Home and community management of acute respiratory infections in children in eight Ugandan districts

Källander, Karin; Nsungwa-Sabiiti, Jesca; Balyeku, Andrew; Pariyo, George; Tomson, Göran; Peterson, Stefan

doi:10.1179/146532805x72430

Cited by 27 publications

(27 citation statements)

References 18 publications

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“…59 With regard to chronic respiratory problems in under-5s, cough and breathing difficulties were highly prevalent in Ugandan children aged <2 years exposed in interviews using 2-week recall; of 3,249 children studied, 10% reported cough, difficult or rapid breathing and/or fever. 60 None of these children had been diagnosed with or treated for asthma or wheeze, although recurrent cough and difficult breathing are core symptoms of asthma. Similarly, ethnographic studies from several regions of Africa, Asia, and Latin America described longterm cough and breathing difficulties in under-5s interpreted as respiratory illness or infections.…”

Section: Under-diagnosis Of Asthmamentioning

confidence: 99%

Childhood asthma in low income countries: an invisible killer?

Østergaard

Nantanda

Tumwine

et al. 2012

Primary Care Respiratory Journal

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Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing remain undiagnosed. New studies demonstrate that approximately 50% of acutely admitted under-5s diagnosed with pneumonia according to Integrated Management of Childhood Illnesses could be re-diagnosed with asthma or wheezing when using re-defined diagnostic criteria and treatment. It is hypothesised that untreated asthma may contribute to respiratory mortality since respiratory syncytial virus (RSV) is an important cause of respiratory death in childhood, and asthma in under-5s is often exacerbated by viral infections, including RSV. Furthermore, acute respiratory treatment failures were predominantly seen in under-5s without fever, which suggests the diagnosis of asthma/wheezing rather than bacterial pneumonia. Ultimately, underlying asthma may have contributed to malnutrition and fatal bacterial pneumonia. In conclusion, preschool asthma in low-income countries may be significantly under-diagnosed and misdiagnosed as pneumonia, and may be the cause of much morbidity and mortality.

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Section: Under-diagnosis Of Asthmamentioning

confidence: 99%

Childhood asthma in low income countries: an invisible killer?

Østergaard

Nantanda

Tumwine

et al. 2012

Primary Care Respiratory Journal

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“…This may be particularly problematic in children presenting with wheezing [89] who may have asthma or viral bronchiolitis and in children with malaria who may present with tachypnoea [90]. In addition clinical management of children living in areas with high HIV and TB prevalence or with high rates of malnutrition is more complicated, requiring adaptation of management guidelines.…”

Section: Management Of Childhood Pneumonia In Low and Middle Income Cmentioning

confidence: 99%

“…Delayed care seeking is an important risk for fatal childhood pneumonia and is commonly reported [92]. In 2004 only 29% of Ugandan children with symptoms of pneumonia reported to have used first or second line antibiotics during their illness [90]. In a recent review of care seeking in children with fatal pneumonia, carers waited a median of 2 days from recognition of illness before seeking care outside of home.…”

Section: Management Of Childhood Pneumonia In Low and Middle Income Cmentioning

confidence: 99%

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Childhood Pneumonia in Low and Middle Income Countries: Burden, Prevention and Management

