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- Beer, Netta, et al.
(author)
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High effective coverage of vector control interventions in children after achieving low malaria transmission in Zanzibar, Tanzania.
- 2013
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In: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12
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Journal article (peer-reviewed)abstract
- ABSTRACT: Background: Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission. Methods: A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases. Results: Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage. Conclusions: While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions.
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- Källander, Karin
(author)
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Case management of childhood fevers in the community : exploring malaria and pneumonia care in Uganda
- 2006
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Doctoral thesis (other academic/artistic)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<0.001) (III). Among caretakers of children referred by DDs, 82% stated having completed referral but 52% had delayed >=2 days (IV). DD assessment of rapid breathing was adequate with 75% sensitivity and 83% specificity (V). Many biomedically relevant terms for ARI existed in the local language but most were related to fever and perceived to need antimalarial treatment (V). Discussion: Addressing only malaria in community management strategies may increase treatment delays for potential pneumonia. More comprehensive community management covering also pneumonia could potentially increase child survival. While management of pneumonia in the community involves dispensing of antibiotics by non-medically trained distributors, antibiotic drugs are already widely used in the community. With adequate training, supervision and support for DDs there is potential to rationalise antibiotic use while concurrently increasing access to treatment. To achieve high community uptake and minimise drug misuse, the local illness concepts and treatment actions need to be addressed. While DDs can operate to identify and treat children early in the disease, the high rate of referral completion demonstrates that also links to the formal health system can be maintained. With these findings, the feasibility and impact of full-scale implementation of integrated management of malaria and pneumonia in the community should be tested.
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- Källander, Karin, et al.
(author)
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Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal
- 2020
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:6, s. 1207-1220
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Journal article (peer-reviewed)abstract
- AIM: Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal.METHODS: A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews.RESULTS: FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned.CONCLUSION: Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs.
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- Lindstrand, Ann, et al.
(author)
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Pneumococcal Carriage in Children under Five Years in Uganda-Will Present Pneumococcal Conjugate Vaccines Be Appropriate?
- 2016
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:11
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Journal article (peer-reviewed)abstract
- BACKGROUND: Pneumonia is the major cause of death in children globally, with more than 900,000 deaths annually in children under five years of age. Streptococcus pneumoniae causes most deaths, most often in the form of community acquired pneumonia. Pneumococcal conjugate vaccines (PCVs) are currently being implemented in many low-income countries. PCVs decrease vaccine-type pneumococcal carriage, a prerequisite for invasive pneumococcal disease, and thereby affects pneumococcal disease and transmission. In Uganda, PCV was launched in 2014, but baseline data is lacking for pneumococcal serotypes in carriage.OBJECTIVES: To study pneumococcal nasopharyngeal carriage and serotype distribution in children under 5 years of age prior to PCV introduction in Uganda.METHODS: Three cross-sectional pneumococcal carriage surveys were conducted in 2008, 2009 and 2011, comprising respectively 150, 587 and 1024 randomly selected children aged less than five years from the Iganga/Mayuge Health and Demographic Surveillance Site. The caretakers were interviewed about illness history of the child and 1723 nasopharyngeal specimens were collected. From these, 927 isolates of S. pneumoniae were serotyped.RESULTS: Overall, the carriage rate of S. pneumoniae was 56% (957/1723). Pneumococcal carriage was associated with illness on the day of the interview (OR = 1.50, p = 0.04). The most common pneumococcal serotypes were in descending order 19F (16%), 23F (9%), 6A (8%), 29 (7%) and 6B (7%). One percent of the strains were non-typeable. The potential serotype coverage rate for PCV10 was 42% and 54% for PCV13.CONCLUSION: About half of circulating pneumococcal serotypes in carriage in the Ugandan under-five population studied was covered by available PCVs.
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- Rutebemberwa, Elizeus, et al.
(author)
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High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda : A cross-sectional study
- 2015
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In: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 120:4, s. 249-256
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Journal article (peer-reviewed)abstract
- BACKGROUND: In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia-often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics.METHODS: In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test.RESULTS: Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates had intermediate resistance to penicillin, none was highly resistant. Whereas no isolate was resistant to erythromycin, 98.9% were resistant to trimethoprim-sulphamethoxazole (co-trimoxazole).CONCLUSIONS: In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. To inform treatment policies on the clinical efficacy of current treatment protocols for pneumonia in health facilities and at the community level, routine surveillance of resistance in pneumonia pathogens is needed as well as research on treatment efficacy in cases with resistant strains. Improved clinical algorithms and diagnostics for pneumonia should be developed.
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