy” for childhood pneumonia. Using DHS5 and MICS5 survey tools, this study aimed to assess how accurately caregivers report of “symptoms of acute respiratory infection” reflect pneumonia episodes and antibiotic use in children under five. Methods Children aged 0 to 59 months presenting with cough and/or difficult breathing were recruited from four study hospitals in Ibadan, Nigeria from August 2015 to March 2017. Children were assessed using World Health Organization (WHO) standard criteria by study physicians to identify whether they had pneumonia. Three hundred and two matched children in each category of ‘pneumonia’ and “no pneumonia” were followed up at home, either two or eight weeks later, using questions from DHS5 and MICS5 surveys to assess the accuracy of caregiver recall of pneumonia. Results The specificity of DHS5 and MICS5 questions for identifying childhood pneumonia were 87.4 (95% confidence interval (CI) = 83.1-91.0) and 86.1 (95% CI = 81.7–89.8) respectively and the sensitivity of questions were 37.1 (95% CI = 31.6-42.8) and 37.1 (95% CI = 31.6-42.8). Correct recall of antibiotic treatment was poor (kappa statistic = 0.064) but improved with the use of medicine pill boards (kappa statistic = 0.235). Conclusions DHS5 and MICS5 survey questions are not designed to identify childhood pneumonia and this study confirms that they do not accurately discern episodes of childhood pneumonia from cough/cold in children under five. The proportion of pneumonia episodes appropriately treated with antibiotics cannot be accurately assessed using current DHS and MICS surveys. If these results are used to guide programmatic decisions, it is likely to encourage overuse and inappropriate prescribing of antibiotics for episodes of cough/cold. International agencies who continue to use these household data to monitor the proportion of children with pneumonia who receive antibiotic treatment should be discouraged from doing this as these data are likely to mislead national and global programmes. Medicine pill boards are used in a number of DHS surveys and should be promoted for wider use in national population surveys to improve the accuracy of antibiotic recall.
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Affiliation(s)
- Adejumoke I Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria.,Joint first authorships
| | - Amir Kirolos
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.,Joint first authorships
| | | | - Linda J Williams
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | | | | | | | | | | | | | | | | | - Shamim A Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Adegoke G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria.,Joint last authorships
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.,Joint last authorships
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30
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Munos MK, Blanc AK, Carter ED, Eisele TP, Gesuale S, Katz J, Marchant T, Stanton CK, Campbell H. Validation studies for population-based intervention coverage indicators: design, analysis, and interpretation. J Glob Health 2018; 8:020804. [PMID: 30202519 PMCID: PMC6126515 DOI: 10.7189/jogh.08.020804] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Population-based intervention coverage indicators are widely used to track country and program progress in improving health and to evaluate health programs. Indicator validation studies that compare survey responses to a “gold standard” measure are useful to understand whether the indicator provides accurate information. The Improving Coverage Measurement (ICM) Core Group has developed and implemented a standard approach to validating coverage indicators measured in household surveys, described in this paper. Methods The general design of these studies includes measurement of true health status and intervention receipt (gold standard), followed by interviews with the individuals observed, and a comparison of the observations (gold standard) to the responses to survey questions. The gold standard should use a data source external to the respondent to document need for and receipt of an intervention. Most frequently, this is accomplished through direct observation of clinical care, and/or use of a study-trained clinician to obtain a gold standard diagnosis. Follow-up interviews with respondents should employ standard survey questions, where they exist, as well as alternative or additional questions that can be compared against the standard household survey questions. Results Indicator validation studies should report on participation at every stage, and provide data on reasons for non-participation. Metrics of individual validity (sensitivity, specificity, area under the receiver operating characteristic curve) and population-level validity (inflation factor) should be reported, as well as the percent of survey responses that are “don’t know” or missing. Associations between interviewer and participant characteristics and measures of validity should be assessed and reported. Conclusions These methods allow respondent-reported coverage measures to be validated against more objective measures of need for and receipt of an intervention, and should be considered together with cognitive interviewing, discriminative validity, or reliability testing to inform decisions about which indicators to include in household surveys. Public health researchers should assess the evidence for validity of existing and proposed household survey coverage indicators and consider validation studies to fill evidence gaps.
