Pre-hospital care seeking behaviour for childhood acute respiratory infections in south-western Nigeria.

WHO/UNICEF currently recommend that childhood malaria and pneumonia be managed together in the community; most African countries are in the process of developing this policy. We conducted a cross-sectional study to determine maternal awareness of general danger signs of childhood illnesses and the prevalence, determinants and sources of pre-hospital treatment by mothers during their child's acute respiratory illness in a poor urban community in south-western Nigeria. A total of 226 mothers were interviewed. Only 4.9% of the mothers were aware of the two pneumonia symptoms: difficult breathing and fast breathing. About 75% of the children were given pre-hospital medication at home and only 16.5% of them received the drugs within 24 hour of symptom recognition. Drug shops/patent medicine vendors (PMVs; 70.6%) were the most common source of care. Wishing to try home management first (46.6%); waiting for the child to improve (14.4%) and lack of money (31.6%) delayed care-seeking. Older maternal age (aOR 2.3; 95% CI 1.2-4.4) and having a child with cough and difficult and/or fast breathing (aOR 2.3; 95% CI 1.1-5.2) were positive predictors of pre-hospital treatment. Maternal education and adequately equipping PMVs could improve prompt access to integrated community-based child health services in Nigeria.

Clinical overlap between malaria and pneumonia: can malaria rapid diagnostic test play a role?

INTRODUCTION: Malaria and pneumonia account for 40% of mortality among children under five years of age in sub-Saharan Africa. Due to lack of diagnostic facilities, their management is based on the integrated management of childhood illnesses (IMCI) strategy. Symptoms of malaria and pneumonia overlap in African children, necessitating dual IMCI classifications at health centres and treatment with both antibiotics and antimalarials. This study determined the prevalence of malaria-pneumonia symptom overlap and confirmed the diagnosis of malaria in these cases using a rapid diagnostic test. METHODOLOGY: Consecutive consultations of 1,216 children (two months to five years old) were documented over a three-month period in a comprehensive health centre. Malaria rapid diagnostic tests were conducted only for children who had symptom overlap. RESULTS: Of the 1,216 children enrolled, 1,090 (90%) reported cough or fever. Among the children fulfilling the malaria case definition, 284 (30%) also met the pneumonia case definition. Twenty-three percent (284) of all children enrolled met the criteria for both malaria and pneumonia. However, only 130 (46%) of them had a positive result for malaria using a malaria rapid diagnostic test. During a malaria-pneumonia overlap, female children (chi-square 5.9, P = 0.01) and children ≥ one year (chi-square 4.8, P = 0.003) were more likely to seek care within two days of fever. CONCLUSION: Dual treatment with antimalarials and antibiotics in children with malaria-pneumonia overlap may result in unnecessary over-prescription of antimalarial medications. Use of rapid diagnostic tests in their management can potentially avoid over-prescribing of malaria medications.

Outcome of presumptive versus rapid diagnostic tests-based management of childhood malaria - pneumonia overlap in urban Nigeria: a pilot quasi-experimental study.

BACKGROUND: Symptoms of malaria and pneumonia overlap in African under-five children and the integrated management of childhood illness strategy require that such children be managed presumptively with both antibiotics and antimalarials. A 2003 WHO expert meeting recommended the evaluation of malaria rapid diagnostic test in the management of children with this overlap, but this has not been evaluated. Therefore, the objective of this study was to compare the clinical outcome of presumptive versus malaria rapid diagnostic test-based management of childhood malaria-pneumonia overlap in Nigeria. METHODS: A pilot quasi-experimental study was conducted November 2009 through February 2010 in an urban comprehensive health centre in Ogun, South-Western Nigeria. First, 50 children with malaria-pneumonia symptom overlap were consecutively enrolled and treated presumptively with antibiotics and antimalarials irrespective of malaria test result (control arm).Then, another 50 eligible children were enrolled and treated with antibiotics with/out antimalarials based on rapid diagnostic test result (intervention arm). Primary endpoint: clinical cure at day-5. The data were analyzed using Epi Info version 3.4.1. RESULTS: The intervention and control arms did not differ significantly regarding patient demographic and clinical characteristics. Clinical cure rate was slightly higher in children managed presumptively 49 (98%) than those managed rapid diagnostic test -based 47 (94%) (P = 0.31). However, rapid diagnostic test -based treated children had lower risk of receiving antimalarials compared to those treated presumptively (48% vs. 100%), (P = <0.001; relative risk 2.08, CI 1.56 to 2.78). No death or severe complications were recorded in either group at day-5 follow-up. CONCLUSION: Outcome of rapid diagnostic test-based treatment is not inferior to presumptive management in children with malaria-pneumonia symptom overlap. More extensive studies with larger sample sizes are needed.