Abstract
Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers’ U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children’s recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.
Highlights
Acute respiratory infections are a leading cause of morbidity, hospitalisation and mortality among children under 5 years (U5s) worldwide, in developing countries.[1,2]Despite the availability of clinical practice guidelines, the management of lower respiratory tract illness (LTR-illness) in young children is often inconsistent[3] due to challenges in distinguishing between the main diagnostic categories.[4]
In young children presenting with LTR-illnesses, former studies have pointed to an over-diagnosis of bacterial pneumonia with overuse of antibiotics and a corresponding under-diagnosis of asthma/viral wheeze.[5,6,7,8,9,10,11]
Streptocid, Amoxiclav and Cephalosporin) were frequently pre- when admitted to hospitals, the children with respiratory disease scribed by a majority of the health professionals (HPs) for U5s presenting with cough and were treated routinely with antibiotics, often intramuscularly, breathing problems
Summary
Acute respiratory infections are a leading cause of morbidity, hospitalisation and mortality among children under 5 years (U5s) worldwide, in developing countries.[1,2]. HP18 (Paramedic, Chui): Children with chronic bronchitis come, This study was conducted as part of the FRESH AIR programme[23] in two rural provinces in Kyrgyzstan Kyrgyzstan is their condition is usually severe: breathing with help of an auxiliary musculature, shortness of breathing, and with normal a 200,000 square km mountainous country situated in Central Asia. When asked about the hypothetical prognosis for the children’s LRT-illness, several caregivers and HPs feared a development into disability, respiratory failure, suffocation and death and chronic dependence on medicine. They circled around asthma as a possible prognostic outcome, and some associated asthma with mortality.
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