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Affiliation(s)
- Melinda K Munos
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Emily D Carter
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Lousiana, USA
| | | | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
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31
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Amouzou A, Kanyuka M, Hazel E, Heidkamp R, Marsh A, Mleme T, Munthali S, Park L, Banda B, Moulton LH, Black RE, Hill K, Perin J, Victora CG, Bryce J. Independent Evaluation of the Integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design. Am J Trop Med Hyg 2018; 94:1434-1435. [PMID: 27252480 PMCID: PMC4889770 DOI: 10.4269/ajtmh.16-0110b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | | | | | | | - Andrew Marsh
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mails: , , and
| | - Tiope Mleme
- National Statistical Office, Zomba, Malawi. E-mail:
| | - Spy Munthali
- Chancellor College, University of Malawi, Zomba, Malawi. E-mail:
| | - Lois Park
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mail:
| | | | | | | | | | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mails: , , , and
| | | | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mail:
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32
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Carter ED, Ndhlovu M, Eisele TP, Nkhama E, Katz J, Munos M. Evaluation of methods for linking household and health care provider data to estimate effective coverage of management of child illness: results of a pilot study in Southern Province, Zambia. J Glob Health 2018; 8:010607. [PMID: 29983929 PMCID: PMC6013179 DOI: 10.7189/jogh.08.010607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Existing population-based surveys have limited accuracy for estimating the coverage and quality of management of child illness. Linking household survey data with health care provider assessments has been proposed as a means of generating more informative population-level estimates of effective coverage, but methodological issues need to be addressed. Methods A 2016 survey estimated effective coverage of management of child illness in Southern Province, Zambia, using multiple methods for linking temporally and geographically proximate household and health care provider data. Mothers of children <5 years were surveyed about seeking care for child illness. Information on health care providers’ capacity to manage child illness, or structural quality, was assessed using case scenarios and a tool modeled on the WHO Service Availability and Readiness Assessment (SARA). Each sick child was assigned the structural quality score of their stated (exact-match) source of care. Effective coverage was calculated as the average structural quality experienced by all sick children. Children were also ecologically linked to providers using measures of geographic proximity, with and without data on non-facility providers, to assess the effects of these linking methods on effective coverage estimates. Results Data were collected on 83 providers and 385 children with fever, diarrhea, and/or symptoms of ARI in the preceding 2 weeks. Most children sought care from government facilities or community-based agents (CBAs). Effective coverage of management of child illness estimated through exact-match linking was approximately 15-points lower in each stratum than coverage of seeking skilled care due to providers’ limited structural quality. Estimates generated using most measures of geographic proximity were similar to the exact-match estimate, with the exception of the kernel density estimation method in the urban area. Estimates of coverage in rural areas were greatly reduced across all methods using facility-only data if seeking care from CBAs was treated as unskilled care. Conclusions Linking household and provider data may generate more informative estimates of effective coverage of management of child illness. Ecological linking with provider data on a sample of all skilled providers may be as effective as exact-match linking in areas with low variation in structural quality within a provider category or minimal provider bypassing.
