Pneumonia mortality and healthcare utilization in young children in rural Bangladesh: a prospective verbal autopsy study

Abstract

BackgroundThe present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012.ResultsPneumonia was the primary cause of death, accounting for 26.4% (n = 81) of all 307 deaths. Of the pneumonia deaths, 58% (n = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24.7% (n = 20) in older infants (aged 6–11 months). The median duration of illness before pneumonia death was 8 days (interquartile range [IQR] 3–20 days). Prior to death, 91.4% (n = 74) children with pneumonia sought treatment, and of those who sought treatment, 52.7% (n = 39) sought treatment ≥ 2 days after the onset of disease. Younger infants of 4 weeks to < 6 months old were at 5.5-time (95% confidence interval [CI] 2.5, 12.0) and older infants aged 6–11 months were at 3-time (1.2, 7.5) greater risk of dying from pneumonia than older children aged 12–59 months. Children with a prolonged duration of illness (2–10 days) prior to death were at more risk for death by pneumonia than those who died from other causes (5.8 [2.1, 16.1]). Children who died from pneumonia sought treatment 3.4-time more than children who died from other causes. Delayed treatment seeking (≥ 2 days) behavior was 4.9-time more common in children who died from pneumonia than those who died from other causes. Children who died from pneumonia more often had access to care from multiple sources (5.7-time) than children who died from other causes.ConclusionsDelay in seeking appropriate care and access to multiple sources for treatment are the underlying risk factors for pneumonia death in young children in Bangladesh. These results indicate the perplexity in guardians’ decisions to secure appropriate treatment for children with pneumonia. Therefore, it further underscores the importance of focusing on mass media coverage that can outline the benefits of seeking care early in the progression of pneumonia and the potential negative consequences of seeking care late.Electronic supplementary materialThe online version of this article (10.1186/s41182-018-0099-4) contains supplementary material, which is available to authorized users.

Factors affecting mothers’ intentions to visit healthcare facilities before hospitalisation of children with pneumonia in Biliran province, Philippines: a qualitative study

“…Previous studies showed that children with pneumonia had a significantly longer delay in receiving adequate treatment due to visiting multiple facilities than children without pneumonia but with issues such as diarrhoea and malaria. 39 40 Visiting multiple facilities, including traditional healers, may be one of the main reasons for the delay in receiving appropriate treatment. There were also different patterns of visited facilities between children living in Naval and outside; all children from Naval went BPH without a referral, while seven out of eight children living outside Naval were referred by RHU.…”

Identification of Disaggregated Hotspots of Child Morbidity in Bangladesh: An Application of Small Area Estimation Method

“…In Bangladesh, 15% and 6% of 119,000 total under-5 children deaths are still due to diarrhoea and pneumonia diseases in 2015 [26]. Delay in seeking appropriate care and lack of access to multiple sources for treatment are recognized as the underlying risk factors for children death due to diarrhoea and pneumonia in Bangladesh in several research works [12,13]. Thus, government should focus on the effective interventions of proper life-saving treatment for the children with suspected pneumonia and diarrhoea to achieve the GDDP goals on reducing child mortality due to ARI and diarrhoea.…”

“…No study has also been found conducted at the sub-district or lower administrative units. Most of the studies of ICDDR'B are related to environmental and clinical risk factors of different types of diarrhoeal diseases [12,13]. Using BDHS data, there are studies on modelling diarrhoea or ARI prevalence based on logistic or logistic mixed model for determining their risk factors [14,15], not for prediction purpose since information of the risk factors are not available in the census data.…”

Disaggregated level child morbidity in Bangladesh: An application of small area estimation method

“…No study has also been found conducted at the sub-district or lower administrative units. Most of the studies conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR'B) are related to environmental and clinical risk factors of different types of diarrhoeal diseases [12,13]. Using BDHS data, there are studies on modelling diarrhoea or ARI prevalence based on the logistic or logistic mixed model for determining their risk factors [14,15], not for prediction purpose since information of the risk factors are not available in the census data.…”