Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.
Joint first authorship.
J Glob Health. 2018 Dec;8(2):020805. doi: 10.7189/jogh.08.020805.
This study aimed to investigate the differences in reported care seeking behaviour and treatment between children with pneumonia and children without pneumonia with cough and/or difficult breathing.
Three hundred and two children aged 0-59 months with fast breathing pneumonia were matched with 302 children seeking care for cough and/or difficult breathing at four outpatient clinics in Ibadan, Nigeria. After follow up at home, Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questionnaires were administered in the community by trained field workers to gather information around care seeking delay, patterns of care seeking, appropriateness of care seeking and treatment provided once care was sought. Multivariable analysis was carried out to determine significant factors associated with care seeking delay.
Children with pneumonia had a significantly longer delay (median = 3d) before seeking care than those without pneumonia (median = 2d; = 0.001). The length of the delay was 21% (95% confidence interval (CI) = 1%-42%) greater in those aged 0-1 month and 11% (95% CI = 5%-42%) greater in those aged 2-11 months compared to those aged 12-59 months. The length of delay was 17% (95% CI = 5%-30%) greater in rural locations than urban ones, and 33% (95% CI = 7%-51%) shorter in fathers with only primary education compared to higher education, adjusted for covariates. The range of places where care was sought showed the same distribution in those with and without pneumonia. Twenty two per cent of those with pneumonia sought care first from inappropriate providers. The number of children for whom caregivers reported having received antibiotic treatment was 92% for those with pneumonia and 84% for those without pneumonia.
Given that children with pneumonia and cough/cold had similar patterns of reported care seeking information gathered on care seeking (type of provider visited) from DHS and MICS surveys on those with 'symptoms of acute respiratory infection' in this setting provide a reasonably valid indication of care seeking behaviours in children with pneumonia. There are high levels of antibiotic overuse for children with cough/cold in this setting which risks worsening antibiotic resistance.
本研究旨在调查患有肺炎和咳嗽/呼吸困难但无肺炎的儿童之间报告的就诊行为和治疗差异。
302 名 0-59 月龄患有快速性呼吸肺炎的儿童与在尼日利亚伊巴丹的四家门诊就诊的 302 名患有咳嗽/呼吸困难的儿童相匹配。在家庭随访后，由经过培训的现场工作人员在社区中使用人口与健康调查（DHS）和多指标类集调查（MICS）问卷收集有关就诊延迟、就诊模式、就诊合理性以及寻求医疗后提供的治疗方面的信息。采用多变量分析确定与就诊延迟相关的显著因素。
患有肺炎的儿童在就诊前的延迟时间明显长于没有肺炎的儿童（中位数=3d 比中位数=2d；=0.001）。与 12-59 月龄的儿童相比，0-1 月龄的儿童的延迟时间长 21%（95%置信区间[CI]：1%-42%），2-11 月龄的儿童的延迟时间长 11%（95% CI：5%-42%）。与城市相比，农村地区的延迟时间长 17%（95% CI：5%-30%），与受教育程度较高的父亲相比，受教育程度较低的父亲的延迟时间短 33%（95% CI：7%-51%），调整了协变量。在肺炎患者和无肺炎患者中，寻求医疗的地点范围相似。22%的肺炎患者首先从不合适的提供者那里寻求医疗。报告接受抗生素治疗的儿童人数为肺炎患者 92%，无肺炎患者 84%。
鉴于在该环境中，DHS 和 MICS 调查中患有肺炎和咳嗽/感冒的儿童的报告就诊信息在就诊类型上相似，因此患有肺炎的儿童的就诊行为提供了合理有效的指示。在这种情况下，儿童咳嗽/感冒中抗生素过度使用的比例很高，这会增加抗生素耐药性的风险。
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