Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
Department of Community Medicine, University College Hospital, Ibadan, Nigeria.
Front Public Health. 2023 Jul 18;11:1198225. doi: 10.3389/fpubh.2023.1198225. eCollection 2023.
Between 2013 and 2022, Nigeria did not meet globally defined targets for pneumonia control, despite some scale-up of vaccinations, oxygen and antibiotics. A deliberate focus on community-based programs is needed to improve coverage of protective, preventive and treatment interventions. We therefore aimed to describe caregiver knowledge and care seeking behaviour for childhood pneumonia, in a high child mortality setting in Nigeria, to inform the development of effective community-based interventions for pneumonia control.
We conducted a cross-sectional household survey in Kiyawa Local Government Area, Jigawa State, Nigeria between December 2019 and March 2020. We asked caregivers about their knowledge of pneumonia symptoms, prevention, risks, and treatment. A score of 1 was assigned for each correct response. We showed them videos of pneumonia specific symptoms and asked (1) if their child had any respiratory symptoms in the 2-weeks prior; (2) their subsequent care-seeking behaviour. Multivariate regressions explored socio-demographic and clinical factors associated with care seeking.
We surveyed 1,661 eligible women, with 2,828 children under-five. Only 4.9% of women could name both cough and difficulty/fast breathing as pneumonia symptoms, and the composite knowledge scores for pneumonia prevention, risks and treatment were low. Overall, 19.0% (536/2828) of children had a report of pneumonia specific symptoms in the prior two-weeks, and of these 32.3% (176/536) were taken for care. The odds of care seeking was higher among children: with fever (AOR:2:45 [95% CI: 1.38-4.34]); from wealthiest homes (AOR: 2:13 [95% CI: 1.03-4.38]) and whose mother first married at 20-26 years compared to 15-19 years (AOR: 5.15 [95% CI: 1.38-19.26]). Notably, the caregiver's knowledge of pneumonia was not associated with care seeking.
While some socio-demographic factors were associated with care seeking for children with symptoms of Acute Respiratory Infection (ARI), caregiver's knowledge of the disease was not. Therefore, when designing public health interventions to address child mortality, information-giving alone is likely to be insufficient.
尽管在 2013 年至 2022 年期间，尼日利亚在肺炎控制方面并未达到全球定义的目标，但疫苗接种、氧气和抗生素的使用有所增加。需要有针对性地关注基于社区的项目，以提高保护性、预防性和治疗性干预措施的覆盖面。因此，我们旨在描述在尼日利亚高儿童死亡率地区，照顾者对儿童肺炎的知识和寻求护理的行为，以为肺炎控制的基于社区的有效干预措施的制定提供信息。
我们于 2019 年 12 月至 2020 年 3 月在尼日利亚吉加瓦州基亚瓦地方政府区进行了一项横断面家庭调查。我们询问了照顾者对肺炎症状、预防、风险和治疗的了解情况。对于每个正确的回答，我们给 1 分。我们向他们展示了肺炎特定症状的视频，并询问了以下问题：（1）他们的孩子在过去两周内是否有任何呼吸道症状；（2）他们随后的护理寻求行为。多变量回归分析探讨了与护理寻求相关的社会人口学和临床因素。
我们调查了 1661 名符合条件的妇女，其中有 2828 名 5 岁以下儿童。只有 4.9%的妇女能说出咳嗽和呼吸困难都是肺炎的症状，而对肺炎预防、风险和治疗的综合知识得分较低。总的来说，在过去两周内，有 19.0%（536/2828）的儿童有肺炎的特定症状报告，其中 32.3%（176/536）接受了治疗。有发热的儿童（优势比：2:45[95%置信区间：1.38-4.34]）、来自最富裕家庭的儿童（优势比：2:13[95%置信区间：1.03-4.38]）和母亲首次结婚年龄在 20-26 岁的儿童（优势比：5.15[95%置信区间：1.38-19.26]）更有可能寻求护理。值得注意的是，照顾者对肺炎的了解与护理寻求无关。
虽然一些社会人口学因素与有急性呼吸道感染（ARI）症状的儿童的护理寻求有关，但照顾者对疾病的了解却没有。因此，在设计解决儿童死亡率的公共卫生干预措施时，仅仅提供信息可能是不够的。
