Revisiting Community Case Management of Childhood Pneumonia: Perceptions of Caregivers and Grass Root Health Providers in Uttar Pradesh and Bihar, Northern India

Abstract

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of under-five mortality globally with almost one-quarter of deaths occurring in India.ObjectivesTo identify predisposing, enabling and service-related factors influencing treatment delay for CAP in rural communities of two states in India. Factors investigated included recognition of danger signs of CAP, health care decision making, self-medication, treatment and referral by local practitioners, and perceptions about quality of care.MethodsQualitative research employing case studies (CS) of care-seeking, key informant interviews (KII), semi-structured interviews (SSI) and focus group discussions (FGD) with both video presentations of CAP signs, and case scenarios. Interviews and FGDs were conducted with parents of under-five children who had suffered CAP, community health workers (CHW), and rural medical practitioners (RMP).ResultsFrom September 2013 to January 2014, 30 CS, 43 KIIs, 42 SSIs, and 42 FGDs were conducted. Recognition of danger signs of CAP among caregivers was poor. Fast breathing, an early sign of CAP, was not commonly recognized. Chest in-drawing was recognized as a sign of serious illness, but not commonly monitored by removing a child’s clothing. Most cases of mild to moderate CAP were brought to RMP, and more severe cases taken to private clinics in towns. Mothers consulted local RMP directly, but decisions to visit doctors outside the village required consultation with husband or mother-in-law. By the time most cases reached a public tertiary-care hospital, children had been ill for a week and treated by 2-3 providers. Quality of care at government facilities was deemed poor by caregivers.ConclusionTo reduce CAP-associated mortality, recognition of its danger signs and the consequences of treatment delay needed to be better recognized by caregivers, and confidence in government facilities increased. The involvement of RMP in community based CAP programs needs to be investigated further given their widespread popularity.

Epidemiology, clinical characteristics, laboratory findings and severity of respiratory syncytial virus acute lower respiratory infection in Malaysian children, 2008–2013

“…This may be due to poor parental or caretakers' perception and wrong reporting of illness severity and symptoms causing in delayed recognition of and care seeking for severe RSV ALRI. Available evidence suggests that recognition of symptoms of severe childhood ALRI such as chest in‐drawing and rapid breathing is low in third world countries . It is also not uncommon in developing countries to encounter caretakers who prefer self‐treatment with over‐the‐counter prescriptions or traditional medicine first before considering hospital care, when their children develop ALRI albeit lack of data from Malaysia …”

Developing effective health communication messages for community acquired pneumonia in children under five years of age: A rural North Indian qualitative study

“…Research found that Hindi terms for signs of CAP and the term 'pneumonia' as a word connoting serious respiratory condition were understood in all seven districts of the two states. 2 Customizing messages in local dialects was therefore not needed. 2 Five multicolored posters were created using simple language and easy to understand images for pretesting.…”

“…After preliminary data analysis, 42 additional semi-structured interviews (SSIs) with caregivers and 42 focus groups (FGs) with caregivers and CHWs further investigated key issues associated with CAP related response within households reported elsewhere. 2 Core themes identified for CAP related message development are listed elsewhere. 2 Step two: Creative conceptualization of messages Communication experts worked closely with the research team to develop text based messages and evocative images and story based scripts addressing core themes identified during formative research.…”

“…2 Core themes identified for CAP related message development are listed elsewhere. 2 Step two: Creative conceptualization of messages Communication experts worked closely with the research team to develop text based messages and evocative images and story based scripts addressing core themes identified during formative research. Scripts were set in rural settings and anonymous characters were developed from real-life stories gathered during formative research.…”

“…To understand care-seeking behavior in cases of CAP in children in rural North India, we conducted formative research (findings published elsewhere) 2 on illness perceptions and health care seeking practices of caregivers and the knowledge and health care advice of community health workers (CHWs) in seven districts of U.P. and Bihar states.…”