8. Acute respiratory infections
Click on the link for details of the Leeds Health Education Database 2015 Project, a complete listing of papers included and a listing of papers on ARI reviewed but not included in the database
Bang, A.T., Bang, R.A., Tale, O., Sontakke, P., Solanki, J., Wargantiwar, R., and Kelzarkar, P. Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India. Lancet 336:201-206, 1990. Ref ID : 2598
Target Group/Country 58 rural villages in Gadchiroli, India.
Intervention Methodology The interventions included mass education about childhood pneumonia and case management of pneumonia by paramedics, village healthworkers, and traditional birth attendants (TBAs) who were trained to recognize childhood pneumonia and treat it with cotrimoxazole. Four messages were given in the health education: cough in a child without fast breathing of difficulty in breathing is simple and can be managed at home without special medicines, fast breathing and or difficulty in breathing may indicate pneumonia which is life threatening, treatment for pneumonia is available in your village with the paramedic, VHW or TBA, the medicine is called "kotra" which is effective, safe and available free. The health education was carried out by means of a set of flash cards, a wall poster, a slide show and a video cassette and a health carnival in a Women's health and awareness week.,
Evaluation Method 692 children from 25 intervention villages and 18 control villages. Each village health worker visited the same 15 children once every 2 weeks and asked whether any upper respiratory infection ( cough and or nasal dischage or pneumnonia had occurred. . The source of care and the outcome of the attack was noted, Children were weighted twice a year.
Impact Achieved Parents sought treatment, and coverage was 76% without active case-detection efforts. The case-fatality rate among the 612 treated by health workers was 0.8%, compared with 13.5% in the control area. After a year of intervention, pneumonia-specific childhood mortality was significantly lower (p<0.001) in the intervention than in the control area (8.1 vs 17.5 deaths/1000 children under 5 years); the difference between the areas was greatest in children under 1 year. The difference in infant morality (89 vs 121/1000, p<0.001) and total under-5 mortality (28.5 vs 40.7/1000, p<0.005) were highly significant . Mortality from other causes remained similar in the 2 areas but neonatal mortality due to birth injury and prematurity was significantly lower in the intervention area, presumably owing to the combination of better maternal and neonatal care by the TBAs trained in the project and the availability of treatment for pneumonia. The cost of cotrimoxazole was US $0.025/child/year ($2.64/child saved
Chongsuvivatwong, V., Mo-suwan, L., Tayakkanonta, K., Vitsupakorn, K., and McNeil, R. Impacts of training of village health volunteers in reduction of morbidity from acute respiratory infections in childhood in southern Thailand. Southeast Asian J.Trop.Med.Public Health 27(2):333-338, 1996. Ref ID : 7752
Target Group/Country Mothers in Nong Chik District , Pattani Province, Thailand
Intervention Methodology A five-year education program on management of cases with acute respiratory infection (ARI). A 2-day training workshop for village health volunteers from the study villages was conducted. While details of the training programme are briefly discussed, no information is provided of the expected health communication role of the village health volunteers.
Evaluation Method 30 villages in the study district were randomly allocated into 15 study and 15 control villages. The cohort of children age below 5 years in the two areas were followed-up for 19 week in the peak season of the disease. 664 and 649 target children with 67,083 and 67,984 child-days were observed in the study and the control villages,
Impact Achieved 71 and 41 children, in the intervention and control villages respectively, were free from any episode. The preventive odds ratio of treatment adjusted for age and village effects = 0.88, 95% (CI 0.4-1.95). The median of the average sick periods in the individuals were 27 and 34 days, respectively. After adjusting for age, episodes/month and locality, the ratio of average sick days between children in the study and control villages was 0.89 (95% CI 0.76-1.05) or 11% shorter duration without statistical significance. The adjusted odds ratios of visiting the health center, private clinics, the community hospital and provincial hospital were 0.95 (95% CI 0.69-1.25), 1.43 (95% CI 0.98-2.11), 2.01 (95% CI 1.06-3.82) and 4.71 (95% CI 1.50-14.8), respectively. The training program thus had rather little impact on morbidity of the disease but tended to promote utilization of higher level of health services by the affected children .
