Treatment Of Childhood Illnesses Research Articles

Involvement of community health workers in the COVID-19 pandemic response in Uganda: A qualitative study.

Community Health Workers (CHWs) are a key human resource for health particularly in low- and middle-income countries. In many parts of the world, CHWs are known to have played an instrumental role in controlling the COVID-19 pandemic. This study explored the involvement of CHWs in the COVID-19 response in Uganda. A qualitative study that involved 10 focus group discussions (FGDs) among CHWs was conducted. The study was carried out in 5 districts of Amuria, Karenga, Kamwenge, Bugiri and Pader. The FGD guide used explored the role of CHWs in the COVID-19 response in their communities including lived experiences, challenges, and coping mechanisms. The data were analyzed thematically with the support of NVivo version 12 pro (QSR International). CHWs were at the frontline of COVID-19 prevention interventions at households and in the community. CHWs raised awareness on prevention measures including wearing face masks, hand hygiene, and social distancing. They identified suspected cases such as new members entering the community, as well as individuals returning from abroad with signs and symptoms of COVID-19. CHWs mobilized the community and increased awareness on COVID-19 vaccination which played an important role in reducing misinformation. They also supported home-based management of mild COVID-19 cases through isolation of patients; provided health and nutritional guidance among patients in their homes; and referred suspected cases to health facilities for testing and management. Both monetary and non-monetary incentives were provided to support CHWs in the COVID-19 response. However, the adequacy and timing of the incentives were inadequate. Routine services of CHWs such as health promotion and treatment of childhood illnesses were disrupted during the pandemic. CHWs played an instrumental role in response to the pandemic especially on surveillance, risk communication, and observance of preventing measures. Strategies to ensure that routine services of CHWs are not disrupted during pandemics are needed.

Promptness in seeking treatment from Village Health workers for children under five years with malaria, diarrhoea and pneumonia in rural southwestern Uganda

BackgroundVillage Health Workers (VHWs) in Uganda provide treatment for the childhood illness of malaria, pneumonia, and diarrhoea through the integrated community case management (iCCM) strategy. Under the strategy children under five years receive treatment for these illnesses within 24 h of onset of illness. This study examined promptness in seeking treatment from VHWs by children under five years with malaria, pneumonia, and diarrhoea in rural southwestern Uganda.MethodsIn August 2022, a database containing information from the VHWs patient registers over a 5-year study period was reviewed (2014–2018). A total of 18,430 child records drawn from 8 villages of Bugoye sub-county, Kasese district were included in the study. Promptness was defined a caregiver seeking treatment for a child from a VHW within 24 h of onset of illness.ResultsSixty-four percent (64%) of the children included in the study sought treatment promptly. Children with fever had the highest likelihood of seeking prompt treatment (aOR = 1.93, 95% CI 1.80–2.06, p < 0.001) as compared to those with diarrhoea (aOR = 1.43, 95% CI 1.32–1.52, p < 0.001) and pneumonia (aOR = 1.33, 95% CI 1.24–1.42, p < 0.001).ConclusionThe findings provide further evidence that VHWs play a critical role in the treatment of childhood illness in rural contexts. However, the proportion of children seeking prompt treatment remains below the target set at the inception of the iCCM strategy, in Uganda. There is a need to continually engage rural communities to promote modification of health-seeking behaviour, particularly for children with danger signs. Evidence to inform the design of services and behaviour change communication, can be provided through undertaking qualitative studies to understand the underlying reasons for decisions about care-seeking in rural settings. Co-design with communities in these settings may increase the acceptability of these services.

Utilisation of Health and Nutrition Community Interventions to Reach Every Last One of the Most Vulnerable Children: Evidence from A Lifesaving Three-Year Project in Fragile Somalia

