Understanding pre-hospital disease management of fever and diarrhoea in children-Care pathways in rural Tanzania.
antibiotics
child health
diarrhoea
fever
health‐seeking
infectious diseases
malaria
primary health care
self‐medication
Journal
Tropical medicine & international health : TM & IH
ISSN: 1365-3156
Titre abrégé: Trop Med Int Health
Pays: England
ID NLM: 9610576
Informations de publication
Date de publication:
18 Jun 2024
18 Jun 2024
Historique:
medline:
18
6
2024
pubmed:
18
6
2024
entrez:
18
6
2024
Statut:
aheadofprint
Résumé
Many children in sub-Saharan Africa die from infectious diseases like malaria, pneumonia, and diarrhoea that can be prevented by early diagnosis, effective and targeted treatment. This study aimed to gain insights into case management practices by parents before they present their children to hospital. We conducted a cross-sectional study among 332 parents attending a district hospital with their under-fives symptomatic with fever and/or diarrhoea between November 2019 and July 2020 in rural Tanzania. Timely and targeted treatment was defined as seeking health care within 24 h of fever onset, and continued fluid intake in case of diarrhoea. The main admission diagnoses were acute respiratory infections (61.8%), malaria (25.3%), diarrhoea (18.4%) and suspected sepsis (8.1%). The majority of children (91%) received treatment prior to admission, mostly antipyretics (75.6%), local herbal medicines (26.8%), and antibiotics (17.8%)-half of them without prescription from a clinician. For diarrhoea, the use of oral rehydration solution was rare (9.0%), although perceived as easily accessible and affordable. 49.4% of the parents presented their children directly to the hospital, 23.2% went to a pharmacy/drug shop and 19.3% to a primary health facility first. Malaria symptoms began mostly 3 days before the hospital visit; only 25.4% of febrile children visited any health facility within 24 h of disease onset. Prior use of local herbal medicine (AOR = 3.2; 95% CI 1.4-7.3), visiting the pharmacy (adjusted Odds Ratio [AOR] = 3.1; 95% confidence interval [CI]: 1.0-9.8), the dispensary being the nearest health facility (AOR = 3.0; 95% CI: 1.5-6.2), and financial difficulties (AOR = 2.2; 95% CI 1.1-4.5) were associated with delayed treatment. This study suggests that antipyretics and antibiotics dispensed at pharmacies/drug shops, as well as use of local herbal medicines, delay early diagnosis and treatment, which can be life-threatening. Pharmacies/drug shops could be integrated as key focal points for sensitising community members on how to respond to paediatric illnesses and encourage the use of oral rehydration solutions.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors Tropical Medicine & International Health published by John Wiley & Sons Ltd.
Références
Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, et al. Global, regional, and national progress towards sustainable development goal 3.2 for neonatal and child health: all‐cause and cause‐specific mortality findings from the global burden of disease study 2019. Lancet. 2021;398:870–905. https://doi.org/10.1016/S0140-6736(21)01207-1
WHO. Diagnostic stewardship: a guide to implementation in antimicrobial resistance surveillance sites. No. WHO/DGO/AMR/2016.3. World Health Organization; 2016.
Okiro EA, Snow RW. The relationship between reported fever and Plasmodium falciparum infection in African children. Malar J. 2010;9:99. https://doi.org/10.1186/1475-2875-9-99
National Malaria Control Programme. National Guidelines for malaria diagnosis, treatment and preventative therapies. 2020.
Black R, Fontaine O, Lamberti L, Bhan M, Huicho L, El Arifeen S, et al. Drivers of the reduction in childhood diarrhea mortality 1980‐2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health. 2019;9:4–6. https://doi.org/10.7189/jogh.09.020801
Masanja H, Mongi P, Baraka J, Jackson B, Kisisiwe Y, Manji K, et al. Factors associated with the decline in under five diarrhea mortality in Tanzania from 1980‐2015. J Glob Health. 2019;9:1–9. https://doi.org/10.7189/jogh.09.020806
Adinan J, Damian DJ, Mosha NR, Mboya IB, Mamseri R, Msuya SE. Individual and contextual factors associated with appropriate healthcare seeking behavior among febrile children in Tanzania. PLoS One. 2017;12:e0175446. https://doi.org/10.1371/journal.pone.0175446
Ministry of Health. Community development, Gender E and CD es S. Tanzania Demographic and Health Survey and Malaria Indicator Survey 2016.
World Health Organization. Department of Child and AHealth. Handbook IMCI: integrated management of childhood illness; 2005.
Schellenberg JRA, Adam T, Mshinda H, Masanja H, Kabadi G, Mukasa O, et al. Effectiveness and cost of facility‐based integrated Management of Childhood Illness (IMCI) in Tanzania. Lancet. 2004;364:1583–1594. https://doi.org/10.1016/S0140-6736(04)17311-X
Oliphant NP, Manda S, Daniels K, Odendaal WA, Besada D, Kinney M, et al. Integrated community case management of childhood illness in low‐ and middle‐income countries. Cochrane Database Syst Rev. 2021;2021:23–29. https://doi.org/10.1002/14651858.CD012882.pub2 CD012882.
