| dc.description.abstract | Background: Pneumonia is a leading cause of childhood mortality globally, with 17-26% of deaths in children under 5 years in sub-Saharan Africa being attributed to pneumonia. Many of these deaths are attributed to delay in seeking care and inadequacies in health facilities and the referral mechanisms. Thus care-seeking interventions have the potential to substantially reduce mortality. There are no studies done in Kenya to inform on the pattern of pre-admission care-
, seeking behavior for severe and very severe pneumonia in children less than 5 years.
Objectives: To describe the pattern of health care sought and types of treatment received prior to admission at Kenyatta National Hospital (KNH), for 2-59month old children, admitted with severe and very severe pneumonia. ..
Methods: A hospital-based cross-sectional survey was conducted between June and September
2009 at KNH Pediatric Emergency Unit. Subjects were 2-59 month old children with severe and very severe pneumonia and their caregivers. Formal care was considered as healthcare sought from doctors, clinical officers or nurses in government or private health facilities. Informal care was considered as use of home remedies, traditional herbs, over the counter drugs or healthcare sought from a traditional healer or herbalist. Care seeking was classified as appropriate if interval between the caregiver first noticing signs of acute lower respiratory tract infection and contact with a formal health provider was <3days, and no informal care was used.
Results: A total of 385 caregivers and their children were recruited and interviewed. There were
171/385(44.4%) children with severe pneumonia. About half, 204/385(53%) of the children were female. The median age of the patients was 8.8months, and that of the caregivers was 26.1 years. Prior to admission, most (80.6%) patients had sought care at other formal health facilities. A minority (22.6%) of patients had used informal care. Less than half, 174/385(45.2%) of the patients recruited had appropriate care seeking behavior. Antibiotics were used by
245/330(77.3%) of patients, and the commonest antibiotic used was amoxicillin-clavulanate
(51.6%). KNH was the first point of formal care for 73/382(19.1%) of patients. Appropriate care seeking was found to be associated with previous admission (OR=0.53, 95%CI=0.32-0.88), prior
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treatment with antibiotics for the current illness (OR=0.46, 95%CI=0.25-0.83), the presence of wheeze (OR=0.54, 95%CI=0.33-0.88) and with respiratory rates of ?_70 per minute (OR=0.65,
95%CI=0.42-1.00).
Conclusion: Most of the children with severe and very severe pneumonia are treated at other formal health facilities prior to admission (80.6%). Half of the caregivers of 2 to 59 month old children with severe and very severe pneumonia, have inappropriate care seeking behaviour (52.5%). Amoxicillin-clavulanate and macrolides are commonly prescribed antibiotics in the out patient setting | en |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