Objectives: Somalia has some of the worst infant, child and maternal mortality ratios in the world and was unable to achieve its Millennium Development Goals of health and nutrition. This study aimed to examine whether the project achieved its intended outcome in fragile Somalia. Design: The study adopted a quantitative and analysis method. Setting: Data collection involved household surveys and anthropometric measurements. A pre-and post-intervention data collection and analysis was conducted aimed at comparing the performance of the priority indicators, determining if the change was significant with a 95% confidence interval. Participants: It was with caregivers, mainly women of reproductive age (15-49 years) and children 0-59 months as the main participants. Main Outcome Measures: The focus was on Baseline compare to end line, End line Puntland Vs Somaliland and Key indicators to National Targets. Descriptive and inferential statistical analysis of the household questionnaires was conducted using SPSS data analysis software. Cross-tabulation using the McNemar’s Chi-square test was used to compare key outcomes. Results: From baseline to end line, there was statistically significant improvement breastfeeding practices, mothers practice for health timing and spacing of pregnancy, mothers practicing the recommended child birth practices care for children under five when sick and a reduction in the utilization of pregnancy care services and practice of vaccination of children. Comparison of Key indicators to National Targets revealed that the project achieved more in appropriate treatment of childhood illnesses, delivery practices, contractive use, infant and young child feeding, but fell short in the immunization services and ANC services. Conclusions: The health and nutrition care system in Somalia remains weak, poorly resourced and inequitably distributed with the root causes being multipronged. However, the results from this study show that if interventions are appropriately funded, there will always be improvement in the key health and nutrition indicators.

A Review of COVID-19 Response Challenges in Ethiopia.

Background: The COVID-19 pandemic has positioned fragile healthcare systems in low-income countries under pressure, leading to critical gaps in service delivery. The pandemic response demands the healthcare system to be resilient and continue provision of healthcare services. This review is aimed at describing the healthcare response challenges during the pandemic in Ethiopia. Methodology: Eligible studies dealing with challenges of the healthcare system in response to the COVID-19 pandemic in Ethiopia were included. The six World Health Organization (WHO) healthcare system building blocks were used to categorize healthcare challenges. PubMed ProQuest, databases were searched, and results were summarized using systematic review synthesis. Results: Financial constraints led to a shortage of mechanical ventilators. Furthermore, the pandemic hindered the capacity to avail full packages of personal protective equipment in health facilities and intensive care capacity. The pandemic also affected the delivery of maternal, child and new-born services, prevention, and treatment of childhood illness, including immunization services. Conclusions: The COVID-19 pandemic posed various challenges to the performance of the healthcare system in Ethiopia. It is recommended that policy makers and stakeholders enhance pandemic preparedness and strengthen response capacity by considering the six WHO healthcare system building blocks.

Nurturing a “Great Social Organism”: School Hygiene, Body Politics, and the State in Late Imperial Russia

AbstractBy the end of the nineteenth century, social hygiene was a topic of great importance for states experiencing fears of national degeneration. The health of children was of particular concern, as it was thought to reflect the future health of the nation. Although this prompted nation-states like France, Germany, the United Kingdom, and the United States to develop intricate theories about the prevention and treatment of childhood illnesses, it was imperial Russia that became an unacknowledged trailblazer in the institutionalization and implementation of school hygiene measures. As this article will show, autocratic Russia's institutions and ideology allowed the tsarist state to surpass its Western neighbors in the drawing up and application of school hygiene measures.

A network analysis of patient referrals in two district health systems in Tanzania.

Patient referral systems are fragile and overlooked components of the health system in Tanzania. Our study aims at exploring patient referral networks in two rural districts in Tanzania, Kilolo and Msalala. Firstly, we ask whether secondary-level facilities act as gatekeepers, mediating referrals from primary- to tertiary-level facilities. Secondly, we explore the facility and network-level determinants of patient referrals focusing on treatment of childhood illnesses and non-communicable diseases. We use data collected across all public health facilities in the districts in 2018. To study gatekeeping, we employ descriptive network analysis tools. To explore the determinants of referrals, we use exponential random graph models. In Kilolo, we find a disproportionate share of patients referred directly to the largest hospital due to geographical proximity. In Msalala, small and specialized secondary-level facilities seem to attract more patients. Overall, the results call for policies to increase referrals to secondary facilities avoiding expensive referrals to hospitals, improving timeliness of care and reducing travel-related financial burden for households.

Effective Community Mobilization: Lessons Learnt from Implementing the Integrated Care Model in Zimbabwe

