Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers’ U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children’s recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.

Continuity of mental health care is central to improve the treatment and rehabilitation of people with mental disorders. While most studies on continuity of care fail to take the perspectives of service users into account, the aim of this study was to explore the perceived meanings of continuity of care among people with long-term mental disorders. Fifteen service users participated in semi-structured in-depth interviews. We used template analysis to guide the analysis. The main transversal themes of continuity were “Navigating the system” and “Connecting to people and everyday life.” While the first theme related to the participants’ experiences of their interaction with the mental health care system, the latter related to their hopes and perceived opportunities for a good life as desired outcomes of mental health care. We conclude that efforts to improve continuity of mental health care should be tailored to the priorities of service users.

No abstract

Background: Worldwide, asthma is the most frequent non-communicable disease in childhood, often starting in infancy. However, asthma is underdiagnosed in children <5 years of age (Under-5s) in low and middle-income countries. Aims: This study explored perceptions of, and reasons for, underdiagnosis of asthma in Under-5s in rural Kyrgyzstan. Methods: Semi-structured qualitative interviews with 22 rural primary care health professionals and 13 caregivers to Under-5s with recurrent lower respiratory tract illnesses. Results: Most health professionals and caregivers perceived asthma as a severe, debilitating, and potentially fatal disease in young children. None of the health professionals had diagnosed any Under-5s with asthma. In the health professionals’ biomedical understanding, asthma occurs predominantly in adolescents and adults, and consists of attacks of respiratory distress, with mandatory heredity and allergy. The health professionals veered away from the asthma diagnosis to avoid scaring parents, and they replaced the diagnostic vacuum with infectious diagnoses. Surprisingly, stigma regarding the population with asthma appeared to be uncommon. Most caregivers were receptive to the idea of treatment with inhaled medication and to the statement that asthma could also be a mild disease. Conclusion: The apparent systemic underdiagnosis of asthma in rural Kyrgyzstan seemed self-perpetuating. The misconceptions and dated diagnostic criteria and tradition had no provision for asthma in Under-5s; therefore, few children were diagnosed with asthma. This reinforced the inappropriate fear and belief in society that asthma is a rare, severe, and debilitating disease. Training of health professionals and providing information to the public should address the current perception of asthma and raise awareness that asthma is often a mild and treatable disease.

No abstract