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Assessment of Children for Acute Respiratory Infections in Hospital Outpatients in Tanzania: What Drives Good Practice?

Respiratory infections cause significant mortality in developing countries but are frequently undiagnosed. Reasons for this are unclear. We observed 1,081 outpatient consultations with patients less than five years of age in Tanzania. In 554 patients with cough or difficulty breathing, the absolute percentages examined were 5% for respiratory rate counted, 14% chest exposed, and 25% stethoscope used. Decisions to conduct particular examinations did appear to follow clinical logic, with odds ratios of 4.28 for counting respiratory rate (95% confidence interval [CI] = 1.75–10.47), 2.57 for exposing the chest (95% CI = 1.67–3.95), and 18.91 for using a stethoscope (95% CI = 9.52–37.57) in patients with cough or difficulty breathing. Non-clinical variables, including salary level, were also associated with examinations, and history taking was more common among clinicians originating outside the hospital area. Although respiratory examinations are relatively more common in those with cough or difficulty breathing, the absolute rates are low and related to non-clinical and clinical factors.

Received July 16, 2008. Accepted for publication September 17, 2008.

Acknowledgments: We thank all outpatients, clinical officers, and administrations at both participating hospitals for their participation; and the Joint Malaria Programme of Northeast Tanzania and Kini Chonya, Frank Mtei, Beatrice Siteyian, Frida Temba, and Clara Lweno for their assistance.

Financial support: This study was supported by grants from the Sir Halley Stewart Trust; the Economic and Social Research Council; the Medical Research Council, United Kingdom; and the European Commission (SANTE/2004/078-607).

^* Address correspondence to Clare I. R. Chandler, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, United Kingdom. E-mail: clare.chandler{at}lshtm.ac.uk

Authors’ addresses: Clare I. R. Chandler, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, United Kingdom, E-mail: clare.chandler{at}lshtm.ac.uk. Behzad Nadjm, and Christopher J. M. Whitty, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, E-mails: bnadjm{at}yahoo.comhugh.reyburn{at}lshtm.ac.uk and christopher.whitty{at}lshtm.ac.uk. Gloria Boniface and Kaseem Juma, Joint Malaria Programme, Kilimanjaro Christian Medical Centre, PO Box 2228, Moshi, Tanzania, E-mails: glosa2003{at}yahoo.co.uk and kaseem_juma{at}yahoo.co.uk. Hugh Reyburn, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, and Joint Malaria Programme, Kilimanjaro Christian Medical Centre, PO Box 2228, Moshi, Tanzania, E-mail: hugh.reyburn{at}lshtm.ac.uk.