Globally, there has been a heated debate on the effectiveness of community mobilization in improving maternal and child health outcomes. Sustainable Development Goal number three aims at attaining Universal Health Coverage to improve health outcomes to the most marginalized and vulnerable populations. This paper outlines the key lessons that we learnt from the implementation of a novel community mobilization model, the Integrated Care Model (ICM) in Zimbabwe. The keys lessons were:&#x0D; &#x0D; To determine effect of community models, set parameters of measuring the effect at protocol development.&#x0D; Effective community mobilization in maternal and child health needs saturation coverage.&#x0D; Meaningful community engagement is critical throughout the mobilization cycle.&#x0D; Community Health Workers derive motivation from different things that are cheap and cost-effective.&#x0D; Community models should be integrated into the mainstream health delivery system for sustainability.&#x0D; Community models should be integrated into the mainstream health delivery system for sustainability.&#x0D; Participatory facilitation approaches yield better results that lectures in community health promotion.&#x0D; Community Health Workers should have comprehensive kits that are continually replenished for effectiveness in early diagnosis and treatment of childhood illnesses&#x0D; &#x0D; We conclude that integration of the ICM model into the main health delivery system ensures the consistent transference of correct knowledge and skills for better maternal and child health. The Government of Zimbabwe and other developing countries should consider implementing such an approach in their respective community health strategies in order to reduce preventable child morbidity and mortality.

Wake-up call: 10 years remaining to address inequalities on right to health for all

The millennium development goals sought to create a global movement to achieve targets in key areas of health and development. The problem is, we failed to reach most of them.1 Among those missed were important health related targets: reductions in undernutrition, mortality in children under 5, maternal mortality, and incidence of HIV, malaria, and tuberculosis as well as improvements in reproductive health. Inequalities between women and men and uneven progress between wealthy and poor populations largely account for the failure. The sustainable development goals (SDGs) provide a second opportunity to improve health outcomes around the globe.2 If current trends persist, however, we will miss the mark again. For example, although we have achieved progress in reducing under 5, neonatal, and maternal mortality in the past two decades, in recent years maternal mortality has been stagnant in many high burden countries and neonatal mortality has declined at a slower pace.34 The BMJ and BMJ Global Health collection Leaving No One Behind (www.bmj.com/leaving-no-one-behind) shows the improvements we have made in expanding the coverage of key interventions in sexual, reproductive, maternal, newborn, child, and adolescent health and highlights our ongoing challenges. For example, progress has slowed in immunisation and the treatment of childhood illnesses such as pneumonia and diarrhoea, and little progress has been made on curbing gender based violence. An overall lack of data is a further barrier, inhibiting our ability to make evidence based investments in healthcare systems. Although delivery of these key health interventions is largely based on improving primary healthcare services, overall we are still far behind our …

What effect do point of care fees have on childhood consultations in general practice?

BackgroundGeneral practice (GP) has historically been central to the prevention and treatment of childhood illnesses. In Ireland, this role has recently expanded with the introduction of free GP care for children aged under six years in 2015. The Republic of Ireland has the only health system in the European Union which does not offer universal coverage for primary care. This study aims to analyse general practice records to investigate the effect of point of care consultation fees on childhood attendances.MethodsGPs affiliated to the medical school (n = 72) were invited to participate. 100 children aged 1 to 14 years were randomly sampled from each. Data was collected on service utilisation in the previous 12 months, specifically: age, gender, eligibility for free care and whether they had consulted their GP in the 12 month period.ResultsSixty-four practices participated, producing data on 6007 eligible children. The median age of children was seven years; 3688(62%) were ‘fee-paying’. GMS patients aged under six years had a median of three consultations/year, with a quarter attending six times a year or more, while fee paying patients had a median of two consultations/year with a quarter attending four times a year or more.ConclusionsChildren eligible for free care attend more often with a subgroup attending very frequently. This study provides important information on the possible impact of fees on healthcare utilisation for countries considering co-payment.

