Management Of Common Childhood Illnesses Research Articles

Knowledge and perspectives in management of common childhood illnesses by caregivers to under-five children in southwestern nigeria: synopsis of self-medication practices

The information and opinions of the caregivers about various childhood ailments serve as a fundamental foundation for the practice of self-medication among under-five-year-old children. The outcome of the health status of children under five is greatly influenced by the scope of such knowledge and perception. The usage of medications for children is a major global problem since they are viewed as a vulnerable population. Although self-medication behaviors are widespread in Nigeria, little is known about how they affect the youngest, most vulnerable children. The knowledge and perceived management of common pediatric disorders among children under the age of five by their caregivers in southwest Nigeria were the subjects of this study. Based on their degree of cosmopolitanism and lack of cosmopolitanism, two local government areas from the states of Lagos and Osun were chosen for the study. Nine hundred and sixty-eight caregivers to under-five children were systematically randomly selected for the study. Data were collected with the aid of structured interviewer-administered questionnaire through the use of Open Data Kit. The knowledge and the perception of caregivers were assessed via vignette-designed questions that were explained to the respondents by the trained research assistants. The data were analyzed using the STATA Package software. The unit of analysis was frequency distribution and percentages. The common childhood illnesses identified by the respondents were malaria, otitis media (ear infection), gastro-enteritis (diarrheal and vomiting), measles, mumps, respiratory tract infection, and febrile convulsion. In general, the caregivers showed a very good knowledge of the CCI presented to them. They identified correctly the illnesses associated with the symptoms. In assessing the possible causes of these CCI, the caregivers commonly attributed the cause to natural phenomena like weather, seasonal changes, dust, and sunny environment. Also, poor hygienic conditions and infection by parasites were identified to be responsible for these CCI. However, their perceived causes of some CCI were very poor. The most visited source of procurement of medicaments was pharmacy or chemist shops in their locality. Pharmacists, friends, and parents were the sources of medication by adolescents as they procured over-the-counter drugs, analgesics, and antibiotics to self-medicate. The classes of products used mostly were drugs prescribed by doctors and any available medicine in their home. The predominant reason given by a greater proportion of the respondents is their affordability of the products which was represented by the cheap cost of self-medication practice in this study. In conclusion, the caregivers in this study are very knowledgeable on the various CCI affecting their under-five children and their belief in the probable causes of the CCI are tuned towards natural causes, infection by parasites, and environmental causes. It is believed that the degree of the caregiver’s knowledge will determine the quality of childcare practice to their under-five children.

Factors associated with wasting and stunting among children aged 06–59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study

BackgroundChild undernutrition is a major public health problem in Ethiopia despite different nutrition-specific and sensitive interventions implemented by the government. However, evidence regarding the burden and responsible factors is limited in the South Ari district. Hence, this study aimed to assess factors associated with wasting and stunting among children aged 06–59 months in the South Ari district, Southern Ethiopia, 2021.MethodsA community-based cross-sectional study was conducted from March 11 to April 11, 2021, among 717 households with at least one child aged 06–59 months. Anthropometric measurements were taken using standard procedures and were converted to height for age Z score and weight-for-height using WHO Anthro software Version 3.2.2. Data were checked and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25.0. Binary logistic regression analysis was fitted to identify predictors of wasting and stunting. A p-value < 0.05 was used to declare statistical significance.ResultThe prevalence of wasting and stunting among children aged 06–59 months in the district was 9.1% (95% CI: 7.07%, 11.41%) and 59.97% (95% CI: 56.28%, 63.58%), respectively. Family size (8 and above) (AOR = 3.03, 95% CI: 1.31, 7.03), family size (5 to 7) (AOR = 2.05, 95% CI: 1.11, 3.81), poor and medium wealth index (AOR = 3.69, 95% CI: 1.65, 8.26) and (AOR = 2.29, 95% CI: 1.01, 5.16), insufficient maternal knowledge on child feeding practice (AOR = 2.58, 95% CI: 1.31, 5.07), presence of diarrhea in the past two weeks (AOR = 2.05, 95% CI: 1.10, 3.85), non-exclusive breastfeeding (AOR = 2.65, 95% CI: 1.51, 4.65), and birth interval of < 24 months (AOR = 4.49, 95% CI: 2.40, 8.37) were factors significantly associated with wasting. Whereas, children in the age group of 24–59 months (AOR = 2.24, 95% CI: 1.58, 3.16), non-exclusive breastfeeding (AOR = 1.81, 95% CI: 1.24, 2.65), birth interval of fewer than 24 months (AOR = 1.54, 95% CI: 1.11, 2.14), sub-optimal child dietary diversity score (AOR = 1.59, 95% CI: 1.14, 2.22), being a non-beneficiary of productive safety-net program (AOR = 1.91, 95% CI: 1.24, 2.95), and household food insecurity (AOR = 2.60, 95% CI: 1.86, 3.64) were factors significantly associated with stunting.ConclusionsWasting and stunting were found to be key public health problems in the South Ari District. Hence, further interventions should consider strategies to enhance household food security and integration of productive safety net programs with primary health care services. Rigorous work is required in advocating and strengthening the provision of family planning services, child care, and integrated management of common childhood illnesses. Moreover, behavioral change communication is highly demanded to improve child feeding practices.

