Authors: Källander, Karin¹; Nsungwa-Sabiiti, Jesca²; Balyeku, Andrew³; Pariyo, George⁴; Tomson, Göran⁵; Peterson, Stefan⁶

Source: Annals of Tropical Paediatrics: International Child Health, Volume 25, Number 4, December 2005 , pp. 283-291(9)

Publisher: Maney Publishing

Abstract:

Background: Acute respiratory infections (ARI), especially pneumonia, are the second largest child killer in sub-Saharan Africa. Symptoms, including cough and difficult/rapid breathing, frequently overlap those of malaria. In Uganda, the Home-Based Management (HBM) strategy treats all childhood fevers as malaria in the community, ignoring the pneumonia symptom overlap.

Aim: To determine the extent of overlap of fever and ARI symptoms at community level, the timeliness of care-seeking and the treatments sought for ARI with or without fever.

Methods: From eight districts, 3223 households with 3249 children aged <2 years were randomly selected through two-stage cluster sampling and their primary caretakers were interviewed regarding the child's most recent illness episode using 2-week recall.

Results: Of the 1682 children <2 years who had been sick, 19% reported overlapping symptoms of fever, cough and "difficult/rapid breathing". Of these, 45% were given antimalarials alone. Use of health facilities was low and 42% of antibiotics used were obtained from drug shops or home-stocks.

Conclusions: Given the large overlap of fever and ARI symptoms and the reported practice of using primarily antimalarials, the implications of HBM might be the continued or increased mismanagement of pneumonia. Community drug distributors' ability to identify rapid breathing and make a presumptive diagnosis of pneumonia based on respiratory rate should be tested.

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/146532805X72430

Affiliations: 1: Division of International Health, Karolinska Institute, Stockholm, Sweden 2: Division of International Health, Karolinska Institute, Stockholm, Sweden; Department of Pharmacology & Therapeutics, Makerere University, Kampala, Uganda; Institute of Public Health, Makerere University, Kampala, Uganda; Child Health Division, Ministry of Health, Kampala, Uganda 3: Child Health Division, Ministry of Health, Kampala, Uganda 4: Institute of Public Health, Makerere University, Kampala, Uganda 5: Division of International Health, Karolinska Institute, Stockholm, Sweden; Medical Management Centre, Karolinska Institute, Stockholm, Sweden 6: Division of International Health, Karolinska Institute, Stockholm, Sweden; Institute of Public Health, Makerere University, Kampala, Uganda

Publication date: 2005-12-01

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• In 2012 Annals of Tropical Paediatrics changed its name to Paediatrics and International Child Health to reflect changes and developments in the subject area. View the issues of Paediatrics and International Child Health available online.
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