НАУКА ЯК ЧИННИК РОЗВИТКУ СУСПІЛЬНОЇ МЕДИЧНОЇ ОПІКИ В ГАЛИЧИНІ НАПРИКІНЦІ ХIХ – НА ПОЧАТКУ ХХ СТОРІЧЧЯ

The article analyzes the achievements of Ukrainian medical scientists in the area of public medical care of children and adults in Galicia at the end of the nineteenth century – the first third of the twentieth century. The main works of the doctors of science, the contribution of I. Gorbachevskyi, I. Kurovets, S. Okunevskyi-Morachevskyi, Ye. Ozarkevych, М. Panchyshyn, S. Parfanovych and others are briefly analyzed. The activity of the Medical Commission of the Shevchenko Scientific Society in Lviv is analyzed. The contribution of Ye. Ozarkevych as the founder of the Ukrainian medical science in Galicia to the organization of the Ukrainian medical movement, the foundation of public medical care, the creator of Ukrainian medical terminology is emphasized.It is concluded that in the studied period, science was an organic component of public medical care of the Ukrainian people of Galicia. The authors consider it as a distinctive, unique phenomenon, as a social phenomenon. Science was put “at the service of the people”, it was mobile and quickly responded to the challenges that life made up: the scientific research focused on pressing issues of the contemporary society (prevention and treatment of infectious diseases (tuberculosis, abdominal typhus, venereal diseases, etc.), healthcare of the mother and the child (research in the field of gynecology), the fight against cancer, prevention and treatment of childhood illness, etc.). The students who were members of the “Medychna Hromada” actively participated in the development of Ukrainian medical science. Ukrainian medical scientists took part in international medical forums, got acquainted with the achievements of European and world medicine through the subscription of medical periodicals, reading medical literature, publishing on the pages of Ukrainian medical journals the achievements of world medicine, etc. Almost all Ukrainian doctors and medical students were active participants of public life, belonged to two, or even more societies, and also headed them. It is emphasized on the unity of medical theory and medical practice. To characterize the development of the Ukrainian medical science of the studied period, the word “first” is appropriate: the first Ukrainian medical scientific institution, the first outpatient clinic (“Narodna Lichnytsia”), the first Ukrainian medical scientific journal (“Likarskyi Visnyk”), the first Ukrainian Medical Society (ULT), the first Secret Medical Courses, the first Ukrainian Higher School (UTU), the first Ukrainian Hospital named after A. Sheptytskyi, the first Ukrainian-language popular scientific medical journal (“Zdorovlie”), the first female scientist, the first female student of medicine, the first female professor (S. Okunevska-Morachevska), the first medical scientist (I. Gorbachevskyi), the first scientific articles on health resort (Ye. Ozarkevych), the first Ukrainian scientific medical terminology (Ye. Ozarkevych), the first doctor-radiologist (M. Panchyshyn), the first Minister of Health in the world (I. Gorbachevskyi), the first Ukrainian doctor-electrocardiogram (R. Osinchuk), the first Ukrainian-language textbooks on psychology and logic (S. Balei) and so on.

Expanding the population coverage of evidence-based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST).

BackgroundEvidence has been accumulating that community health workers (CHWs) providing evidence–based interventions as part of community–based primary health care (CBPHC) can lead to reductions in maternal, neonatal and child mortality. However, investments to strengthen and scale–up CHW programs still remain modest.MethodsWe used the Lives Saved Tool (LiST) to estimate the number of maternal, neonatal and child deaths and stillbirths that could be prevented if 73 countries effectively scaled up the population coverage of 30 evidence–based interventions that CHWs can deliver in these high–burden countries. We set population coverage targets at 50%, 70%, and 90% and summed the country–level results by region and by all 73 high–burden countries combined. We also estimated which specific interventions would save the most lives.FindingsLiST estimates that a total of 3.0 (sensitivity bounds 1.8–4.0), 4.9 (3.1–6.3) and 6.9 (3.7–8.7) million deaths would be prevented between 2016 and 2020 if CBPHC is gradually scaled up during this period and if coverage of key interventions reaches 50%, 70%, and 90% respectively. There would be 14%, 23%, and 32% fewer deaths in the final year compared to a scenario assuming no intervention coverage scale up. The Africa Region would receive the most benefit by far: 58% of the lives saved at 90% coverage would be in this region. The interventions contributing the greatest impact are nutritional interventions during pregnancy, treatment of malaria with artemisinin compounds, oral rehydration solution for childhood diarrhea, hand washing with soap, and oral antibiotics for pneumonia.ConclusionsScaling up CHW programming to increase population–level coverage of life–saving interventions represents a very promising strategy to achieve universal health coverage and end preventable maternal and child deaths by 2030. Numerous practical challenges must be overcome, but there is no better alternative at present. Expanding the coverage of key interventions for maternal nutrition and treatment of childhood illnesses, in particular, may produce the greatest gains. Recognizing the millions of lives of mothers and their young offspring that could be achieved by expanding coverage of evidence–based interventions provided by CHWs and strengthening the CBPHC systems that support them underscores the pressing need for commitment from governments and donors over the next 15 years to prioritize funding, so that robust CHW platforms can be refined, strengthened, and expanded.

Ending preventable maternal and child deaths in western Nigeria: Do women utilize the life lines?

