Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment

Abstract

Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%), the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool). Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.

Determinants of Care Seeking for Children With Pneumonia and Diarrhea in Guatemala: Implications for Intervention Strategies

“…The reported prevalence rates for severe pneumonia (11.6%) and severe diarrhea (15.3%) are high, but consistent with estimates derived from similar questions used, for example, in Demographic and Health Surveys, 18 and reflect the sensitive but nonspecific characteristics of this method. 19 The nurse auxiliary validation study showed reasonable agreement with fieldworker interviews, allowing for the expected lower specificity of the latter. Furthermore, it is important that care is sought for sick children who-on the basis of symptoms or signs apparent to parents-may have severe pneumonia or diarrhea (and not just clinically confirmed cases).…”

An analysis of national data on care-seeking behaviour by parents of children with suspected pneumonia in Nigeria

“…Caution must be taken in the use of suspected pneumonia as a defining factor for determining true burden of pneumonia as the term includes several false positives and as such overestimates pneumonia two to seven fold. [25] However, its use as a denominator for evaluating careseeking behaviour in large-scale studies (≥20 000 children) is appropriate and has been validated. [25] …”

“…[25] However, its use as a denominator for evaluating careseeking behaviour in large-scale studies (≥20 000 children) is appropriate and has been validated. [25] …”

Factors Related to Incidence of Pneumonia among Toddlers

“…So that, physical condition of house environment should be repaired by management of house ventilation, health counseling and improvement of health worker's capacity in handling of pneumonia among toddlers in order to prevent transmission through air to healthy toddlers. 1,2 Then for condition in relation to smoke around the house environment or outdoor, it needed special actions or strategies, such as managing straw burning that should be limited between sunset to reduce pollution level. 8 …”

“…1 Nowadays, pneumonia is one of largest causes of child mortality, especially in newborn period. 2 So that, World Health Organization (WHO) in cooperation with United Nations Children's Fund (UNICEF) make The Integrated Management of Childhood Illness (IMCI). The aim of this activity is to decrease number of child death and illness due to diseases including pneumonia.…”