Evaluation of Integrated Community Case Management of Common Childhood Illness Program: Quality of Program Implementation in Hadiya Zone, Ethiopia

<i>Background:</i> Integrated community case management of common childhood illnesses (ICCM) is life saving curative health service delivery for common childhood illnesses (CHI) at health post and community level before developing a complication. ICCMCHI quality has little information in the study area. <i>Methods and Materials:</i> The focus of this evaluation was to evaluate the process of ICCMCHI program, and the approach of this evaluation was formative. Availability of program resources, compliance of health extension workers with ICCM guideline and acceptability of services were the dimensions of this study. The case study was conducted with both quantitative and qualitative data. Fifty-seven health posts were included from three woreda of the zone by deviant sampling techniques. For qualitative data health extension workers and health care managers were included. Data was analyzed by using SPSS soft ware version-20. Univariate, bivariate and multivariate logistic regression were used for quantitative data, and qualitative data was analyzed by using thematic analysis. <i>Result:</i> Compliance was 76% which is good even though most of health extension workers (HEW) were missing opportunities and identified reasons were an inadequate use of ICCM chart booklet and poor supportive supervision. 423 mothers or caregivers with sick under-five children were interviewed from 57 health posts. The mean score of client satisfaction on the quality of ICCM services received was 48.97. Satisfaction of caregivers with a mean score of client satisfaction on quality ICCM services was associated with primary level education, family annual income of and Muslim religion and received information about when to return for next revisit were found to be more likely to satisfy on the quality of ICCM services provided. <i>Conclusion and Recommendation:</i> Quality of ICCMCHI program was evaluated as good. There was an inadequate level of resource availability. Client’s satisfaction with integrated community case management of common childhood illness services was also good. All concerned bodies from local government and development partners are expected to strengthen regular supportive supervision, clinical mentoring, and continues performance review.

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.

Педіатрична клініка Одеського національного медичного університету: якість невідкладної медичної допомоги дітям