Gera T, Shah D, Garner P, Richardson M, Sachdev HS. Integrated management of childhood illness (IMCI) strategy for children under five. Cochrane Database Syst Rev. 2016;2016:3–5. https://doi.org/10.1002/14651858.CD010123.pub2 CD010123.
Prosnitz D, Herrera S, Coelho H, Moonzwe Davis L, Zalisk K, Yourkavitch J. Evidence of impact: iCCM as a strategy to save lives of children under five. J Glob Health. 2019;9:4–8. https://doi.org/10.7189/jogh.09.010801
Mengistie B, Berhane Y, Worku A. Predictors of oral rehydration therapy use among under‐five children with diarrhea in eastern Ethiopia: a community based case control study. BMC Public Health. 2012;12:1029. https://doi.org/10.1186/1471-2458-12-1029
Liheluka E, Gibore NS, Lusingu JPA, Gesase S, Minja DTR, Lamshöft M, et al. Community perceptions on the effectiveness of herbal medicines and factors associated with their use in managing diarrhoea among under‐five children in North‐eastern Tanzania. Trop Med Health. 2023;51:48. https://doi.org/10.1186/s41182-023-00537-5
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)‐A metadata‐driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010
World Health Organization. Management of sick children by community health workers: intervention models and programme examples. Geneva: World Health Organization; 2006.
Vyas S, Kumaranayake L. Constructing socio‐economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21:459–468. https://doi.org/10.1093/heapol/czl029
Liheluka E, Gibore NS, Lusingu JPA, Gesase S, Minja DTR, Lamshöft M, et al. Medicinal plants for treatment of diarrhoeal diseases among under‐five children: experience from traditional healers in North‐eastern Tanzania. BMC Complement Med Ther. 2023;23:379. https://doi.org/10.1186/s12906-023-04216-0
Mburu CM, Bukachi SA, Shilabukha K, Tokpa KH, Ezekiel M, Fokou G, et al. Determinants of treatment‐seeking behavior during self‐reported febrile illness episodes using the socio‐ecological model in Kilombero District, Tanzania. BMC Public Health. 2021;21:1075. https://doi.org/10.1186/s12889-021-11027-w
Kahabuka C, Kvåle G, Hinderaker SG. Care‐seeking and management of common childhood illnesses in Tanzania—results from the 2010 demographic and health survey. PLoS One. 2013;2013:8. https://doi.org/10.1371/journal.pone.0058789
Kanté AM, Gutierrez HR, Larsen AM, Jackson EF, Helleringer S, Exavery A, et al. Childhood illness prevalence and health seeking behavior patterns in rural Tanzania. BMC Public Health. 2015;15:1–12. https://doi.org/10.1186/s12889-015-2264-6
Kahabuka C, Kvåle G, Moland KM, Hinderaker SG. Why caretakers bypass primary health care facilities for child care—a case from rural Tanzania. 2011;11. https://doi.org/10.1186/1472-6963-11-315
Ahinkorah BO, Aboagye RG, Seidu A‐A, Frimpong JB, Cadri A, Afaya A, et al. Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under‐five in sub‐Saharan Africa. PLoS One. 2022;17:e0275495. https://doi.org/10.1371/journal.pone.0275495
Mboya EA, Sanga LA, Ngocho JS. Irrational use of antibiotics in the moshi municipality northern Tanzania: a cross sectional study. Pan Afr Med J. 2018;31:1–10. https://doi.org/10.11604/pamj.2018.31.165.15991
Hopkins H, Bruxvoort KJ, Cairns ME, Chandler CIR, Leurent B, Ansah EK, et al. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings. BMJ. 2017;356:j1054. https://doi.org/10.1136/bmj.j1054
Chowdhury F, Sturm‐Ramirez K, Mamun AA, Iuliano AD, Chisti MJ, Ahmed M, et al. Effectiveness of an educational intervention to improve antibiotic dispensing practices for acute respiratory illness among drug sellers in pharmacies, a pilot study in Bangladesh. BMC Health Serv Res. 2018;18:1–11. https://doi.org/10.1186/s12913-018-3486-y
Horumpende PG, Sonda TB, vanZwetselaar M, Antony ML, Tenu FF, Mwanziva CE, et al. Prescription and non‐prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi municipality, Kilimanjaro region in Tanzania: A simulated clients approach. PLoS One. 2018;13:e0207465. https://doi.org/10.1371/journal.pone.0207465
van denBergh D, Messina AP, Goff DA, vanJaarsveld A, Coetzee R, deWet Y, et al. A pharmacist‐led prospective antibiotic stewardship intervention improves compliance to community‐acquired pneumonia guidelines in 39 public and private hospitals across South Africa. Int J Antimicrob Agents. 2020;56:106189. https://doi.org/10.1016/j.ijantimicag.2020.106189
Oga‐Omenka C, Okafor U, Sulis G. Engaging pharmacists and medicine vendors in antimicrobial stewardship in LMICs. Lancet Infect Dis. 2023;23:786–787. https://doi.org/10.1016/S1473-3099(23)00342-0