Carina King1,2, Masford Banda3,4, Naor Bar-Zeev5, James Beard2, Neil French6, Charles Makwenda3, Eric D McCollum5,7, Malizani Mdala3, Yasir Bin Nisar8, Tambosi Phiri3, Shamim Ahmad Qazi8, Tim Colbourn2. 1. Department of Global Public Health, Karolinska Institute, Stockholm, Sweden. 2. Institute for Global Health, University College London, London, UK. 3. Parent and Child Health Initiative, Lilongwe, Malawi. 4. Centres for Disease Control and Prevention, Lilongwe, Malawi. 5. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. 6. Institute of Infection, University of Liverpool, Liverpool, UK. 7. Department of Pediatrics, Johns Hopkins Medicine, Baltimore, USA. 8. Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
Abstract
Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as 'acute respiratory infection' using InterVA-4. Data were extracted from free-text narratives based on domains in the 'Pathways to Survival' framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed. Copyright:
Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as 'acute respiratory infection' using InterVA-4. Data were extracted from free-text narratives based on domains in the 'Pathways to Survival' framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed. Copyright:
Authors: Hamish R Graham; Omotayo E Olojede; Ayobami Adebayo A Bakare; Eric D McCollum; Agnese Iuliano; Adamu Isah; Adams Osebi; Ibrahim Seriki; Tahlil Ahmed; Samy Ahmar; Christine Cassar; Paula Valentine; Temitayo Folorunso Olowookere; Matt MacCalla; Obioma Uchendu; Rochelle Ann Burgess; Timothy Colbourn; Carina King; Adegoke G Falade Journal: BMJ Open Date: 2022-05-02 Impact factor: 3.006
Authors: Carl Otto Schell; Karima Khalid; Alexandra Wharton-Smith; Jacquie Oliwa; Hendry R Sawe; Nobhojit Roy; Alex Sanga; John C Marshall; Jamie Rylance; Claudia Hanson; Raphael K Kayambankadzanja; Lee A Wallis; Maria Jirwe; Tim Baker Journal: BMJ Glob Health Date: 2021-09
Authors: Carina King; Beatiwel Zadutsa; Lumbani Banda; Everlisto Phiri; Eric D McCollum; Josephine Langton; Nicola Desmond; Shamim Ahmad Qazi; Yasir Bin Nisar; Charles Makwenda; Helena Hildenwall Journal: Bull World Health Organ Date: 2022-03-25 Impact factor: 9.408