Gray¹,

Zar²

2010

TOIDJ

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Abstract:Background: Pneumonia is the leading cause of morbidity and mortality in children under five years of age worldwide. The burden of childhood pneumonia occurs predominantly in low or middle income countries. Despite recent advances in management and preventative strategies, high rates of treatment failure and case fatality continue to occur in children in such countries.Aim: To review the current evidence on the epidemiology and management of childhood pneumonia in low and middle income countriesMethods: Direct search of Medline database from 1995 to date through Pubmed was conducted. Search terms included: (pneumonia OR lower respiratory tract infections OR lower respiratory infections OR ARI) AND child. Search was restricted to English articles. In addition reference lists of selected studies were reviewed for relevant information.Findings: Major findings accounting for the high burden include delayed health seeking, poor access to health care, poorly resourced health care systems, inadequate immunisation programs and lack of availability of oxygen delivery systems. The burden of pneumonia deaths has also been increased by the paediatric HIV epidemic in sub-Saharan Africa. Effective preventive interventions include exclusive breastfeeding, optimizing nutrition, reduction of indoor air pollution and immunisations. Wider availability of new immunisations particularly pneumococcal conjugate vaccine can substantially reduce pneumonia incidence. Prophylactic trimethoprim-sulphamethoxazole and antiretroviral therapy are important strategies to prevent pneumonia in HIV infected children, and wider implementation of these is still needed. The most effective treatment strategy remains case management guidelines as contained in the Integrated Management of Childhood Illness program. Case management efficacy is dependent on timely access to health facilities, on health worker ability to recognise and treat pneumonia or severe pneumonia and on availability of appropriate antibiotics and functioning referral pathways. In areas of high HIV prevalence, guidelines must be adapted to broaden antimicrobial coverage including treatment for Pneumocystis jirovecii pneumonia. Monitoring of hypoxia with pulse oximetry and appropriate oxygen delivery systems are still not widely available and should be prioritized in pneumonia management programs.Conclusions: Improved access to preventive and management strategies is urgently needed to reduce the burden of childhood pneumonia in resource limited settings. Further research on childhood pneumonia is needed to delineate the burden of specific pathogens, to develop better diagnostic tests and to improve current management and preventive strategies.

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“…Children who are brought to health centres with malaria-pneumonia symptom overlap are given dual IMCI classifications and are treated with both antimalarials and antibiotics [4,5]. The extent of this overlap has been documented in various settings in Eastern Africa [5,6], but not in routine IMCI practice at the health centre level in Nigeria.…”

Section: Introductionmentioning

confidence: 99%

Clinical overlap between malaria and pneumonia: can malaria rapid diagnostic test play a role?

Ukwaja

Aina

Talabi

2011

J Infect Dev Ctries

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Introduction: Malaria and pneumonia account for 40% of mortality among children under five years of age in sub-Saharan Africa. Due to lack of diagnostic facilities, their management is based on the integrated management of childhood illnesses (IMCI) strategy. Symptoms of malaria and pneumonia overlap in African children, necessitating dual IMCI classifications at health centres and treatment with both antibiotics and antimalarials. This study determined the prevalence of malaria-pneumonia symptom overlap and confirmed the diagnosis of malaria in these cases using a rapid diagnostic test. Methodology: Consecutive consultations of 1,216 children (two months to five years old) were documented over a three-month period in a comprehensive health centre. Malaria rapid diagnostic tests were conducted only for children who had symptom overlap. Results: Of the 1,216 children enrolled, 1,090 (90%) reported cough or fever. Among the children fulfilling the malaria case definition, 284 (30%) also met the pneumonia case definition. Twenty-three percent (284) of all children enrolled met the criteria for both malaria and pneumonia. However, only 130 (46%) of them had a positive result for malaria using a malaria rapid diagnostic test. During a malariapneumonia overlap, female children (chi-square 5.9, P = 0.01) and children ≥ one year (chi-square 4.8, P = 0.003) were more likely to seek care within two days of fever. Conclusion: Dual treatment with antimalarials and antibiotics in children with malaria-pneumonia overlap may result in unnecessary overprescription of antimalarial medications. Use of rapid diagnostic tests in their management can potentially avoid over-prescribing of malaria medications.

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Home and community management of acute respiratory infections in children in eight Ugandan districts

Cited by 27 publications

References 18 publications

Childhood asthma in low income countries: an invisible killer?

Childhood asthma in low income countries: an invisible killer?

Childhood Pneumonia in Low and Middle Income Countries: Burden, Prevention and Management

Clinical overlap between malaria and pneumonia: can malaria rapid diagnostic test play a role?

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