Mothers' perceptions of severe pneumonia in their own children: A controlled study in Pakistan

Mull, Dorothy S.; Mull, J. Dennis; Kundi, M. Z. Malik; Anjum, Muhammad Usman

doi:10.1016/0277-9536(94)90429-4

Cited by 29 publications

(22 citation statements)

References 26 publications

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“…Moreover, recent collaborative work conducted by the authors with a much larger sample of 370 mothers attending a hospital near Islamabad (Kundi et al 1993;Mull et al 1994) has confirmed the major findings. However, as with most studies of community health beliefs and practices, these results give both cause for relief and cause for concern.…”

Section: Implications and Discussionsupporting

confidence: 79%

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Insights from community‐based research on child pneumonia in Pakistan

1993

Medical Anthropology

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Although pneumonia is a major cause of death in Pakistan, little is known about community beliefs and practices surrounding the disease. In this study, 35 mothers and four self-trained allopathic practitioners were interviewed in Karachi squatter settlements and rural Punjab. The findings indicate that maternal ideas about chest anatomy and the cause of pneumonia (principally "coldness") are very different from biomedical concepts. Further, mothers judge fast breathing impressionistically and tend to attribute it to fever alone. Nevertheless, they know that it is abnormal and most also link chest indrawing with pneumonia. Only mothers lacking other options take their children to government health facilities. Instead, most turn to private (frequently unlicensed) practitioners, although observation shows that such individuals are unable to diagnose pneumonia correctly and that they build their practices around the indiscriminate use of antibiotics. The study demonstrates that the target of ARI education in Pakistan should extend beyond government doctors to mothers and private practitioners as well.

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Section: Implications and Discussionsupporting

confidence: 79%

“…There, most mothers interviewed were able to recognize the signs in their own children (Kundi et al 1993;Mull et al 1994). Similar findings have been reported from The Gambia (Campbell, Byass, and Greenwood 1990).…”

Section: Pneumonia Concepts In Pakistan 349supporting

confidence: 83%

Insights from community‐based research on child pneumonia in Pakistan

1993

Medical Anthropology

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“…However, using the mean estimate of sensitivity (31%) and specificity (91%) of caregiver report of fast or difficult breathing for prediction of true pneumonia (diagnosed by a study physician) from two community-based studies in Gambia [18] and Pakistan [19] would yield 94 reported cases of “suspected pneumonia” among 1,000 children. This represents a ratio of “suspected pneumonia” to true pneumonia of 5.2∶1 (94/18) and a positive predictive value of only 6.4% (6/94).…”

Section: How Well Do Reported Symptoms and Signs Of Pneumonia Indicatmentioning

confidence: 99%

“…If we use the data from Gambia [18] and Pakistan [19] on test specificity and sensitivity combined with longer recall periods, the proportion of “suspected pneumonia that is true pneumonia (positive predictive value) would rise from 6.4% to 9.8% (or 16.7%) based on four-week (or eight-week) recall, respectively. Because these predictions are based on the assumption that test performance would not change with the longer recall period, it will be important to test this assumption (see [20]) before any such increase in recall period is introduced into surveys.…”

Section: Another Strategy For Improving the Positive Predictive Valuementioning

confidence: 99%

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

et al. 2013

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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.

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“…Many children who die in developing countries as a result of acute lower respiratory infection (ALRI) do not receive adequate treatment during the early stages of disease either because carers do not recognise the severity of illness in sufficient time,5 6 or because delays are introduced by inappropriate treatment at home or difficulties accessing health care 7. If untreated, pneumonia may cause death within 3–4 days of symptom onset 8.…”

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confidence: 99%