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Affiliation(s)
- Emily D Carter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Micky Ndhlovu
- Chainama College of Health Sciences, Great East Road, Lusaka, Zambia
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation (CAMRE), Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Emmy Nkhama
- Chainama College of Health Sciences, Great East Road, Lusaka, Zambia
| | - Joanne Katz
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda Munos
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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33
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White EE, Downey J, Sathananthan V, Kanjee Z, Kenny A, Waters A, Rabinowich J, Raghavan M, Dorr L, Halder A, Nyumah J, Duokie D, Boima T, Panjabi R, Siedner MJ, Kraemer JD. A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation. Am J Public Health 2018; 108:1252-1259. [PMID: 30024811 DOI: 10.2105/ajph.2018.304555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess a community health worker (CHW) program's impact on childhood illness treatment in rural Liberia. METHODS We deployed CHWs in half of Rivercess County in August 2015 with the other half constituting a comparison group until July 2016. All CHWs were provided cash incentives, supply chain support, and monthly clinical supervision. We conducted stratified cluster-sample population-based surveys at baseline (March-April 2015) and follow-up (April-June 2016) and performed a difference-in-differences analysis, adjusted by inverse probability of treatment weighting, to assess changes in treatment of fever, diarrhea, and acute respiratory infection by a qualified provider. RESULTS We estimated a childhood treatment difference-in-differences of 56.4 percentage points (95% confidence interval [CI] = 36.4, 76.3). At follow-up, CHWs provided 57.6% (95% CI = 42.8, 71.2) of treatment in the intervention group. The difference-in-differences diarrhea oral rehydration therapy was 22.4 percentage points (95% CI = -0.7, 45.5). CONCLUSIONS Implementation of a CHW program in Rivercess County, Liberia, was associated with large, statistically significant improvements treatment by a qualified provider; however, improvements in correct diarrhea treatment were lower than improvements in coverage. Findings from this study offer support for expansion of Liberia's new National Community Health Assistant Program.
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Affiliation(s)
- Emily E White
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Jordan Downey
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Vidiya Sathananthan
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Zahir Kanjee
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Avi Kenny
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Ami Waters
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Jenny Rabinowich
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Mallika Raghavan
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Lorenzo Dorr
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Amal Halder
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Joseph Nyumah
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Derry Duokie
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Tamba Boima
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Raj Panjabi
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Mark J Siedner
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - John D Kraemer
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
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Arnold F, Khan SM. Perspectives and implications of the Improving Coverage Measurement Core Group's validation studies for household surveys. J Glob Health 2018; 8:010606. [PMID: 29977531 PMCID: PMC6005637 DOI: 10.7189/jogh.08.010606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Formal validation studies are of critical importance in determining whether or not household survey questions are providing accurate information on what they intend to measure. These studies supplement an array of methods used to evaluate survey questions. Methods and Findings This paper summarizes the methods used by the two major international household survey programmes - The Demographic and Health Surveys Program (DHS) and the Multiple Indicator Cluster Surveys (MICS) - to decide on possible modifications to the survey questions, nomenclature, tables, and interpretation of findings over time as additional information on the validity of the questions becomes available. Conclusions Validation studies are most useful if they are conducted in a variety of different settings in low- and middle-income countries, preferably using representative samples and procedures that replicate DHS and MICS field conditions. Pilot tests, pre-tests in each country, feedback from interviewers and survey staff, and cognitive interviewing provide additional information about how well survey questions are understood and provide accurate information. The paper provides specific examples of changes that have been made in response to findings from validation studies and changes in international recommendations.
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Affiliation(s)
- Fred Arnold
- Demographic and Health Surveys Program, ICF, Rockville, Maryland, USA
| | - Shane M Khan
- Data & Analytics, Division of Data, Research and Policy, UNICEF, New York, New York, USA
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Carter ED, Ndhlovu M, Munos M, Nkhama E, Katz J, Eisele TP. Validity of maternal report of care-seeking for childhood illness. J Glob Health 2018; 8:010602. [PMID: 29619212 PMCID: PMC5854307 DOI: 10.7189/jogh.08.010602] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Accurate data on care-seeking for child illness are needed to improve public health programs and reduce child mortality. The accuracy of maternal report of care-seeking for child illness as collected through household surveys has not been validated. Methods A 2016 survey compared reported care-seeking against a gold-standard of health care provider documented care-seeking events among a random sample of mothers of children <5 years in Southern Province, Zambia. Enrolled children were assigned cards with unique barcodes. Seventy-five health care providers were given smartphones with a barcode reader and instructed to scan the cards of participating children seeking care at the source, generating an electronic record of the care-seeking event. Additionally, providers gave all caregivers accessing care for a child <5 years provider-specific tokens used to verify the point of care during the household survey. Reported care-seeking events were ascertained in each household using a questionnaire modeled off the Zambia Demographic and Health Survey (DHS) / Multiple Indicator Cluster Survey (MICS). The accuracy of maternal report of care-seeking behavior was estimated by comparing care-seeking events reported by mothers against provider-documented events. Results Data were collected on 384 children with fever, diarrhea, and/or symptoms of ARI in the preceding 2 weeks. Most children sought care from government facilities or community-based agents (CBAs). We found high sensitivity (Rural: 0.91, 95% confidence interval CI 0.84-0.95; Urban: 0.98, 95% CI 0.92-0.99) and reasonable specificity (Rural: 0.71, 95% CI 0.57-0.82; Urban: 0.76, 95% CI 0.62-0.85) of maternal report of care-seeking for child illness by type of provider. Maternal report of any care-seeking and seeking care from a skilled provider had slightly higher sensitivity and specificity. Seeking care from a traditional practitioner was associated with lower odds of accurately reporting the event, while seeking care from a government provider was associated with greater odds of accurate report. The measure resulted in a slight overestimation of true care-seeking behavior in the study population. Conclusions Maternal report is a valid measure of care-seeking for child illness in settings with high utilization of public sector providers. The study findings were limited by the low diversity in care-seeking practices for child illness and the exclusion of shops.