IntroductionNigeria which constitutes just one percent of the world population, accounts for 13% of the world maternal and under-five mortality. Utilization of health care services has been an important determinant of maternal and child outcomes. The vast majority of maternal and child deaths could be prevented if women utilize the available life lines. The study objective was to determine utilization of maternal and child health care services among women of child bearing age in Western Nigeria.MethodsA community based, cross sectional study was done in Oshodi/Isolo Local Government Area among women of child bearing age (15-49 years) with at least one child under five years. Multistage sampling was used to select 371 respondents. Data was collected with a structured, pretested, interviewer administered questionnaire and analyzed with Epi info 3.5.1. Summary and inferential statistics were done. Level of significance was set at 5%(p<0.05).ResultsOf the 371 respondents interviewed, the health facility was used for antenatal care (74.3% n = 276), delivery (59.9% n = 222), postnatal services (77.9% n = 289), family planning services (28.8% n = 107), immunization (95.1% n = 353), growth monitoring (77.4% n = 287), nutritional services (64.7% n = 240) and treatment of childhood illness (49.6% n = 184). Only 31.5% (n = 117) of the respondents practiced exclusive breastfeeding and 82% (n = 263) of the mothers used oral rehydration solution for diarrhoea management. Maternal education significantly influenced utilization. In addition maternal age, employment status, number of children, spouse employment and educational status played significant roles.ConclusionUtilization of maternal and child health services among respondents was above national average but not optimal, especially family planning services, exclusive breastfeeding and curative services for children. Interventions that improve maternal educational status and wealth creation should be undertaken to achieve the SDGs.

Treatment-seeking and out-of-pocket expenditure on childhood illness in a migrant tribal community in Bhubaneswar, Odisha State, India

Background: In India, migrant status, tribal affiliation and poverty render tribal migrants more vulnerable than any other group which leads to high treatment costs and the risk of low access to health care.Objective: To examine treatment-seeking behaviour and out-of-pocket (OOP) expenditure on the treatment of childhood illnesses, with a focus on gender in a migrant tribal community in Bhubaneswar, eastern India.Methods: A total of 175 households with a child aged 0–14 years and who had migrated within the last 12 years were selected from tribal-dominated slums. Data on health-seeking behaviour and expenditure on a recent illness in the youngest child were collected by interviewing mothers during October 2007 to March 2008.Results: Of the 175 children, 78.8% had at least one episode of illness during the previous year. Of the total number of episodes, 71% had been treated and 61% of them had incurred OOP expenditure. A significantly lower proportion of episodes of illness in girls had been treated than in boys (P = 0.01) and incurred OOP expenditure (P = 0.05). Private health care was preferred and only 16.5% availed themselves of the government sources. About 89 and 87% of households of boys and girls, respectively, incurred OOP expenditure. A child’s gender (female) (P = 0.05), mother’s education (P = 0.002) and type of illness (P = 0.002) were significantly associated with total OOP expenditure.Conclusion: Further studies are warranted to address the low access to government health care and thereby reduce high OOP expenditure by tribal migrants on low incomes. Efforts are required to increase the ability of communities and health providers to identify and address the issues of gender and equity in health care along with a focus on culture-sensitive service provision.

Cultural knowledge and treatment of childhood illness

Traditional knowledge emerges as a relevant figure in care used by mothers and caregivers for the management of acute respiratory infections, diarrhea and anemia. To understand the meaning given to the use of traditional knowledge by mothers or caregivers for the treatment of these illnesses, their reflexes to conventional treatment, as well as discuss the role of health professionals with regard to the use of plants and animals by mothers or responsible for the management the respiratory infections; diarrhea and anemia. The research was conducted in Santo Antônio community (Barbalha - CE). Techniques as “rapport” and “Snowball” were used for data collection, and a closed questionnaire and semi-structured interview were applied. For data analysis, the Collective Subject Discourse (CSD) was used. The sample included 54 informants. There were 19 key ideas identified, which revealed an appreciation of the use of natural resources to treat the respiratory infections; diarrhea and anemia, an association between conventional and traditional medicine in the management these common childhood illnesses and the need for health professionals value the popular knowledge in assistance provided. Health professionals are encouraged to include behaviors in their care practice that allow greater contact with local cultures, being able to measure what resources are used and how they can interfere on the prescribed therapy.

Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful nationalscale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reducedthe mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage ofhigh-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategyto re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of communityhealth workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and thatthe role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhoodillnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient densitycan have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acuteconditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed todo more.

Determinants of Utilization and Community Experiences with Community Health Volunteers for Treatment of Childhood Illnesses in Rural Sierra Leone

In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities' experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17-8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88-11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13-23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.