Ellerbeck, E., Khallaf, N., el Ansary, K.S., Moursi, S. and Black, R. (1995) Caretaker compliance with different antibiotic formulations for treatment of childhood pneumonia. J. Trop. Pediatr. 41, 103-108. Ref ID : 4104
Target Group/Country Care-givers to children at outpatient clinics at the Ismailiya governorate of Egypt
Intervention Methodology Treatment involved one of the following formulations of cotrimoxazole: 1. syrup accompanied by a 10-ml measuring cup; 2. syrup accompanied by a 5-ml measuring spoon; 3. tablets; 4. single-dose sachets of antibiotic powder. All care givers were given standardised verbal instructions on giving the antibiotics
Evaluation Method 400 children, aged 2 months to 5 years, with a presumptive diagnosis of pneumonia, were randomly assigned to receive each formulation. A research assistant visited the child's home on the fourth day of therapy, asked the care-giver about compliance, and observed the care-giver prepare a dose of the medication. The remaining amount of medicine was measured, and when possible (n = 151), a urine specimen was tested for the presence of sulphamethoxazole.
Impact Achieved All of the care-givers reported giving at least one dose on the first day of therapy. By the fourth day, 82 per cent of those receiving syrup were still taking their medication compared to 71 and 55 per cent of those receiving sachets or tablets, respectively (P < 0.01). Of those who received syrup accompanied by a spoon, 38 per cent under-dosed the medicine by at least 30 per cent. Overall, compliance was highly correlated with the care-giver's report of difficulty in administering the medication.
Gunay, O., Ozturk, A., and Ozturk, Y. The impact of mothers' health education on the prevalence of acute respiratory infections in children. Turk.J.Pediatr. 36:1-5, 1994. Ref ID : 4431
Target Group/Country Mothers in Hacilar district of Kayseri, a province in Central Anatolia
Intervention Methodology The intervention consisted of 30 minutes of face-to-face education in the home by the health centre doctor of mothers regarding ARI prevention and treatment. This was supported by a booklet that was given to the mothers.
Evaluation Method The intervention group included 69 children and the control group 57 children between the ages of 0 and 4 years. The children in both groups were checked for symptoms of acute respiratory infections (ARI) in January 1990 and 1991, before and after intervention. In addition, the numbers of clinic visits by children for acute infections before and after intervention were compared.
Impact Achieved The prevalence of acute respiratory infections decreased from 49.3% to 27.5% in the intervention group and from 43.9% to 38.6% in the control group. The decrease in the prevalence of acute respiratory infections in the intervention group differed significantly (p<0.05), from that of the control group. On the other hand, clinic visits by the intervention group for acute respiratory infections increased significantly (p<0.05).
Lye, M.S., Nair, R.C., Choo, K.E., Kaur, H., and Lai, K.P. Acute respiratory tract infection: a community-based intervention study in Malaysia. J.Trop.Pediatr. 42(3):138-143, 1996. Ref ID : 6310
Target Group/Country Mothers in Kelantan, Malaysia
Intervention Methodology Interventions included health education of mothers on childhood pneumonia and training of health staff on case management. Illustrated billboards showing key messages were placed in the market place and other locations. Pamphlets containing messages on the signs and symptoms of ARI and appropriate management were distributed to the households in the intervention area. Mothers attending well-baby clinics were shown a video followed y health education talks on recognition of symptoms and signs of pneumonia and its management. A mobile health education team travelled to the villages giving talks on ARI control. In the control area no special interventions were instituted except for the routine measures for ARI treatment and control.
Evaluation Method In a house-to-house survey 1382 and 1107 children less than 5 years of age in the intervention and control areas, respectively, were followed up every 2 weeks over a 62-week period.
Impact Achieved The reduction in the incidence of severe ARI cases in the intervention area was significantly greater than in the control area (P < 0.05). The ARI mortality rates were low in both the intervention and control areas (p < 0.1%). Note while this study is of value in demonstrating a reduction in case fatality rates a disappointing feature is the lack of any supporting data to identify the contribution of the educational components.
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