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Affiliation(s)
- Emily D Carter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Melinda Munos
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emmy Nkhama
- Chainama College of Health Sciences, Lusaka, Zambia
| | - Joanne Katz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation (CAMRE), Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Munos MK, Stanton CK, Bryce J. Improving coverage measurement for reproductive, maternal, neonatal and child health: gaps and opportunities. J Glob Health 2018; 7:010801. [PMID: 28607675 PMCID: PMC5460400 DOI: 10.7189/jogh.07.010801] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Regular monitoring of coverage for reproductive, maternal, neonatal, and child health (RMNCH) is central to assessing progress toward health goals. The objectives of this review were to describe the current state of coverage measurement for RMNCH, assess the extent to which current approaches to coverage measurement cover the spectrum of RMNCH interventions, and prioritize interventions for a novel approach to coverage measurement linking household surveys with provider assessments. Methods We included 58 interventions along the RMNCH continuum of care for which there is evidence of effectiveness against cause–specific mortality and stillbirth. We reviewed household surveys and provider assessments used in low– and middle–income countries (LMICs) to determine whether these tools generate measures of intervention coverage, readiness, or quality. For facility–based interventions, we assessed the feasibility of linking provider assessments to household surveys to provide estimates of intervention coverage. Results Fewer than half (24 of 58) of included RMNCH interventions are measured in standard household surveys. The periconceptional, antenatal, and intrapartum periods were poorly represented. All but one of the interventions not measured in household surveys are facility–based, and 13 of these would be highly feasible to measure by linking provider assessments to household surveys. Conclusions We found important gaps in coverage measurement for proven RMNCH interventions, particularly around the time of birth. Based on our findings, we propose three sets of actions to improve coverage measurement for RMNCH, focused on validation of coverage measures and development of new measurement approaches feasible for use at scale in LMICs.
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Affiliation(s)
- Melinda K Munos
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ratnayake R, Ratto J, Hardy C, Blanton C, Miller L, Choi M, Kpaleyea J, Momoh P, Barbera Y. The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation. Am J Trop Med Hyg 2017; 97:964-973. [PMID: 28722630 PMCID: PMC5590598 DOI: 10.4269/ajtmh.17-0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/19/2017] [Indexed: 11/07/2022] Open
Abstract
Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month (P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] (P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.