Мета роботи — обговорити питання підвищення якості невідкладної допомоги дітям при найбільш поширених захворюваннях. Матеріали та методи. Якість медичної допомоги включає 6 показників: ефективність, обґрунтованість, економічна доступність, прийнятність/зосередженість на пацієнта, рівність, безпека. Результати. У педіатричній клініці Одеського національного медичного університету (ОНМедУ) створений блок інтенсивного спостереження, основним завданням якого є надання невідкладної допомоги дітям, які потребують моніторингу дихання та серцевої діяльності, проведення кисневої терапії та регідратаційної терапії великого об’єму. У клініці діє система сортування пацієнтів за тяжкістю стану з урахуванням даних обстеження і пульсоксиметрії. Запорукою ефективності медичної допомоги є локальні протоколи, розроблені на принципах доказової медицини; всі ліки, включені в них, входять у Лист необхідних ліків Всесвітньої організації охорони здоров’я. Прийнятність медичної допомоги визначають пацієнторієнтовані технології: спільне перебування матері та дитини; перевага надається оральній регідратації, а не внутрішньовенному введенню рідини; мінімізація болю і відмова від внутрішньом’язових ін’єкцій; зволоження повітря навколо пацієнта та ін. Середня тривалість перебування у блоці інтенсивного спостереження — 2 дні. Культура безпеки пацієнтів є пріоритетом і включає в себе: зміну ставлення співробітників до медичної безпеки; виявлення тригерів і ризиків медичної допомоги; виявлення медичних помилок і промахів; використання безпечних технологій і простих алгоритмів дій; навчання медичного персоналу. Було проведено більше 40 лекцій і практичних занять для медичного персоналу, включаючи тренінги на манекенах Code Blue. Висновки. Заходи, спрямовані на підвищення якості невідкладної медичної допомоги дітям в педіатричній клініці ОНМедУ, включають: 1) організацію блоку інтенсивного спостереження і його оснащення сучасним обладнанням для діагностики та лікування дітей; 2) сортування пацієнтів за тяжкістю стану за об’єктивними критеріями; 3) скорочення термінів госпіталізації; 4) стандартизацію медичної допомоги шляхом розробки локальних протоколів на принципах доказової медицини; 5) підвищення прийнятності медичного обслуговування за рахунок впровадження технологій, орієнтованих на пацієнта; 6) впровадження культури безпеки пацієнта; 7) постійне навчання медичного персоналу.

Changes in care-seeking for common childhood illnesses in the context of Integrated Community Case Management (iCCM) program implementation in Benishangul Gumuz region of Ethiopia.

Integrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses. We conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017-18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2-59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model. Over the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (p<0.001). Care sought from health centres (p = 0.420) and public hospitals (p = 0.129) did not meaningfully change while proportion of caregivers who approached private (p = 0.003) and informal providers (p<0.001) declined. Caregivers who visited health posts for the treatment of diarrhea (19.2 PP, p<0.001), fever (15.5 PP, p<0.001), cough (17.8 PP, p<0.001) and cough with respiratory difficulty (17.3 PP, p = 0.038) significantly increased. After accounting for extraneous variables, we observed that care-seeking from iCCM providers was almost doubled (adjusted odds ratio = 2.32: 95% confidence interval; 1.88-2.86) over the period. iCCM implementation was associated with a meaningful shift in care-seeking to health posts.

Variation in UK guidelines for the first-line antimicrobial management of paediatric orbital cellulitis-time for national recommendations.

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The authors declare that they have no conflict of interest. Publisher’s note Springer...

Hispanic Parental Beliefs and Practices in the Management of Common Childhood Illnesses: A Review of the Literature.

Introduction: Hispanic parents are more likely to perceive common childhood illnesses as serious and needing immediate attention compared with other groups. The purpose of this review is to describe the factors that influence Hispanic parental management of common childhood illnesses. Method: A systematic search of PubMed, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature was conducted. Studies were screened and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: Fifteen studies met the inclusion criteria for synthesis. Key findings include the following: (a) parental fears around common illnesses, (b) belief in folk illnesses, (c) use of traditional healers and remedies, (d) family members as a source of health information, (e) medical pluralism, and (f) barriers to care. Conclusion: Hispanic parents simultaneously engage both biomedical and folk spheres of treatment. More current research is needed to understand Hispanic beliefs and practices and to formulate culturally sensitive interventions in this population.

Understanding potential uptake of a proposed mHealth program to support caregiver home management of childhood illness in a resource-poor setting: a qualitative evaluation.

