Universal Versus Conditional Third Day Follow-Up Visit for Children With Nonsevere Unclassified Fever at the Community Level in Ethiopia: Protocol for a Cluster Randomized Noninferiority Trial

Källander, Karin; Alfvén, Tobias; Workineh, Ayalkibet Abebe; Hailemariam, Abreham; Petzold, Max; Getachew, Dawit; Barat, Lawrence M.; Steinhardt, Laura C.; Gutman, Julie

doi:10.2196/resprot.9780

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…The design and results of this trial are published elsewhere, as is the qualitative evaluation of HEW's and caregivers' perception of the recommendations. [25][26][27] For this study, 24 semistructured interviews were conducted with fathers who had at least one child aged 2-59 months presenting to the HEW with fever. Half of the interviews (n=12) were conducted in Halaba woreda, 8 in Boloso Sore and 4 in Damot Gale.…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

‘I also take part in caring for the sick child’: a qualitative study on fathers’ roles and responsibilities in seeking care for children in Southwest Ethiopia

Funk

Källander

Abebe³

et al. 2020

BMJ Open

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ObjectivesFathers play an important role in household decision-making processes and child health development. Nevertheless, they are under-represented in child health research, especially in low-income settings. Little is known about what roles fathers play in the care-seeking processes or how they interact with the health system when their child is sick. This study aimed to understand Ethiopian fathers’ roles and responsibilities in caring for their children when they are or become ill.DesignQualitative study using semistructured interviews with fathers.SettingThis study was conducted in three rural districts of the Southern Nations, Nationalities and People’s Region of Ethiopia.ParticipantsTwenty-four fathers who had at least one child between 2 and 59 months who visited a health extension worker with fever.ResultsThe overarching theme of this study was ‘changing perceptions of paternal responsibilities during children’s ill health’. It constituted three subthemes, namely, ‘fathers’ burden of earning money for care’, ‘fatherhood entails advocating children’s healthcare needs’ and ‘investing in children’s health can benefit the family in the future’. Fathers described that they were the ones mainly responsible for the financial arrangement of care and that this financial responsibility can involve stress when resources are scarce. Fathers knew what health services were available and accessible to them and were involved in different ways in the care seeking of the child. Changes in the importance ascribed to child health were expressed by fathers who described being more alert to children’s ill-health.ConclusionFathers play various roles in the care-seeking process during children’s illness episodes. This included, for instance, arranging resources to seek care, (co)-deciding where to seek care as well as accompanying the child to the health facility. The inability to organise necessary resources for care can lead to involuntary delays in care seeking for the child. This demonstrates the importance of including fathers in future interventions on maternal and child health.

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Section: Study Design and Data Collectionmentioning

confidence: 99%

‘I also take part in caring for the sick child’: a qualitative study on fathers’ roles and responsibilities in seeking care for children in Southwest Ethiopia

Funk

Källander

Abebe³

et al. 2020

BMJ Open

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Usability and acceptability of a multimodal respiratory rate and pulse oximeter device in case management of children with symptoms of pneumonia: A cross‐sectional study in Ethiopia

et al. 2020

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Aim Pneumonia is the leading infectious cause of death among children under five globally. Many pneumonia deaths result from inappropriate treatment due to misdiagnosis of signs and symptoms. This study aims to identify whether health extension workers (HEWs) in Ethiopia, using an automated multimodal device (Masimo Rad‐G), adhere to required guidelines while assessing and classifying under five children with cough or difficulty breathing and to understand device acceptability. Methods A cross‐sectional study was conducted in three districts of Southern Nations, Nationalities, and Peoples' Region, Ethiopia. Between September and December 2018, 133 HEWs were directly observed using Rad‐G while conducting 599 sick child consultations. Usability was measured as adherence to the World Health Organization requirements to assess fast breathing and device manufacturer instructions for use. Acceptability was assessed using semi‐structured interviews with HEWs, first‐level health facility workers and caregivers. Results Adherence using the Rad‐G routinely for 2 months was 85.3% (95% CI 80.2, 89.3). Health workers and caregivers stated a preference for Rad‐G. Users highlighted a number of device design issues. Conclusion While demonstrating high levels of acceptability and usability, the device modifications to consider include better probe fit, improved user interface with exclusive age categories and simplified classification outcomes.

