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Development of ARI case management at primary and secondary level in southern Vietnam
Insights
Training mothers and health workers in Vietnam significantly improved acute respiratory infection (ARI) case management. This pilot project enhanced knowledge, attitude, and practice (KAP) in managing childhood pneumonia and bronchitis, reducing severity and mortality risks.
Area of Science:
- Pediatrics
- Public Health
- Infectious Disease Epidemiology
Background:
- Childhood pneumonia and acute respiratory infections (ARI) are significant causes of mortality in children under 5 in southern Vietnam.
- Effective case management by mothers and healthcare workers is crucial for reducing ARI severity and mortality.
- Pediatric Hospital N1 (PHN1) in Ho Chi Minh City was tasked with training healthcare professionals in ARI case management.
Purpose of the Study:
- To provide epidemiological data on ARI in southern Vietnam.
- To develop and implement training and intervention modules for managing moderate to severe pneumonia and acute bronchitis.
- To evaluate the impact of these modules on the knowledge, attitude, and practice (KAP) of mothers and healthcare workers.
Main Methods:
- Development of training modules at PHN1 based on WHO ARI management guidelines.
- Implementation in 10 selected commune health stations, with training for local health workers and district hospital staff.
- Interviews to assess mothers' KAP before and after seminars, with follow-up surveys to measure KAP spread and retention.
Main Results:
- Mothers' KAP scores increased by 25% two months after attending seminars.
- A further 5-10% increase in KAP was observed in the untrained group 4-6 months later.
- Reliable statistics on ARI morbidity or mortality were not obtainable within the project area.
Conclusions:
- The developed training modules and interventions effectively improved mothers' and health workers' KAP regarding ARI case management.
- Community-based health education and improved access to essential drugs are vital for reducing ARI impact.
- Further research is needed to quantify the impact on morbidity and mortality rates.
Abstract:
In southern Vietnam it is not uncommon that children under 5 years of age die from pneumonia. Reduction of severity and mortality has to rely on proper case management by mothers and health workers on both grass root level and referral level. The responsibility of training of clinical skills of ARI case management in the southern provinces of Vietnam has been delegated to Pediatric Hospital N1 (PHN1) Ho Chi Minh City (HCMC) by Ministry of Health. A pilot project was carried out by the Danish-Vietnamese Study Group. The immediate objects were: to provide basic epidemiological information about ARI in southern Vietnam, to develop training modules and case management intervention modules at primary and secondary level in order to enable mothers, village workers, health post staff and district hospital emergency department staff to treat moderate and severe pneumonia and acute bronchitis in accordance with the WHO management guide for ARI and to evaluate the effect of those modules after implementation in a limited number of communes. The modules were developed at PHN1. Ten commune health stations were carefully selected. The purpose of the project and the conditions for taking part had been explained to the health workers. The doctors and other commune health workers from the 10 commune health stations and doctors from the connected district hospitals attended the training courses at PHN1, HCMC and also at the belonging provincial hospitals. Essential equipment was provided and a pharmacy with essential drugs established. The registered health statistics was collected yearly during on site visits. The local doctors and commune health workers gave seminars for mothers in the villages of the 10 project communes. The mothers' knowledge, attitude and practice (KAP) was tested in interviews before and two months after the seminars had taken place. The spread of KAP was measured by random interviews of mothers six month later. In the interviews information on social conditions was obtained. The mothers' KAP had risen by 25% two months after attending the seminars. A further increase of KAP by 5-10% within the untrained group appeared in a survey 4-6 months later. It was not possible to obtain reliable statistics on morbidity or mortality of ARI in the project area.