Extensive uptake of mobile phones offers an unprecedented opportunity to improve global healthcare delivery, especially among underserved populations. Mobile health (mHealth) has been increasingly recognized as a promising approach to addressing challenges in global maternal-child health and may play an important role in accelerating progress towards improved outcomes. However, more evidence guiding development of mHealth interventions is needed. The current study explores factors that may support or hinder adoption and use of a proposed mHealth intervention to improve caregiver home management of common childhood illnesses in order to shape program development. Elicitation interviews were conducted with a convenience sample of 25 mothers recruited from a larger cluster-randomized survey sample in the Cono Norte region of Arequipa, Peru. Interview data were analyzed in Spanish to preserve important cultural nuances. Thematic analysis revealed potential facilitators of and barriers to uptake of the proposed mHealth program. Potential facilitators of caregiver participation include opportunity to engage in two-way communication with healthcare providers, development of instrumental and support knowledge to care for sick children, and healthcare challenges faced in a resource-poor community. Potential barriers include preference for in-person healthcare visits, program cost, text messaging abilities, and concern around program legitimacy. This study underscores the potential for mHealth to improve global healthcare delivery in the area of maternal-child health. It demonstrates that mHealth interventions can meet the needs of vulnerable populations by offering novel approaches to promoting evidence-based care. This in-depth understanding of factors that may influence participation and use of this proposed mHealth program will help shape development of the intervention in this community.

How a Population Health Approach Improves Health and Reduces Disparities: The Case of Head Start.

How a Population Health Approach Improves Health and Reduces Disparities: The Case of Head Start.

A Study to Assess Empowerment of Adolescent Girls in Terms of Knowledge-Based Life Skills Education About Child Survival and Safe Motherhood Practices.

This study has been designed with the intention to bring a substantial change in the mindsets or life skills of adolescent girls at secondary school level regarding their concept of child survival and safe motherhood practices in order to deal effectively with real-life situations. A cross-sectional analytical study was carried out with 538 adolescent girls regarding assessment of their knowledge on variables like correct nutrition, iron-deficiency anemia and its prevention, care during pregnancy, safe birth, skilled birth attendance, breast feeding and complementary feeding practices, child's growth and development issues, immunization, management of common childhood illnesses. etc. Analysis was done using Mc Nemar's Chi-square test for paired data. Values obtained were highly significant for nutrition, iron-deficiency anemia and its prevention, care during pregnancy, and management of childhood illnesses variables, whereas study findings were found to be insignificant for rest of the variables. This study based on life skills approach and counseling worked well to promote and motivate adolescent girls for positive decision making. In this context, every adolescent girl should be encouraged to raise her unsolved issues in order to achieve safe motherhood plus growth and development of their children.

Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa.

Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs’ workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5–57), was valued at USD 6.9 (range 0.9–20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4–169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes.

Discussion and Training to Health Professionals on IMNCI 2015

Ethiopia, with 74 million people, has 6^th highest number of child death in the world. Every year half a million children under five die. More than 70% of these deaths occur from the five IMCI targeted diseases namely acute respiratory infections (28%), malaria (20%) diarrhea (20%) and malnutrition (55%) and often in combination. Therefore, integrated Management new born and Childhood Illness (IMNCI) strategy is an evidence-based cost effective strategy for managing common childhood illnesses. Similarly, our needs assessment finding on child health services in under-five OPD in ten sample health center selected among five affiliated practice sites of CHS-AKU shows low implementation of IMNCI due to high turnover of trained staffs, high transfer rate of the trained health providers from place to place and mismanagement of the trained staffs at the health center level i.e. these trained was not assigned in the intended site/ for intended specific task. Therefore, the Objective of this project is: To provide in-service training for 20 health professional and to conduct forum discussion with 20 stake holders in affiliated practice site of CHS-AKU on IMNCI to equip the health workers with necessary knowledge and skill management of common childhood illnesses and to strengthen the existing under five child services in all aspects. This project will improve case management in practice site of CHS-AKU by equipping with necessary knowledge and skills to deal IMNCI strategy. It has also improving the practical training settings where students are undergoing professional practice guided by exemplary trained/skilled/ health professionals in practice site –CHS- AKU.

Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda

BackgroundEfforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community case management of common childhood illnesses is now recommended but its effect on promptness of appropriate pneumonia treatment is unclear.ObjectivesTo determine the effect of integrated malaria and pneumonia management on receiving prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes as well as determine associated factors.MethodsA follow-up study was nested within a cluster-randomized trial that compared under-five mortality in areas where community health workers (CHWs) treated children with malaria and pneumonia (intervention areas) and where they treated children with malaria only (control areas). Children treated by CHWs were enrolled on the day of seeking treatment from CHWs (609 intervention, 667 control) and demographic, illness, and treatment seeking information was collected. Further information on illness and treatment outcomes was collected on day four. The primary outcome was prompt and appropriate antibiotics for pneumonia symptoms and the secondary outcome was treatment outcomes on day four.ResultsChildren in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03). Children in the intervention areas were also less likely to have temperature ≥37.5°C on day four (RR = 0.29, 95%CI = 0.11-0.78). The decrease in fast breathing between day one and four was greater in the intervention (9.2%) compared to the control areas (4.2%, p-value = 0.01).ConclusionsIntegrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes.Trial registrationISRCTN: ISRCTN52966230