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Universal versus conditional day 3 follow-up for children with non-severe unclassified fever at the community level in Ethiopia: A cluster-randomised non-inferiority trial

Källander¹,

Alfvén²,

Funk³

et al. 2018

PLoS Med

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BackgroundWith declining malaria prevalence and improved use of malaria diagnostic tests, an increasing proportion of children seen by community health workers (CHWs) have unclassified fever. Current community management guidelines by WHO advise that children seen with non-severe unclassified fever (on day 1) should return to CHWs on day 3 for reassessment. We compared the safety of conditional follow-up reassessment only in cases where symptoms do not resolve with universal follow-up on day 3.Methods and findingsWe undertook a 2-arm cluster-randomised controlled non-inferiority trial among children aged 2–59 months presenting with fever and without malaria, pneumonia, diarrhoea, or danger signs to 284 CHWs affiliated with 25 health centres (clusters) in Southern Nations, Nationalities, and Peoples’ Region, Ethiopia. The primary outcome was treatment failure (persistent fever, development of danger signs, hospital admission, death, malaria, pneumonia, or diarrhoea) at 1 week (day 8) of follow-up. Non-inferiority was defined as a 4% or smaller difference in the proportion of treatment failures with conditional follow-up compared to universal follow-up. Secondary outcomes included the percentage of children brought for reassessment, antimicrobial prescription, and severe adverse events (hospitalisations and deaths) after 4 weeks (day 29). From December 1, 2015, to November 30, 2016, we enrolled 4,595 children, of whom 3,946 (1,953 universal follow-up arm; 1,993 conditional follow-up arm) adhered to the CHW’s follow-up advice and also completed a day 8 study visit within ±1 days. Overall, 2.7% had treatment failure on day 8: 0.8% (16/1,993) in the conditional follow-up arm and 4.6% (90/1,953) in the universal follow-up arm (risk difference of treatment failure −3.81%, 95% CI −∞, 0.65%), meeting the prespecified criterion for non-inferiority. There were no deaths recorded by day 29. In the universal follow-up arm, 94.6% of caregivers reported returning for reassessment on day 3, in contrast to 7.5% in the conditional follow-up arm (risk ratio 22.0, 95% CI 17.9, 27.2, p < 0.001). Few children sought care from another provider after their initial visit to the CHW: 3.0% (59/1,993) in the conditional follow-up arm and 1.1% (22/1,953) in the universal follow-up arm, on average 3.2 and 3.4 days later, respectively, with no significant difference between arms (risk difference 1.79%, 95% CI −1.23%, 4.82%, p = 0.244). The mean travel time to another provider was 2.2 hours (95% CI 0.01, 5.3) in the conditional follow-up arm and 2.6 hours (95% CI 0.02, 4.5) in the universal follow-up arm (p = 0.82); the mean cost for seeking care after visiting the CHW was 26.5 birr (95% CI 7.8, 45.2) and 22.8 birr (95% CI 15.6, 30.0), respectively (p = 0.69). Though this study was an important step to evaluate the safety of conditional follow-up, the high adherence seen may have resulted from knowledge of the 1-week follow-up visit and may therefore not transfer to routine practice; hence, in an implementation setting it is crucial that CHWs a...

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Universal Versus Conditional Third Day Follow-Up Visit for Children With Nonsevere Unclassified Fever at the Community Level in Ethiopia: Protocol for a Cluster Randomized Noninferiority Trial

Cited by 4 publications

References 19 publications

‘I also take part in caring for the sick child’: a qualitative study on fathers’ roles and responsibilities in seeking care for children in Southwest Ethiopia

‘I also take part in caring for the sick child’: a qualitative study on fathers’ roles and responsibilities in seeking care for children in Southwest Ethiopia

Usability and acceptability of a multimodal respiratory rate and pulse oximeter device in case management of children with symptoms of pneumonia: A cross‐sectional study in Ethiopia

Universal versus conditional day 3 follow-up for children with non-severe unclassified fever at the community level in Ethiopia: A cluster-randomised non-inferiority trial

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