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Affiliation(s)
- Ruwan Ratnayake
- Health Unit, International Rescue Committee, New York, New York
| | - Jeffrey Ratto
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Hardy
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Miller
- International Rescue Committee, Freetown, Sierra Leone
| | - Mary Choi
- Health Unit, International Rescue Committee, New York, New York
| | - John Kpaleyea
- International Rescue Committee, Freetown, Sierra Leone
| | | | - Yolanda Barbera
- Health Unit, International Rescue Committee, New York, New York
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Puspitasari D, Hasmono D, Rahman T. AMPICILLIN SULBACTAM AND CEFOTAXIME ARE SIMILARLY EFFECTIVE IN PEDIATRIC PNEUMONIA. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v52i2.5225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pneumonia is an infection of the lungs that occurs and still cause high mortality in young children today. The main cause is bacterial or viral. Antibiotics still recommended though it is difficult to know the cause is bacterial or viral. Ampicillin be the first option some guideline. Increased resistance worldwide become one of them concerns the effectiveness of antibiotics. The main treatment of toddler pneumonia in Muhammadiyah Hospital Lamongan are ampicillin sulbactam and cefotaxime. The study was conducted to analyze the effectiveness of both antibiotics. This study aims to analyze comparison in the use of ampicillin sulbactam and cefotaxime pneumonia patients aged 3-59 months from November 2013 to March 2014. Patients who met the inclusion criteria were prospectively observed for clinical data, laboratory data, the data microbiology. After it is analyzed to know the difference between the effectiveness of antibiotics. In this study of 29 patients included in the inclusion criteria, 17 patients who received antibiotics ampicillin sulbactam and 12 patients receiving cefotaxime. In the comparison of the mean pulse pulse is known there is a significant reduction in both groups of patients on the second day and was not significantly different between the two groups (p = 0.084). Likewise, the average ratio of temperature (p = 0.117), breath rate (p = 0.839), leukocytes of patients (p = 0.429). Length of stay for ampicillin sulbactam group was 4.77 days and 5.17 days for cefotaxime group. Analysis showed no differences between the two groups for lenght (p = 0.275). Of the 22 patients who were sampled for blood culture examination only 1 patient with positive results. Based on these results we can conclude that ampicillin sulbactam and cefotaxime effective in cases of children pneumonia, and there is no distinction based on the parameters in body temperature, breath rate, pulse, leukocytes and long hospitalization of patients. Regimentation dosage is appropriate based on guidelines, and length of stay less than 10 days. Found no side effects of both drugs.
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Noordam AC, Sharkey AB, Hinssen P, Dinant G, Cals JWL. Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries. BMC Health Serv Res 2017; 17:107. [PMID: 28153011 PMCID: PMC5290628 DOI: 10.1186/s12913-017-2060-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched. Methods Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers’ knowledge of symptoms related to pneumonia – namely fast or difficulty breathing – and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing). Results Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone. Conclusions These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking.
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Affiliation(s)
- Aaltje Camielle Noordam
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands.
| | - Alyssa B Sharkey
- United Nations Children Fund (UNICEF), Three United Nations Plaza, New York, NY, 10017, USA
| | - Paddy Hinssen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands
| | - GeertJan Dinant
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands
| | - Jochen W L Cals
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands
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Do M, Micah A, Brondi L, Campbell H, Marchant T, Eisele T, Munos M. Linking household and facility data for better coverage measures in reproductive, maternal, newborn, and child health care: systematic review. J Glob Health 2016; 6:020501. [PMID: 27606060 PMCID: PMC5012234 DOI: 10.7189/jogh.06.020501] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Currently many measures of intervention coverage obtained from household surveys do not measure actual health intervention/service delivery, resulting in a need for linking reports of care-seeking with assessments of the service environment in order to improve measurements. This systematic review aims to identify evidence of different methods used to link household surveys and service provision assessments, with a focus on reproductive, maternal, newborn and child health care, in low- and middle-income countries. METHODS Using pre-defined search terms, articles published in peer-reviewed journals and the grey literature after 1990 were identified, their reference lists scanned and linking methods synthesized. FINDINGS A total of 59 articles and conference presentations were carefully reviewed and categorized into two groups based on the linking method used: 1) indirect/ecological linking that included studies in which health care-seeking behavior was linked to all or the nearest facilities or providers of certain types within a geographical area, and 2) direct linking/exact matching where individuals were linked with the exact provider or facility where they sought care. The former approach was employed in 51 of 59 included studies, and was particularly common among studies that were based on independent sources of household and facility data that were nationally representative. Only eight of the 59 reviewed studies employed direct linking methods, which were typically done at the sub-national level (eg, district level) and often in rural areas, where the number of providers was more limited compared to urban areas. CONCLUSIONS Different linking methods have been reported in the literature, each category has its own set of advantages and limitations, in terms of both methodology and practicality for scale-up. Future studies that link household and provider/facility data should also take into account factors such as sources of data, the timing of surveys, the temporality of data points, the type of services and interventions, and the scale of the study in order to produce valid and reliable results.