Care-seeking and management of common childhood illnesses in Tanzania--results from the 2010 Demographic and Health Survey.

BackgroundMalaria, pneumonia and diarrhoea continue to kill millions of children in Africa despite the available and effective treatments. Correct diagnosis and prompt treatment with effective drugs at the first option consulted for child care is crucial for preventing severe disease and death from these illnesses. Using the 2010 Demographic and Health Survey data, the present study aims to assess care-seeking and management of suspected malaria, pneumonia and diarrhoea at various health care facilities in Tanzania.MethodsWe analyzed data for 8176 children born within a 5 years period preceding the survey.The information was collected by interviewing 5519 women aged 15–49 years in 10,300 households selected from 475 sample points throughout Tanzania.ResultsThe most common first option for child care was PHC facilities (54.8%), followed by private pharmacies (23.4%). These were more commonly utilized in rural compared to urban areas: 61.2% versus 34.5% for PHC facilities, and 26.5% versus 17.7% for pharmacies. Women in urban areas and those with higher level of education more commonly utilized higher level hospitals and private facilities as their first option for child care. Only one in four children with fever had received a blood test during the illness with lowest proportion being reported among children solely attended at PHC facilities. Use of abandoned antimalarial drugs for the treatment of suspected malaria was also observed in public health facilities and antibiotics use for diarrhoea treatment was high (49.0%).ConclusionsPHC facilities and pharmacies most commonly provided sub-optimal care. These facilities were more commonly utilized as the first option for child care in rural areas and among the poor and non-educated families. These are groups with the highest child mortality, which calls for interventions’ targeting improvement of care at these facilities to further reduce child mortality from treatable illnesses in Tanzania.

Effects of an Education and Training Intervention on Caregiver Knowledge of Nonurgent Pediatric Complaints and on Child Health Services Utilization

The objective of this study was to test the impact of an education and training intervention about management of common childhood illnesses on caregiver knowledge and health service use by an index child. This was a quasi-experimental, preintervention-postintervention pilot study of a primary care-based intervention among 32 caregivers of urban children aged 7 months to 5 years. Intervention consisted of a 90-minute educational activity developed after input from focus groups and taught by pediatric nurses; it addressed management of fever, colds, and minor trauma in children at home. Caregiver knowledge before, immediately after, and 6 months after intervention was tested using a written instrument. Health services utilization for an index child in the family was collected 6 months before and after intervention. Caregiver knowledge, as assessed by mean score on the test instrument, increased immediately after the intervention. It was lower at 6-month follow-up but remained higher than pretest. Total health services utilization, adjusted for patient and caregiver factors, did not change significantly 6 months after the intervention. After-hours calls to the primary care physician increased from a mean of 0.33 to 1.46 per patient (P = 0.047), making it the only behavior with significant change. Preintervention health services utilization was the strongest positive predictor of postintervention health services use. The primary care-based intervention led to increased caregiver knowledge regarding management of common minor childhood illnesses and to increased after-hours telephone use. There was no significant decrease in ED use. To reduce reliance on the ED for nonurgent conditions, additional strategies may be needed.

