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Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study
Karin Källander1, Helena Hildenwall, Peter Waiswa
1Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. karin.kallander@ki.se <e-mail:karin.kallander@ki.se>
Insights
In rural Uganda, children with fatal pneumonia often received incorrect treatment and faced delays in seeking care. Improving community health worker training is crucial to reduce child pneumonia deaths.
Area of Science:
- Pediatric infectious diseases
- Global child health
- Public health interventions
Background:
- Pneumonia remains a leading cause of mortality in children under five globally.
- Sub-Saharan Africa, particularly rural areas, faces significant challenges in child healthcare access and quality.
- Understanding care-seeking behaviors and treatment practices is vital for reducing preventable child deaths.
Purpose of the Study:
- To examine case histories of children who died from pneumonia in rural Uganda.
- To identify factors contributing to mortality, including care-seeking and treatment received.
- To inform strategies for improving child survival rates from pneumonia.
Main Methods:
- Case-series study in Iganga/Mayuge demographic surveillance site, Uganda (November 2005 - August 2007).
- Inclusion of children aged 1-59 months.
- Verbal and social autopsies to determine cause of death and care-seeking actions.
Main Results:
- Pneumonia was the cause of death for 27% of the 164 analyzed child deaths.
- Half of pneumonia deaths occurred in hospitals; one-third at home.
- Significant delays in seeking care (median 2 days) and mistreatment with antimalarials (52%) and antibiotics (27%) were observed.
Conclusions:
- Fatal pneumonia cases in children were associated with mistreatment, delayed care-seeking, and potentially low-quality care.
- Training community health workers and drug vendors in integrated pneumonia and malaria management should be explored.
- Interventions focusing on timely and appropriate care are essential to reduce child mortality from pneumonia.
Objective:
To review individual case histories of children who had died of pneumonia in rural Uganda and to investigate why these children did not survive.
Methods:
This case-series study was done in the Iganga/Mayuge demographic surveillance site, Uganda, where 67 000 people were visited once every 3 months for population-based data and vital events. Children aged 1-59 months from November 2005 to August 2007 were included. Verbal and social autopsies were done to determine likely cause of death and care-seeking actions.
Findings:
Cause of death was assigned for 164 children, 27% with pneumonia. Of the pneumonia deaths, half occurred in hospital and one-third at home. Median duration of pneumonia illness was 7 days, and median time taken to seek care outside the home was 2 days. Most first received drugs at home: 52% antimalarials and 27% antibiotics. Most were taken for care outside the home, 36% of whom first went to public hospitals. One-third of those reaching the district hospital were referred to the regional hospital, and 19% reportedly improved after hospital treatment. The median treatment cost for a child with fatal pneumonia was US$ 5.8.
Conclusion:
There was mistreatment with antimalarials, delays in seeking care and likely low quality of care for children with fatal pneumonia. To improve access to and quality of care, the feasibility and effect on mortality of training community health workers and drug vendors in pneumonia and malaria management with prepacked drugs should be tested.
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