Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study

Abstract

BackgroundRespiratory disease and, specifically, pneumonia, is the major cause of mortality and morbidity in young children. Diagnosis of both pneumonia and asthma in primary care rests principally on clinical signs, history taking, and bronchodilator responsiveness. This study aimed to describe clinical practices in diverse global primary care settings concerning differential diagnosis of respiratory disease in young children, especially between pneumonia and asthma.MethodsHealth professionals in Greece, Kyrgyzstan, Vietnam, and Uganda were observed during consultations with children aged 2–59 months, presenting with cough and/or difficult breathing. Data were analyzed descriptively and included consultation duration, practices, diagnoses and availability/use of medications and equipment. The study is part of the European Horizon 2020 FRESH AIR project.ResultsIn total, 771 consultations by 127 health professionals at 74 facilities in the four countries were observed. Consultations were shorter in Vietnam and Uganda (3 to 4 minutes) compared to Greece and Kyrgyzstan (15 to 20 minutes). History taking was most comprehensive in Greece. Clinical examination was more comprehensive in Vietnam and Kyrgyzstan and less in Uganda. Viral upper respiratory tract infections were the most common diagnoses (41.7% to 67%). Pneumonia was diagnosed frequently in Uganda (16.3% of children), and rarely in other countries (0.8% to 2.9%). Asthma diagnosis was rare (0% to 2.8%). Antibiotics were prescribed frequently in all countries (32% to 69%). Short acting β-agonist trials were seldom available and used during consultations in Kyrgyzstan (0%) and Uganda (1.8%), and often in Greece (38.9%) and Vietnam (12.6%).ConclusionsDuration and comprehensiveness of clinical consultations observed in this study seemed insufficient to guide respiratory diagnosis in young children. Appropriate treatment options may further not be available in certain studied settings. Actions aiming at educating and raising professional awareness, along with developing easy-to-use tools to support diagnosis and a general strengthening of health systems are important goals.

Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis

“…Most studies were conducted in lower-middle-or upper-middle-income countries (22 and 19, respectively), while only 6 were in a low-income country. Additionally, 1 study was carried out in 3 countries (1 low income and 2 lower-middle income) [70]. Both public and private healthcare services were involved in 10 of the 48 (20.8%) included studies, whereas 26 (54.2%) studies were focused on the public sector, 4 (8.3%) were focused on the private sector, and 8 (16.7%) did not provide this information; none of the studies mentioned any involvement of informal practitioners.…”

Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda

“…Inappropriate care for these common childhood infections has been described by other researchers in Uganda and other LMICs. Mbonye et al in their research among private clinics and drug shops found that children with normal respiratory rates received unnecessary antibiotics for pneumonia [44], while Kjaergaad et al found inappropriate prescription rate of antibiotics for viral upper respiratory tract infections of 23-68% in Uganda and other countries across the globe [45]. Other studies carried out in private and public health facilities in Uganda and other African countries found that 7-24% children testing positive for malaria never received the correct malaria medicine [46,47].…”

Health workers’ perspectives of a mobile health tool to improve diagnosis and management of paediatric acute respiratory illnesses in Uganda: a qualitative study

“…The The two specific Health Centre IV were selected for this study based on prior research indicating that (1) adherence to IMCI was low, (2) consultations were performed by health workers with limited training, (3) antibiotics were overprescribed and (4) inhaled bronchodilators for wheezing illness were not prescribed. 9…”