Global use of the WHO Pocket Book of Hospital Care for Children

Background: Studies in the last decade have identified major deficiencies in the care of seriously ill children in hospitals in developing countries. Effective implementation of clinical guidelines is an important strategy for improving quality of care. In 2005 the World Health Organization produced the Pocket Book of Hospital Care for Children — Guidelines for Management of Common Childhood Illnesses in Rural and District Hospitals with Limited Resources.Objective: To determine the worldwide distribution, uptake and use of the WHO Pocket Book of Hospital Care for Children.Methods: A systematic online and postal survey was conducted to assess coverage and uptake of the Pocket Book in low- and middle-income countries (LMICs). More than 1000 key stakeholders with varied roles and responsibilities for child health in 194 countries were invited to participate. Indicators used to measure implementation of the guidelines included local adaptation, use as standard treatment and incorporation into undergraduate and postgraduate training.Results: Information was gathered from 354 respondents representing 134 countries; these included 98 LMICs and 50 countries with under-5 childhood mortality rates >40 deaths/1000 live births. Sixty-four LMICs (44% of 145 LMICs worldwide) including 42 high-mortality countries (66% of 64 high-mortality countries worldwide) reported at least partial implementation of the Pocket Book. However, uptake remains fragmented within countries.Conclusion: More than half of all LMICs with high rates of child mortality have reported use and substantial implementation activities, a considerable achievement given minimal resources available for implementation. Improving the accessibility of the Pocket Book and its implementation tools to health workers, and developing a strategic approach to implementation in each country could improve quality of hospital care for children and support efforts towards achieving the Millennium Development Goal 4 targets.

Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

BackgroundThere are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial.MethodsRepeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention.Results9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02).ConclusionWe found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea.Trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN42996612

Improving caregivers’ home management of common childhood illnesses through community level interventions

The study obtained information using quantitative and qualitative techniques, on key home management practices of common childhood illnesses in Community-Integrated Management of Childhood Illnesses (C-IMCI) and non-C-IMCI implemented local government areas (LGAs) in Osun state, to determine if any differences existed between them. Data analysis was done using Epi-info version 6.0 for the quantitative survey and content analysis method for the qualitative survey. Findings revealed better key home management practices in the C-IMCI compliant LGA than in the non-CIMCI compliant LGA. The proportion of caregivers who gave appropriate home treatment for malaria during their children's illnesses differed significantly (p = 0.000) between the two LGAs. Similarly, caregivers from the compliant LGA demonstrated better treatment practices for diarrhoea and cough. Community Resource Persons (CORPs) were the major source of information on these key practices in the compliant LGA; while in the non-compliant LGA, the traditional healers, elders, and to a lesser extent, health workers gave information. Findings showed that the C-IMCI strategy improved caregivers' home management of common childhood illnesses.

Childhood illnesses and the use of paracetamol (acetaminophen): a qualitative study of parents' management of common childhood illnesses.

Parents frequently give over-the-counter paracetamol (acetaminophen) during childhood illness. This study aims at exploring parents' use of this medicine in relation to their management of common childhood illnesses and the impact on the family. Parents of pre-school aged children were asked open-ended questions about their perceptions of illness, its impact on the family, the use of paracetamol and sources of medical information. The interviews were audiotaped. The transcribed text was condensed and different views and opinions were identified for each question. The parents were recruited from six Norwegian public health centres during a questionnaire study on the use of paracetamol among their children. Volunteering parents supplied their name and telephone number for further contact. A strategic sample of 24 parents was selected for interviews according to their responses to the questionnaire and family characteristics. Parents recognized illness among their children either intuitively or by taking notice of specific signs or symptoms. Fever was considered a definite sign of illness, almost congruent with the disease itself. Some parents acknowledged that low or moderate fever reflected a battle between the body and the disease-causing organism. High or rapidly increasing fever, however, was frequently looked upon as dangerous. Mothers preferred to stay close to their child during illness and postponed other duties. Inexperienced parents felt particularly anxious and helpless since they often found the severity of the illness difficult to judge. Administration of paracetamol gave parents the feeling of mastery. The medicine was also used to calm down the child enabling sleep and rest for the whole family. Some parents were generally interested in information about child diseases, others were only eager to know more about it during periods of illness, and some parents were not interested as they felt information only caused more anxiety. Fever was often judged to cause discomfort and danger. Thus antipyretics like paracetamol were regarded as a medicine counteracting disease. Paracetamol constituted an important tool for parents in managing different upsets during childhood illnesses. Information was not always wanted. Better knowledge about the significance of fever and how to handle children during common illnesses might need to be presented in a context familiar to parents, for instance, in relation to general information on childcare.