Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study
Autoři:
Jesper Kjærgaard aff001; Marilena Anastasaki aff002; Marianne Stubbe Østergaard aff003; Elvira Isaeva aff004; Azamat Akylbekov aff005; Nhat Quynh Nguyen aff006; Susanne Reventlow aff003; Christos Lionis aff002; Talant Sooronbaev aff007; Le An Pham aff008; Rebecca Nantanda aff009; James W. Stout aff010; Anja Poulsen aff001;
Působiště autorů:
Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital “Rigshospitalet”, Copenhagen, Denmark
aff001; Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
aff002; The Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
aff003; National Center of Maternity and Childhood Care, Bishkek, Kyrgyzstan
aff004; National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
aff005; Family Medicine Department, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
aff006; Kyrgyz Thoracic Society, Respiratory, Critical Care and Sleep Medicine Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
aff007; Vietnamese Association Family Medicine, Center for training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
aff008; Department of Paediatrics, Mulago Hospital and Makere University, Kampala, Uganda
aff009; University of Washington, Seattle, Washington, United States of America
aff010
Vyšlo v časopise:
PLoS ONE 14(11)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0221389
Souhrn
Background
Respiratory disease and, specifically, pneumonia, is the major cause of mortality and morbidity in young children. Diagnosis of both pneumonia and asthma in primary care rests principally on clinical signs, history taking, and bronchodilator responsiveness. This study aimed to describe clinical practices in diverse global primary care settings concerning differential diagnosis of respiratory disease in young children, especially between pneumonia and asthma.
Methods
Health professionals in Greece, Kyrgyzstan, Vietnam, and Uganda were observed during consultations with children aged 2–59 months, presenting with cough and/or difficult breathing. Data were analyzed descriptively and included consultation duration, practices, diagnoses and availability/use of medications and equipment. The study is part of the European Horizon 2020 FRESH AIR project.
Results
In total, 771 consultations by 127 health professionals at 74 facilities in the four countries were observed. Consultations were shorter in Vietnam and Uganda (3 to 4 minutes) compared to Greece and Kyrgyzstan (15 to 20 minutes). History taking was most comprehensive in Greece. Clinical examination was more comprehensive in Vietnam and Kyrgyzstan and less in Uganda. Viral upper respiratory tract infections were the most common diagnoses (41.7% to 67%). Pneumonia was diagnosed frequently in Uganda (16.3% of children), and rarely in other countries (0.8% to 2.9%). Asthma diagnosis was rare (0% to 2.8%). Antibiotics were prescribed frequently in all countries (32% to 69%). Short acting β-agonist trials were seldom available and used during consultations in Kyrgyzstan (0%) and Uganda (1.8%), and often in Greece (38.9%) and Vietnam (12.6%).
Conclusions
Duration and comprehensiveness of clinical consultations observed in this study seemed insufficient to guide respiratory diagnosis in young children. Appropriate treatment options may further not be available in certain studied settings. Actions aiming at educating and raising professional awareness, along with developing easy-to-use tools to support diagnosis and a general strengthening of health systems are important goals.
Klíčová slova:
Antibiotics – Asthma – Coughing – Pneumonia – Primary care – Uganda – Vietnam – Greece
Zdroje
1. Zar HJ, Ferkol TW. The global burden of respiratory disease-Impact on child health. Pediatr Pulmonol 2014; 434: 430–4.
2. GBD 2015 Child Mortality Collaborators. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England) 2016; 388: 1725–74.
3. WHO. Integrated management of childhood illness: conclusions. WHO Division of Child Health and Development. Bull World Health Organ 1997; 75 Suppl 1: 119–28.
4. WHO. Estimated coverage of IMCI training. 2010. http://gamapserver.who.int/mapLibrary/Files/Maps/World_IMCI_trainingcov_Dec2009.png?ua=1&ua=1.
5. Edward A, Dam K, Chege J, Ghee AE, Zare H, Chhorvann C. Measuring pediatric quality of care in rural clinics-a multi-country assessment-Cambodia, Guatemala, Zambia and Kenya. Int J Qual Heal care J Int Soc Qual Heal Care 2016; 28: 586–93.
6. Østergaard MS, Nantanda R, Tumwine JK, Aabenhus R. Childhood asthma in low income countries: An invisible killer? Prim Care Respir J 2012; 21: 214–9. doi: 10.4104/pcrj.2012.00038 22623048
7. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53: 617–30. doi: 10.1093/cid/cir625 21890766
8. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011; 66 Suppl 2: ii1–23.