Effect of shortened Integrated Management of Childhood Illness training on classification and treatment of under-five children seeking care in Rwanda.

BackgroundIntegrated Management of Childhood Illness (IMCI) is an effective 11-day standard training; however, due to budgetary expenses and human resource constraints, many health professionals cannot take 11 days off work. As a result, shortened training curriculums (6-day) have been proposed. We used a cross-sectional study to evaluate the effect of this shortened training on appropriate IMCI classification and treatment of under-five childhood illness management in Rwanda.MethodsA cross-sectional study was conducted in 22 health centers in Rwanda, comparing data from 121 nurses, where 55 nurses completed the 11-day and 66 nurses completed the 6-day training. Among 768 children, we evaluated clinical outcomes from May 2011 to April 2012. Descriptive statistics were used to display the sociodemographic characteristics of health providers; including level of education, sex, age, and professional experiences. Bivariable and multivariable analyses were used to test for differences between nurses in the 6-day versus 11-day training on the appropriate classification and treatment of childhood illness.ResultsOur findings show that at the bivariable level and after controlling for confounders in the multivariable analysis, the only significant differences detected between nurses in the long and short training was the classification of fever (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.64–0.75) and treatment of pneumonia (aOR 0.8, 95% CI 0.70–0.89). Nurses in the short training had lower odds of inappropriate misclassification and treatment for these two conditions.ConclusionThere was no difference in classification and treatment of childhood illness among nurses who completed the standard and short IMCI training courses. Short-training could be a more cost-saving option for health facilities without compromising the key outcomes related to case management.

Clinical Outcomes of a Comprehensive Integrated Program for HIV-Exposed Infants

Prevention of mother-to-child transmission of HIV services are often inadequate in promoting HIV-free child survival in rural areas with limited resources. An integrated comprehensive child survival program in rural Rwanda with special emphasis on HIV-exposed infants was established in 2005 and scaled-up. The objective of this study was to report program outcomes and identify predictors of program retention. We conducted a retrospective study of infants born to HIV-infected women enrolled in the program at or before birth from March 1, 2007, to February 28, 2010, in Eastern Rwanda. Key program elements included improved access to health care, antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV, clean water sources and replacement feeding, home visits by community health workers, prevention and treatment of childhood illness, nutritional support, family planning, and socioeconomic support for the extremely vulnerable. Overall,1038 infants enrolled in the program in the study period during which time there was a 4-fold increase in the number of current participants. Uptake of contraception and treatment for diarrheal disease were high. The 18-month survival probability and retention probability were 0.93 (95% confidence interval: 0.91 to 0.94) and 0.88 (95% confidence interval: 0.86 to 0.90), respectively. Twenty-seven (2.6%) children tested positive for HIV, of which 1 died and none were lost-to-follow-up at 18 months. No statistically significant predictors of retention were identified. Our findings demonstrate that a comprehensive integrated program to promote HIV-free survival can achieve high rates of retention and survival in a highly vulnerable population, even during a period of rapid growth.

A Rural—Urban Comparison of Client-Provider Interactions in Patent Medicine Shops in South West Nigeria

The increasing prominence of patent medicine vendors (PMVs) in healthcare provision makes information about how they operate of interest. This study assessed consumers' behavior and PMVs' performance in the treatment of childhood illnesses in rural and urban communities in South West Nigeria. Non-participatory observations were carried out in 163 licensed patent medicine stores in Oyo State, Nigeria. Many PMV shops (70.6% rural and 61.9% urban; p = 0.141); stocked non proprietary drugs. Clients often requested for drugs by name (75.4% urban versus 62.2% rural; p = 0.002) and PMVs mostly sold drugs as requested without questions (65.3% urban 57.8% rural; p = 0.07). Inappropriate treatment practices and invasive procedures were observed more often in urban PMVs shops (p < 0.001). PMVs functioned mostly as sales persons supplying clients' drug requests. Strategies to improve PMV treatment practices should include caregiver education to be effective.

Your Child's Health Your Child's Health I Blumenthal Published by Faber & Faber 372pp £6.95 0-571-14707-0.

For the parent with an enquiring mind Ivan ' Blumenthal provides a wealth of information about a wide range of medical dis- I orders from which a child may suffer. Structured in the form of questions a parent may ask of a doctor or nurse, the book describes in considerable depth the diagnosis and treatment of childhood illness.