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Impact on mortality of a community-based programme to control acute lower respiratory tract infections
V Fauveau1, M K Stewart, J Chakraborty
1International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka.
Insights
A targeted program combining specific and non-specific health services significantly reduced acute lower respiratory infection (ALRI) mortality in young children in rural Bangladesh. This intervention lowered ALRI deaths by 32% and overall child mortality by 30%.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Acute lower respiratory tract infections (ALRIs) are a leading cause of mortality in young children in developing nations.
- Effective interventions are crucial to reduce child mortality from ALRI in resource-limited settings.
Purpose of the Study:
- To evaluate the impact of a targeted ALRI program, integrated with existing primary health services, on child mortality in rural Bangladesh.
- To assess the combined effect of specific ALRI case management and non-specific health interventions on mortality rates.
Main Methods:
- A comparative study design was employed, evaluating ALRI-specific mortality in an intervention area and a control area over two periods (1986-87 and 1988-89).
- The intervention involved community health workers systematically detecting and managing ALRI cases, supported by a referral system.
- Non-ALRI-specific services included promotion of oral rehydration therapy, immunization, vitamin A distribution, and nutritional support.
Main Results:
- During the baseline period (1986-87), ALRI mortality was 28% lower in the intervention area compared to the control area (P < 0.01).
- Following program implementation (1988-89), ALRI mortality decreased by 32% in the intervention area compared to the preceding phase.
- The combined interventions demonstrated a potential to reduce ALRI mortality by up to 50% and overall under-5 mortality by 30% in the study region.
Conclusions:
- The integration of targeted ALRI management with broader primary health care services is highly effective in reducing child mortality.
- Community health worker-led interventions play a vital role in improving child survival rates from respiratory infections in developing countries.
Abstract:
Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P less than 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.