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Affiliation(s)
- Mai Do
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, Tulane, LA, USA
| | - Angela Micah
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, Tulane, LA, USA
| | - Luciana Brondi
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Harry Campbell
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Tanya Marchant
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Tropical Medicine, Tulane, LA, USA
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mohanan M, Babiarz KS, Goldhaber-Fiebert JD, Miller G, Vera-Hernández M. Effect Of A Large-Scale Social Franchising And Telemedicine Program On Childhood Diarrhea And Pneumonia Outcomes In India. Health Aff (Millwood) 2016; 35:1800-1809. [DOI: 10.1377/hlthaff.2016.0481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Manoj Mohanan
- Manoj Mohanan is an assistant professor of public policy and economics in the Sanford School of Public Policy at Duke University, an assistant research professor at the Duke Global Health Institute, and faculty research scholar at the Duke Population Research Institute, all in Durham, North Carolina
| | - Kimberly S. Babiarz
- Kimberly S. Babiarz is a research associate in the Center for Primary Care and Outcomes Research (CHP/PCOR), School of Medicine, at Stanford University, in California
| | | | - Grant Miller
- Grant Miller is an associate professor at the School of Medicine, Stanford University; director of the Stanford Center for International Development; senior fellow, Freeman Spogli Institute for International Studies; senior fellow, Stanford Institute for Economic Policy Research; and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
| | - Marcos Vera-Hernández
- Marcos Vera-Hernández is a reader in economics at University College London and a research fellow at the Institute for Fiscal Studies, both in the United Kingdom
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Marchant T, Bryce J, Victora C, Moran AC, Claeson M, Requejo J, Amouzou A, Walker N, Boerma T, Grove J. Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals. J Glob Health 2016; 6:010506. [PMID: 27418960 PMCID: PMC4938381 DOI: 10.7189/jogh.06.010506] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND An urgent priority in maternal, newborn and child health is to accelerate the scale-up of cost-effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition. Tracking intervention coverage is a key activity to support scale-up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development. METHODS We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need. We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development. RESULTS Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community-based data, and improved guidance for effective coverage measurement that reflects the provision of high-quality care. CONCLUSION Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health. Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage.
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Affiliation(s)
- Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Bryce
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Cesar Victora
- International Center for Equity in Health, Post–Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Allisyn C Moran
- Global Health Fellows Program II, Bureau for Global Health, US Agency for International Development, Washington, USA
| | | | - Jennifer Requejo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ties Boerma
- WHO, Health Systems and Innovation, Geneva, Switzerland
| | - John Grove
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Victora CG, Requejo JH, Barros AJD, Berman P, Bhutta Z, Boerma T, Chopra M, de Francisco A, Daelmans B, Hazel E, Lawn J, Maliqi B, Newby H, Bryce J. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet 2016; 387:2049-59. [PMID: 26477328 PMCID: PMC7613171 DOI: 10.1016/s0140-6736(15)00519-x] [Citation(s) in RCA: 286] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Conceived in 2003 and born in 2005 with the launch of its first report and country profiles, the Countdown to 2015 for Maternal, Newborn, and Child Survival has reached its originally proposed lifespan. Major reductions in the deaths of mothers and children have occurred since Countdown's inception, even though most of the 75 priority countries failed to achieve Millennium Development Goals 4 and 5. The coverage of life-saving interventions tracked in Countdown increased steadily over time, but wide inequalities persist between and within countries. Key drivers of coverage such as financing, human resources, commodities, and conducive health policies also showed important, yet insufficient increases. As a multistakeholder initiative of more than 40 academic, international, bilateral, and civil society institutions, Countdown was successful in monitoring progress and raising the visibility of the health of mothers, newborns, and children. Lessons learned from this initiative have direct bearing on monitoring progress during the Sustainable Development Goals era.
