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Acute respiratory infections in children: a case management intervention in Abbottabad District, Pakistan
Insights
A community health program in Pakistan significantly reduced child mortality from acute lower respiratory infection (ALRI) and overall deaths. This case management approach proved effective in saving young lives.
Area of Science:
- Public Health
- Epidemiology
- Child Health
Background:
- Acute lower respiratory infection (ALRI) is a major cause of infant and child mortality globally.
- Effective community-based interventions are crucial for reducing child mortality in resource-limited settings.
Purpose of the Study:
- To evaluate the impact of a community-based case management program for ALRI on infant and child mortality in rural Pakistan.
Main Methods:
- A community-based program involving active case-finding and maternal health education for ALRI was implemented.
- The study compared ALRI-specific and total child mortality rates in intervention and control villages before and after the intervention.
Main Results:
- ALRI-specific mortality rate in intervention villages was 6.3/1000 children/year vs. 14.4/1000 in control villages (P=0.0001).
- Total child mortality rate was 29.0/1000 in intervention villages vs. 39.4/1000 in control villages (P=0.01).
- Following intervention, ALRI-specific and total child mortality rates significantly declined in previously control villages.
Conclusions:
- Community-based case management of ALRI by local health workers can significantly reduce ALRI-specific and total infant and child mortality.
- The findings highlight the effectiveness of accessible, community-level healthcare interventions in improving child survival rates.
Abstract:
Between 1985 and 1987, a community-based case-management programme for acute lower respiratory infection (ALRI) was conducted in a rural district of northern Pakistan. The impact on infant and child mortality of this programme, which included active case-finding and maternal health education, was evaluated. In 1985-86, the ALRI-specific mortality rate among children less than 5 years old in 31 intervention villages was 6.3 deaths per 1000 children per year, compared with 14.4 in seven control villages (P = 0.0001). Within one year of the interventions being extended to the control villages in 1987, the ALRI-specific mortality rate in these villages dropped by 55% to 6.5 per 1000 children per year (P = 0.06). The total child mortality rate in 1985-86 was 29.0 per 1000 children per year in the intervention villages and 39.4 per 1000 children in the control villages, a difference of 26% (P = 0.01). With the interventions in 1987, the total child mortality rate in the control villages declined by 29% to 27.8 per 1000 children per year (P = 0.09). Similar intervention-associated declines in the infant mortality rate were also observed. Case management of acute respiratory infection by village-level community health workers backed up by local health centre staff appeared to significantly reduce both ALRI-specific and total infant and child mortality rates in this setting.