Prescribing for acute childhood infections in developing and transitional countries, 1990-2009

Area of Science:

• Global Health
• Paediatric Infectious Diseases
• Health Services Research

Background:

• Evidence on global progress in treating acute paediatric infections is scarce.
• Childhood infections remain a significant global health challenge, particularly in developing and transitional countries.

Purpose of the Study:

• To assess two decades of progress in prescribing practices for childhood infections.
• To review empirical evidence on interventions aimed at improving the treatment of paediatric infections in developing and transitional countries.

Main Methods:

• Systematic extraction of data on medicine use for diarrhoea, respiratory infections, and malaria in children under 5 (1990-2009).
• Calculation of medians across studies based on year, region, sector, income level, and prescriber type.
• Estimation of intervention effects using methodologically accepted study designs (RCTs, pre-post with control, time series).

Main Results:

• Analysis of 344 studies from 78 countries; 44 intervention studies with adequate designs were used for effect estimation.
• Significant decrease in anti-diarrhoeal use for acute diarrhoea (P<0.01), but sub-optimal treatment for malaria and acute respiratory infections.
• Multi-component interventions showed greater improvement (e.g., community case-management: 28% improvement) than single-component ones (e.g., provider education alone: 9% improvement).

Conclusions:

• Diarrhoea treatment in children has improved over 20 years, but treatment for other common childhood infections remains suboptimal.
• Multi-component interventions show promise for improving the management of acute childhood illnesses.