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Affiliation(s)
| | | | | | - Peter Berman
- Harvard School of Public Health, Boston, MA, USA
| | - Zulfiqar Bhutta
- Robert Harding Chair in Global Child Health and Policy, Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ties Boerma
- World Health Organization, Geneva, Switzerland
| | | | | | | | - Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Holly Newby
- United Nations Children's Fund, New York, NY, USA
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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44
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Bhutta ZA. What does India need to do to address childhood malnutrition at scale? Soc Sci Med 2016; 157:186-8. [PMID: 27080066 DOI: 10.1016/j.socscimed.2016.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Zulfiqar A Bhutta
- Robert Harding Chair in Global Child Health & Policy, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Pakistan.
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45
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Munos M, Guiella G, Roberton T, Maïga A, Tiendrebeogo A, Tam Y, Bryce J, Baya B. Independent Evaluation of the Rapid Scale-Up Program to Reduce Under-Five Mortality in Burkina Faso. Am J Trop Med Hyg 2016; 94:584-595. [PMID: 26787147 PMCID: PMC4775895 DOI: 10.4269/ajtmh.15-0585] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/29/2015] [Indexed: 12/14/2022] Open
Abstract
We conducted a prospective evaluation of the "Rapid Scale-Up" (RSU) program in Burkina Faso, focusing on the integrated community case management (iCCM) component of the program. We used a quasi-experimental design in which nine RSU districts were compared with seven districts without the program. The evaluation included documentation of program implementation, assessments of implementation and quality of care, baseline and endline coverage surveys, and estimation of mortality changes using the Lives Saved Tool. Although the program trained large numbers of community health workers, there were implementation shortcomings related to training, supervision, and drug stockouts. The quality of care provided to sick children was poor, and utilization of community health workers was low. Changes in intervention coverage were comparable in RSU and comparison areas. Estimated under-five mortality declined by 6.2% (from 110 to 103 deaths per 1,000 live births) in the RSU area and 4.2% (from 114 to 109 per 1,000 live births) in the comparison area. The RSU did not result in coverage increases or mortality reductions in Burkina Faso, but we cannot draw conclusions about the effectiveness of the iCCM strategy, given implementation shortcomings. The evaluation results highlight the need for greater attention to implementation of iCCM programs.
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Affiliation(s)
- Melinda Munos
- *Address correspondence to Melinda Munos, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail:
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46
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Noordam AC, Carvajal-Velez L, Sharkey AB, Young M, Cals JWL. Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality. PLoS One 2015; 10:e0117919. [PMID: 25706531 PMCID: PMC4338250 DOI: 10.1371/journal.pone.0117919] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022] Open
Abstract
Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.
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Affiliation(s)
- Aaltje Camielle Noordam
- Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
- * E-mail:
| | - Liliana Carvajal-Velez
- Division of Policy and Strategy, Data and Analytics Section, United Nations Children Fund (UNICEF), New York, New York, United States of America
| | - Alyssa B. Sharkey
- Health Section, United Nations Children Fund (UNICEF), New York, New York, United States of America
| | - Mark Young
- Health Section, United Nations Children Fund (UNICEF), New York, New York, United States of America
| | - Jochen W. L. Cals
- Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
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47
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Requejo JH, Bryce J, Barros AJD, Berman P, Bhutta Z, Chopra M, Daelmans B, de Francisco A, Lawn J, Maliqi B, Mason E, Newby H, Presern C, Starrs A, Victora CG. Countdown to 2015 and beyond: fulfilling the health agenda for women and children. Lancet 2015; 385:466-76. [PMID: 24990815 PMCID: PMC7613194 DOI: 10.1016/s0140-6736(14)60925-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.
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Affiliation(s)
- Jennifer Harris Requejo
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Peter Berman
- Harvard School of Public Health, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | | | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Andres de Francisco
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Joy Lawn
- London School of Hygiene and Tropical Medicine, London, UK
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Elizabeth Mason
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Holly Newby
- United Nations Children's Fund, New York, NY, USA
| | - Carole Presern
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Ann Starrs
- Family Care International, New York, NY, USA
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48
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Langston A, Weiss J, Landegger J, Pullum T, Morrow M, Kabadege M, Mugeni C, Sarriot E. Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:342-54. [PMID: 25276593 PMCID: PMC4168637 DOI: 10.9745/ghsp-d-14-00067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/18/2014] [Indexed: 11/15/2022]
Abstract
During national scale up of iCCM in Rwanda, greater improvements in care-seeking were found in the districts where Kabeho Mwana implemented its model than in the rest of the country. Success was attributed to an emphasis on routine data review, intensive monitoring, collaborative supervision, community mobilization, and, in particular, CHW peer support groups. Background: The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.
