malaria transmission is holoendemic 7-12 months of the year (MARA/ARMA, 2005). ... (Linder, 1965) while minor problems may be under-reported during a two ...
Case management of childhood fevers in the community Exploring malaria and pneumonia care in Uganda Karin Källander
Stockholm 2006
From the Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
CASE MANAGEMENT OF CHILDHOOD FEVERS IN THE COMMUNITY EXPLORING MALARIA AND PNEUMONIA CARE IN UGANDA
Karin Källander
Stockholm 2006
Published and printed by Karolinska University Press Box 200, SE-171 77 Stockholm, Sweden © Karin Källander, 2006 ISBN 91-7140-557-7
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“The most widespread and fatal of all acute diseases, pneumonia, is now captain of the men of death” Sir William Osler, 1901, British (Canadian-born) physician
“It takes a village to raise a child” African proverb
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ABSTRACT Background: Acute respiratory infections (ARI), especially pneumonia, are leading causes of death in children under-five. Symptoms often overlap with those of malaria. In Uganda, the Home Based Management of fever (HBM) strategy recommends treating all febrile children with antimalarials provided by local community health workers (CHWs) – in Uganda called drug distributors (DDs). However, HBM overlooks the pneumonia symptom overlap, with potentially adverse effects for the affected children. Main aim: To explore aspects of home and community care for childhood fevers in Uganda and devise recommendations for integrated community based management of malaria and pneumonia. Methodology: Five sub-studies (I-V) were performed using a triangulation of qualitative (II & V) and quantitative (I, III, IV and V) methods in households (III & IV), communities (II, IV & V), health centres (I & IV) and a hospital (IV & V). Study I was cross-sectional in 14 health centres where 3,671 child consultation records were analysed for symptom overlap. Study II used 10 focus group discussions (FGDs) with mothers, fathers and grandparents. Study III was a cross-sectional household survey where mothers of 3,249 children were interviewed using 2 week recall. Study IV used case-series in the community, interviewing caretakers of 117 referred children and tracking the child in the outpatient records of nearby health facilities. Study V used performance assessment of 96 DDs in a hospital, 4 FGDs with mothers in the community and unstructured interviews with 2 key informants. Results: Thirty percent of children seen in health facilities (I) and 19% of sick children in the community (III) had symptoms compatible with both malaria and pneumonia. Some febrile conditions were perceived to require urgent allopathic treatment, and others were first treated with traditional remedies (II). Of children with cough and difficult/rapid breathing in the community, 35% were treated with antibiotics but when fever was present, antibiotic use dropped (p=0.12) and antimalarial use increased (p
