Kakaire A. Kirunda
25 June 2008
Mistreatment with anti-malarials, delays in seeking care and likely low quality of care for children with fatal pneumonia is killing many of them.
This is the conclusion from a study that sought to review individual case histories of children who had died of pneumonia in rural Uganda and to investigate why these children did not survive.
Published last month in the bulletin of the World Health Organisation (WHO), the study was conducted by researchers attached to the Makerere University School of Public Health and Uppsala University, Sweden.
The study was done in the Iganga/Mayuge demographic surveillance site, where 67,000 people were visited once every three months for population-based data and vital events. Children aged 1-59 months from November 2005 to August 2007 were included. Verbal and social autopsies were done to determine likely cause of death and care-seeking actions.
Children who had died of pneumonia were analysed for care seeking before death. This included timing of actions and the duration of illness, types of treatments used at home, sources of care sought, and treatment costs.
According to the study results, cause of death was ascertained for 164 children, 27 percent with pneumonia. "Of the pneumonia deaths, half occurred in hospital and one-third at home. Median duration of pneumonia illness was seven days, and median time taken to seek care outside the home was two days.
Most first received drugs at home: 52 percent anti-malarials and 27 percent antibiotics," wrote the authors. The researchers found that geographic barriers are not the only factors that compel carriers to first use home treatment with drugs obtained from the private sector before seeking formal care. Other outlined barriers include gender aspects of decision-making, other responsibilities at home, and local perceptions of illness and care providers.
And finding that every third child who sought hospital care before dying of pneumonia was referred to the regional or national hospital to get better care, the researchers concluded that care in district hospitals is poor. They therefore called for a great need to improve quality of care at the first referral level.
The researchers concluded that in order to improve access to and quality of care, "the feasibility and effect on mortality of training community health workers and drug vendors in pneumonia and malaria management with pre-packed drugs should be tested."
The WHO and the UN Children agency (Unicef) say that Reduction of childhood mortality due to acute respiratory infections is a worldwide health priority. Studies published in the medical journal the Lancet have also showed that in Sub-Saharan Africa countries like Uganda, the estimated proportion of death in children aged under five years attributed to pneumonia is 17-26 percent.
The Iganga/Mayuge study aside, the national indicators are not rosy either, if the annual health sector performance report 2006/2007 is anything to go by.
The government espouses the Integrated Management of Childhood Illness (IMCI), which is a key strategy for delivery of integrated child health through improvement of health worker skills in regard to integrated assessment and management of malaria, acute respiratory infections, diarrhoea, and malnutrition, which contribute to over 70 percent of overall child mortality.
However, the AHSPR 2006/07 shows that the proportion of under fives with pneumonia receiving appropriate antibiotic treatment stands at just 47 percent.
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