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Affiliation(s)
- Anne Langston
- International Rescue Committee , New York, NY. , USA
| | | | | | - Thomas Pullum
- ICF International, The Demographic and Health Surveys Program , Rockville, MD. , USA
| | - Melanie Morrow
- ICF International, The Demographic and Health Surveys Program , Rockville, MD. , USA
| | | | | | - Eric Sarriot
- ICF International, Center for Design and Research on Sustainability , Calverton, MD. , USA
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49
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Mosites EM, Matheson AI, Kern E, Manhart LE, Morris SS, Hawes SE. Care-seeking and appropriate treatment for childhood acute respiratory illness: an analysis of Demographic and Health Survey and Multiple Indicators Cluster Survey datasets for high-mortality countries. BMC Public Health 2014; 14:446. [PMID: 24884919 PMCID: PMC4024183 DOI: 10.1186/1471-2458-14-446] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute lower respiratory illness (ALRI) is a major global cause of morbidity and mortality among children under 5. Antibiotic treatment for ALRI is inexpensive and decreases case fatality, but care-seeking patterns and appropriate treatment vary widely across countries. This study sought to examine patterns of appropriate treatment and estimate the burden of cases of untreated ALRI in high mortality countries. METHODS This study used cross-sectional survey data from the Phase 5/Phase 6 DHS and MIC3/MICS4 for 39 countries. We analyzed care-seeking patterns and antibiotic treatment based on country-level trends, and estimated the burden of untreated cases using country-level predictors in a general linear model. RESULTS According to this analysis, over 66 million children were not treated with antibiotics for ALRI in 2010. Overall, African countries had a lower proportion of mothers who sought care for a recent episode of ALRI (41% to 86%) relative to Asian countries (75% to 87%). Seeking any care for ALRI was inversely related to seeking public sector care. Treatment with antibiotics ranged from 8% in Nepal to 87% in Jordan, and was significantly associated with urban residence. CONCLUSIONS Untreated ALRI remains a substantial problem in high mortality countries. In Asia, the large population numbers lead to a high burden of children with untreated ALRI. In Africa, care-seeking behaviors and access to care issues may lead to missed opportunities to treat children with antibiotics.
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Affiliation(s)
- Emily M Mosites
- Department of Global Health START Program, University of Washington, 325 9th Avenue, Seattle, WA, USA
| | - Alastair I Matheson
- Department of Global Health START Program, University of Washington, 325 9th Avenue, Seattle, WA, USA
| | - Eli Kern
- Department of Global Health START Program, University of Washington, 325 9th Avenue, Seattle, WA, USA
| | - Lisa E Manhart
- Department of Global Health START Program, University of Washington, 325 9th Avenue, Seattle, WA, USA
| | - Saul S Morris
- The Bill & Melinda Gates Foundation, 500 5th Ave N, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Global Health START Program, University of Washington, 325 9th Avenue, Seattle, WA, USA
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50
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van Velthoven MH, Car J, Zhang Y, Marušić A. mHealth series: New ideas for mHealth data collection implementation in low- and middle-income countries. J Glob Health 2013; 3:020101. [PMID: 24363911 PMCID: PMC3868820 DOI: 10.7189/jogh.03.020101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The use of mobile devices in healthcare, or mHealth, has the potential to play an important role in low– and middle–income countries in a wide range of areas. A particular area with great potential to improve global health is using mHealth for data collection. We propose three ideas: (i) to validate and conduct household surveys, (ii) to monitor large–scale programs, and (iii) to measure the global burden of disease. We need to know more about mHealth interventions and their validity to maximise their potential.
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Affiliation(s)
| | - Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Ana Marušić
- Croatian Centre for Global Health, University of Split School of Medicine, Split, Croatia ; Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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