Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia

English version České info

Background:
Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh.

Methods and Findings:
Caregivers of 950 children under 5 y with pneumonia and 980 with “no pneumonia” were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated.

Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry.

Conclusions:
Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia. PLoS Med 10(5): e32767. doi:10.1371/journal.pmed.1001422
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001422

Souhrn

Zdroje

1. United Nations Children's Fund, World Health Organization, World Bank, United Nations (2012) Levels and trends in child mortality: Report 2012. New York: United Nations Children's Fund.

2. GrahamSM, EnglishM, HazirT, EnarsonP, DukeT (2008) Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings. Bull World Health Organ 86: 349–355.

3. MarshDR, GilroyKE, Van de WeerdtR, WansiE, QaziS (2008) Community case management of pneumonia: At a tipping point? Bull World Health Organ 86: 381–389.

4. Commission on Information and Accountability for Women's and Children's Health (2011) Keeping promises, measuring results. Available: http://whqlibdoc.who.int/publications/2011/9789241564328_eng.pdf. Accessed 13 March 2013.

5. HarrisonLH, MoursiS, GuinenaAH, GadomskiAM, el-AnsaryKS, KhallafN, et al. (1995) Maternal reporting of acute respiratory infection in Egypt. Int J Epidemiol 24: 1058–1063.

6. LanataCF, QuintanillaN, VerasteguiHA (1994) Validity of a respiratory questionnaire to identify pneumonia in children in Lima, Peru. Int J Epidemiol 23: 827–834.

7. World Health Organization (1990) Acute respiratory infections in children: Case management in small hospitals in developing countries. WHO/ARI/90.5. Geneva: World Health Organization.

8. LiuL, JohnsonHL, CousensS, PerinJ, ScottS, et al. (2012) Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–2161.

9. TheodoratouE, Al-JilaihawiS, WoodwardF, FergusonJ, JhassA, et al. (2010) The effect of case management on childhood pneumonia mortality in developing countries. Int J Epidemiol 39 (Suppl 1)

i155–i171.

10. SelwynBJ (1990) The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries. Rev Infect Dis 12 (Suppl 8)

S870–S888.

11. CampbellH, el ArifeenS, HazirH, O'KellyJ, BryceJ, et al. (2013) Measuring coverage in MNCH: Challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment. PLoS Med 10: e1001421 doi:10.1371/journal.pmed.1001421.

12. National Institute of Population Studies, Macro International (2008) Pakistan Demographic and Health Survey 2006-07. Islamabad (Pakistan): National Institute of Population Studies, Macro International.

13. NizamiSQ, BhuttaZA, HasanR (2006) Incidence of acute respiratory infections in children 2 months to 5 years of age in periurban communities in Karachi. J Pak Med Assoc 56: 163–167.

14. CastroAV, Nascimento-CarvalhoC, Ney-OliveriaF, Araujo-NetoCA, AndradeSCS, et al. (2005) Additional markers to refine the World Health Organization algorithm for diagnosis of pneumonia. Indian Pediatr 42: 773–781.

15. CardosoMR, Nascimento-CarvalhoCM, FerreroF, AlvesFM, CousensSN (2011) Adding fever to WHO criteria for diagnosing pneumonia enhances the ability to identify pneumonia cases among wheezing children. Arch Dis Child 96: 58–61.

16. BlandRM, RollinsNC, SolarshG, Van den BroeckJ, CoovadiaHM, et al. (2003) Maternal recall of exclusive breast feeding duration. Arch Dis Child 88: 778–783.

17. LiR, ScanlonKS, SerdulaMK (2005) The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev 63: 103–110.

18. FeikinDR, AudiA, OlackB, BigogoGM, PolyakC, et al. (2010) Evaluation of the optimal recall period for disease symptoms in home based morbidity surveillance in rural and urban Kenya. Int J Epidemiol 39: 450–458.

19. MullDS, MullJD (1994) Insights from community-based research on child pneumonia in Pakistan. Med Anthropol 15: 335–352.

20. RehmanGN, QaziSA, MullDS, KhanMA (1994) ARI concepts of mothers in Punjabi villages: A community-based study. J Pak Med Assoc 44: 185–188.

21. HussainR, LoboMA, InamB, KhanA, QureshiAF, et al. (1997) Pneumonia perceptions and management: An ethnographic study in urban squatter settlements of Karachi, Pakistan. Soc Sci Med 45: 991–1004.