Community health worker and caretaker recognition of pneumonia in children

1. Over treatment Failure-to-treat 50% 40% Percent of DD assessments 30% 20% 10% 0% 0% 20% 40% 60% 80% 100% Prevalence of pneumonia All observations n=576 (100 %) 12 missing values Correctly classified compared to gold standard n=445 (79%) Wrongly classified compared to gold standard n=119 (21%) Community health worker and caretaker recognition of pneumonia in children Karin Källander1, Göran Tomson1, Xavier Nsabagasani2, Jesca Nsungwa Sabiiti1,3,4, George Pariyo3 and Stefan Peterson1,3 Conclusions and policy implications Community health workers (CHWs), in Uganda ”drug distributors” or DDs, could successfully assess rapid breathing in children with pneumonia. Also caretakers were aware of ARI symptoms but linked them to fever and malaria treatment. To avoid over-treatment and failure-to-treat, highly focused training and context specific education messages are required. A standard set of both qualitative and quantitative methods are proposed as a toolkit.With such a standardised toolkit, the full-scale feasibility of integrated home and community management of both malaria and pneumonia should be tested. Figure 1. Drug Distributors counting breathing rate on a child with pneumonia Results Of all CHW assessments 71% of were within ±5 breaths/minute from gold standard. Sensitivity of CHW classification was 87% and specificity 84%. Many local terms existed for respiratory illness, such as ‘Quick breathing’ and ‘Groaning breathing’. There was consistency in the interpretation of severity, cause and treatment of ARI - most being related to fever and treated with antimalarials. IntroductionAcute respiratory infections (ARI) are leading killers of children worldwide. Case management of ARI using CHWs has halved ARI mortality in children in Asia. WHO and UNICEFrecommend integrating pneumonia care with Home Management of Malaria. However, in sub-Saharan Africa, performance of CHWs to assess rapid breathing has rarely been demonstrated. Study objectives To assess antimalarial drug distributors (DDs) ability to assess rapid breathing in children under-five and to explore caretaker recognition and interpretation of pneumonia symptoms in western Uganda. Figure 3. The relationship between pneumonia prevalence and projected over treatment and failure to treat. Lines indicate the range resulting from sensitivity analysis for values of sensitivity (76-81 %)* and specificity (60-89%)*. * Data deduced from Kolstad et al. (1997) Bull WHO, 75 Suppl 1:77-85 & Weber et al. (1997) Bull WHO, 75 Suppl 1:25-32 Methods Quantitative and qualitative methods were used. Ninety-six DDs were trained in recognition of pneumonia symptoms and their skills evaluated on in-patient children in the paediatric ward. Respiratory illness concepts and actions were obtained from a triangulation of 4 focus group discussions using video probing and feedback interviews with 2 key informants. Figure 2. Schematic presentation of DDs’ ability to classify children according to breathing rate. • Division of International Health (IHCAR) 2) Uganda Program for Human and 3) Institute of Public Health4) Child Health Division • Karolinska InstitutetHolistic Development (UPHOLD)Makerere University Ministry of Health • Stockholm, SwedenKampala UgandaKampala Uganda Kampala, Uganda • karin.kallander@ki.se