Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria

Shittu, Funmilayo; Agwai, Imaria; Falade, Adegoke G; Bakare, Ayobami A; Graham, Hamish; Iuliano, Agnese; Aranda, Zeus; McCollum, Eric D.; Isah, Adamu; Bahiru, Solomon; Ahmed, Tahlil; Burgess, Rochelle; King, Carina; Colbourn, Tim

doi:10.1002/ppul.24660

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…More than 70% of the facilities lacked health workers trained in IMCI and the IMCI booklets and algorithm charts for management of common childhood illnesses were also rare in these LLPHFs. This is comparable to another study carried out in Nigeria [ 51 ] and may explain the lack of good knowledge on management of these illnesses, exhibited in this survey especially among the lower professional cadres. This calls for training of health workers in LLPHF in IMCI and availing them with guidelines.…”

Section: Discussionsupporting

confidence: 88%

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

et al. 2021

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Background Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. Methods We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. Results Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. Conclusion Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.

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Section: Discussionsupporting

confidence: 88%

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

et al. 2021

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“…This is comparable to what other studies have described in Uganda [8,18,29], where most referrals from private clinics are sent to public hospitals. Most LLPHFs have minimum capacity with HWs who may have limited knowledge, inadequate infrastructure, lack of equipment and materials for managing critically ill children, such as oxygen, and often limited laboratory services as has been described in Nigeria [31]. To increase financial risk protection of households against impoverishment due to health expenditure, the Ugandan MoH planned on upgrading the status of all public HCII medical facilities to HCIII medical facilities and creating community hospitals [32].…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda

et al. 2021

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Over 50% of sick children are treated by private primary-level facilities, but data on patient referral processes from such facilities are limited. We explored the perspectives of healthcare providers and child caretakers on the referral process of children with common childhood infections from private low-level health facilities in Mbarara District. We carried out 43 in-depth interviews with health workers and caretakers of sick children, purposively selected from 30 facilities, until data saturation was achieved. The issues discussed included the process of referral, challenges in referral completion and ways to improve the process. We used thematic analysis, using a combined deductive/inductive approach. The reasons for where and how to refer were shaped by the patients’ clinical characteristics, the caretakers’ ability to pay and health workers’ perceptions. Caretaker non-adherence to referral and inadequate communication between health facilities were the major challenges to the referral process. Suggestions for improving referrals were hinged on procedures to promote caretaker adherence to referral, including reducing waiting time and minimising the expenses incurred by caretakers. We recommend that triage at referral facilities should be improved and that health workers in low-level private health facilities (LLPHFs) should routinely be included in the capacity-building trainings organised by the Ministry of Health (MoH) and in workshops to disseminate health policies and national healthcare guidelines. Further research should be done on the effect of improving communication between LLPHFs and referral health facilities by affordable means, such as telephone, and the impact of community initiatives, such as transport vouchers, on promoting adherence to referral for sick children.

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“…From November 2018 to June 2019, we conducted a situational analysis of paediatric pneumonia in Lagos and Jigawa states of Nigeria, to inform the design of an intervention programme to reduce paediatric mortality. We found that while protective and preventive factors, such as vaccine coverage and clean cooking fuel, were high in Lagos, care-seeking and health facility service readiness were poor 3–6. Therefore, taking an approach that targets improved quality of care for pneumonia diagnosis and treatment could achieve mortality impact.…”

Section: Introductionmentioning

confidence: 92%

“…The WHO’s Integrated Management of Childhood Illness (IMCI) guidelines also recommend pulse oximetry for identifying severely ill patients with hypoxaemia in primary care settings, requiring referral to hospital 7–9. Despite their potential for reducing mortality, pulse oximeters are rarely available in frontline facilities in low-income and middle-income countries 6 10–12. Indeed, our survey of 58 Lagos health facilities in 2020 found pulse oximeters in none of the primary health facilities, 56% (15/27) of private health facilities and exclusively on the paediatric ward of three secondary health facilities 13…”

Section: Introductionmentioning

confidence: 95%

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation

et al. 2022

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IntroductionThe aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker (HCW) training improves the quality of care for children with pneumonia aged 0–59 months. We will explore to what extent, how, for whom and in what contexts the intervention works.Methods and analysisQuasi-experimental time-series impact evaluation with embedded mixed-methods process and economic evaluation. Setting: seven government primary care facilities, seven private health facilities, two government secondary care facilities. Target population: children aged 0–59 months with clinically diagnosed pneumonia and/or suspected or confirmed COVID-19. Intervention: ‘stabilisation rooms’ within participating primary care facilities in Ikorodu local government area, designed to allow for short-term oxygen delivery for children with hypoxaemia prior to transfer to hospital, alongside HCW training on integrated management of childhood illness, pulse oximetry and oxygen therapy, immunisation and nutrition. Secondary facilities will also receive training and equipment for oxygen and pulse oximetry to ensure minimum standard of care is available for referred children. Primary outcome: correct management of hypoxaemic pneumonia including administration of oxygen therapy, referral and presentation to hospital. Secondary outcome: 14-day pneumonia case fatality rate. Evaluation period: August 2020 to September 2022.Ethics and disseminationEthical approval from University of Ibadan, Lagos State and University College London. Ongoing engagement with government and other key stakeholders during the project. Local dissemination events will be held with the State Ministry of Health at the end of the project (December 2022). We will publish the main impact results, process evaluation and economic evaluation results as open-access academic publications in international journals.Trial registration numberACTRN12621001071819; Registered on the Australian and New Zealand Clinical Trials Registry.

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Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria

Abstract: This is the author manuscript accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 12 publications

References 16 publications

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation

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