Prevention and treatment of suspected pneumonia in Ethiopian children less than five years from household to primary care.

Amare Tariku,Yemisrach B Okwaraji,Gashaw Andargie Biks,Yemane Berhane,Lars Åke Persson,Alemayehu Worku

doi:10.1111/apa.15380

Abstract

AimEthiopia has implemented the integrated community case management to reduce mortality in childhood diseases. We analysed prevention, care seeking and treatment of suspected pneumonia from household to health facility in Ethiopia.MethodsAnalyses were based on a survey in four regions that included modules covering 5714 households, 169 health posts with 276 health extension workers and 155 health centres with 175 staff. Caregivers of children aged 2‐59 months responded to questions on awareness of services and care seeking for suspected pneumonia. Pneumonia‐related knowledge of health workers was assessed.ResultsWhen a child had suspected pneumonia, 46% (95% CI: 25,68) sought care at health facilities, and 27% (95% CI: 12,51) received antibiotics. Forty‐one per cent had received full immunisation. One‐fifth (21%, 95%: 19,22) of the caregivers were aware of pneumonia treatment. Sixty‐four per cent of the health extension workers correctly mentioned fast or difficult breathing as signs of suspected pneumonia, and 88% suggested antibiotics treatment.ConclusionThe caregivers' awareness of suspected pneumonia treatment and the utilisation of these services were low. Some of the health extension workers were not knowledgeable about suspected pneumonia. Strengthening primary health care, including immunisation, and enhancing the utilisation of services are critical for further reduction of pneumonia mortality.

Highlights

Pneumonia is the leading cause of childhood mortality in low- and middle-income countries, which contributed to 0.9 million child deaths in 2015.1 The World Health Organization recommends the implementation of the integrated community case management programme to reduce mortality in pneumonia and other common childhood illnesses
We have shown that Ethiopian caregivers' awareness of the availability and utilisation of services for suspected childhood pneumonia and their preference to use the first-level services provided by health extension workers were low
We found that only a quarter of caregivers were aware of pneumonia treatment, which was considerably lower than similar studies in other low-income countries.[11]

Summary

Introduction

Pneumonia is the leading cause of childhood mortality in low- and middle-income countries, which contributed to 0.9 million child deaths in 2015.1 The World Health Organization recommends the implementation of the integrated community case management programme to reduce mortality in pneumonia and other common childhood illnesses. Ethiopia achieved a two-thirds reduction of under-five mortality during the Millennium Development Goals era.[3] Still, pneumonia remains the number one killer of children below the age of 5 years in this country.[4] Following the WHO recommendation, the integrated community case management of childhood illnesses was adopted in 2010 as a national programme for the implementation at the community level through health extension workers. The 2016 Ethiopia Demographic and Health Survey reported that less than a third of caregivers sought health care for their child with suspected pneumonia, and a very few (3%) received antibiotic treatment.[3] Studies that investigated the background to the low utilisation of integrated community case management of childhood illnesses services have identified demand as well as supply-side factors. This intervention was based on a barrier analysis and included three evidence-based strategies with possible synergies: (a) community engagement activities, (b) capacity building of health extension workers and Women's Development Group leaders, and (c) strengthening the district health services' ownership and accountability of the primary newborn and child health services

Objectives

Findings

Discussion

Conclusion