9. Masoli M, Fabian D, Holt S, Beasley R, Global Initiative for Asthma (GINA) Program. The global burden of asthma: Executive summary of the GINA Dissemination Committee Report. Allergy Eur J Allergy Clin Immunol 2004; 59: 469–78.
10. WHO. Integrated Management of Childhood Illness Chart Booklet. 2014.
11. Kolstad PR, Burnham G, Kalter HD, Kenya-Mugisha N, Black RE. The integrated management of childhood illness in western Uganda. Bull World Health Organ 1997; 75 Suppl 1: 77–85.
12. Lai CKW, Beasley R, Crane J, Foliaki S, Shah J, Weiland S, the ISAAC Phase Three Study Group. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009; 64: 476–83. doi: 10.1136/thx.2008.106609 19237391
13. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733–43. doi: 10.1016/S0140-6736(06)69283-0 16935684
14. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332: 133–8. doi: 10.1056/NEJM199501193320301 7800004
15. Benício MHD, Ferreira MU, Cardoso MR, Konno SC, Monteiro CA. Wheezing conditions in early childhood: prevalence and risk factors in the city of São Paulo, Brazil. Bull World Health Organ 2004; 82: 516–22. 15508196
16. Hazir T, Qazi S, Nisar YB, Ansari S, Maqbool S, Randhawa S, et al. Assessment and management of children aged 1–59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan. Arch Dis Child 2004; 89: 1049–54. doi: 10.1136/adc.2003.035741 15499063
17. Sachdev HP, Mahajan SC, Garg A. Improving antibiotic and bronchodilator prescription in children presenting with difficult breathing: experience from an urban hospital in India. Indian Pediatr 2001; 38: 827–38. 11520993
18. Nantanda R, Tumwine JK, Ndeezi G, Ostergaard MS. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda: Evidence of under-diagnosis of asthma. PLoS One 2013; 8: 1–9.
19. Zar HJ, Levin ME. Challenges in treating pediatric asthma in developing countries. Pediatr Drugs 2012; 14: 353–9.
20. Cragg L, Williams S, Chavannes NH. FRESH AIR: an implementation research project funded through Horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings. npj Prim Care Respir Med 2016; 26: 16035. doi: 10.1038/npjpcrm.2016.35 27356621
21. World Health Organization. Tool to evaluate the quality of care delivered to sick children attending outpatients facilities. Geneva, 2003.
22. Harris PA, Taylor R, Thielke R, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 2009; 42: 377–81.
23. Chandler CIR, Nadjm B, Boniface G, Juma K, Reyburn H, Whitty CJM. Assessment of children for acute respiratory infections in hospital outpatients in Tanzania: What drives good practice? Am J Trop Med Hyg 2008; 79: 925–32. 19052307
24. Reyburn H, Mwakasungula E, Chonya S, Mtei F, Bygbjerg I, Poulsen A, et al. Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania. Bull World Health Organ 2008; 86: 123–39.
25. Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H, WHO Child Health Epidemiology Reference Group. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ 2004; 82: 895–903. 15654403
26. WHO. Essential Medicines List. 2017 http://www.who.int/medicines/publications/essentialmedicines/20th_EML2017.pdf?ua=1.
27. WHO. ANTIMICROBIAL RESISTANCE Global Report on Surveillance. Geneva, 2014 http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1.
28. O’Neill J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. 2016 https://amr-review.org/sites/default/files/160525_Finalpaper_with cover.pdf.
29. Havers FP, Hicks LA, Chung JR, Gaglani M, Murthy K, Zimmerman RK, et al. Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons. JAMA Netw Open 2018; 1: e180243. doi: 10.1001/jamanetworkopen.2018.0243 30646067
30. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane database Syst Rev 2014;: CD001831. doi: 10.1002/14651858.CD001831.pub5 25420096
31. De Sutter A. There is no good evidence for the effectiveness of commonly used over-the-counter medicine to alleviate acute cough. Evid Based Med 2015; 20: 98. doi: 10.1136/ebmed-2014-110156 25743170
32. Leonard K, Masatu MC. Outpatient process quality evaluation and the Hawthorne Effect. Soc Sci Med 2006; 63: 2330–40. doi: 10.1016/j.socscimed.2006.06.003 16887245
33. Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, et al. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ 2017; 95: 537–9. doi: 10.2471/BLT.16.187476 28670019
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PLOS One
2019 Číslo 11
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