1921
Volume 101, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Pneumonia, as defined by WHO, is a syndromic diagnosis characterized by presence of cough or difficult breathing. Presentation to health-care provider depends on timely identification of signs and symptoms by caretakers. We explored patterns of health-care utilization among caretakers of a randomly selected sample of 1,152 children aged 2–59 months, residing in low-income settlements of Karachi, Pakistan. Information on household demographics, occurrence of pneumonia-specific symptoms, care seeking, air quality, and knowledge regarding preventive measures for pneumonia was collected. Predictors of care seeking were estimated using weighted logistic regression. Prevalence of pneumonia with cough and rapid or difficulty in breathing was found to be 40.8% and 37.1% in infants (2–11 months) and children (12–59 months), respectively. Ninety-five percentage of caretakers sought care, 68.5% privately. Odds ratios (ORs) for independent predictors of care-seeking were as follows: younger age of child (infants compared with children), 3.60 (95% CI = 2.65–4.87); caretaker with primary education compared with none, 3.40 (2.46–4.70); vaccine awareness, 1.65 (1.45–1.87); and breastfeeding awareness, 1.32 (1.13–1.53). Presence of symptoms such as fever OR, 1.51 (1.30–1.76); tachypnea, 1.57 (1.35–1.83); chest indrawing, 2.56 (2.05–3.18); persistent vomiting, 1.69 (1.37–2.09); and recurrent illness, 2.57 (2.23–2.97) were also predictive. There is high health-care utilization for pneumonia with the skewed presentation toward private services. Strategies should be focused on making pneumonia care standardized, efficient and affordable, especially in the private sector.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. WHO, 2014. Revised WHO Classification and Treatment of Childhood Pneumonia at Health Facilities–Evidence Summaries. Geneva, Switzerland: World Health Organization. [Google Scholar]
  2. UNICEF, 2012. Pneumonia and Diarrhoea: Tackling the Deadliest Diseases for the World’s Poorest Children. New York, NY: UNICEF. [Google Scholar]
  3. Victora CG, Requejo JH, Barros AJ, Berman P, Bhutta Z, Boerma T, Chopra M, De Francisco A, Daelmans B, Hazel E, , 2016. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet 387: 20492059. [Google Scholar]
  4. Shaikh BT, Hatcher J, , 2005. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health 27: 4954. [Google Scholar]
  5. Jehan F, Nisar MI, Kerai S, Brown N, Balouch B, Hyder Z, Ambler G, Ginsburg AS, Zaidi AK, , 2016. A double blind community-based randomized trial of amoxicillin versus placebo for fast breathing pneumonia in children aged 2–59 months in Karachi, Pakistan (RETAPP). BMC Infect Dis 16: 13. [Google Scholar]
  6. Ghanchi NK, Shakoor S, Thaver AM, Khan MS, Janjua A, Beg MA, , 2016. Current situation and challenges in implementing malaria control strategies in Pakistan. Crit Rev Microbiol 42: 588593. [Google Scholar]
  7. Owais A, Tikmani SS, Sultana S, Zaman U, Ahmed I, Allana S, Zaidi AK, , 2010. Incidence of pneumonia, bacteremia, and invasive pneumococcal disease in Pakistani children. Trop Med Int Health 15: 10291036. [Google Scholar]
  8. Sindh Bureau of Statistics, UNICEF, 2015. Sindh Multiple Indicator Cluster Survey 2014 Final Report. Karachi, Pakistan: Sindh Bureau of Statistics and UNICEF. [Google Scholar]
  9. National Institute of Population Studies (NIPS) [Pakistan] and ICF International, 2013. Pakistan Demographic and Health Survey 2012–13. Islamabad, Pakistan, and Calverton, MD: NIPS and ICF International.
  10. Campbell H, el Arifeen S, Hazir T, O’Kelly J, Bryce J, Rudan I, Qazi SA, , 2013. Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment. PLoS Med 10: e1001421. [Google Scholar]
  11. Quadri F, Nasrin D, Khan A, Bokhari T, Tikmani SS, Nisar MI, Bhatti Z, Kotloff K, Levine MM, Zaidi AK, , 2013. Health care use patterns for diarrhea in children in low-income periurban communities of Karachi, Pakistan. Am J Trop Med Hyg 89: 4955. [Google Scholar]
  12. Aftab W, Shipton L, Rabbani F, Sangrasi K, Perveen S, Zahidie A, Naeem I, Qazi S, , 2018. Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community. BMC Health Serv Res 18: 44. [Google Scholar]
  13. Ferdous F, Dil Farzana F, Ahmed S, Das SK, Malek MA, Das J, Faruque ASG, Chisti MJ, , 2014. Mothers’ perception and healthcare seeking behavior of pneumonia children in rural Bangladesh. ISRN Family Med 2014: 8. [Google Scholar]
  14. Agarwal M, Bajpai P, , 2015. Perception about childhood pneumonia among caregivers attending immunisation clinics of tertiary care hospital in Lucknow city. Int J Healthc Pharm Res 4: 2630. [Google Scholar]
  15. Hussain R, Lobo MA, Inam B, Khan A, Qureshi AF, Marsh D, , 1997. Pneumonia perceptions and management: an ethnographic study in urban squatter settlements of Karachi, Pakistan. Soc Sci Med 45: 9911004. [Google Scholar]
  16. Banerjee A, Deaton A, Duflo E, , 2004. Health care delivery in rural Rajasthan. Econ Polit Weekly 39: 944949. [Google Scholar]
  17. Shaikh BT, Haran D, Hatcher J, , 2008. Where do they go, whom do they consult, and why? Health-seeking behaviors in the northern areas of Pakistan. Qual Health Res 18: 747755. [Google Scholar]
  18. Saksena P, Xu K, Elovainio R, Perrot J, , 2010. Health services utilization and out-of-pocket expenditure at public and private facilities in low-income countries. World Health Rep 20: 20. [Google Scholar]
  19. Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, Bischoff EJL, Cameron S, Campbell H, , 2014. The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. PLoS One 9: e93427. [Google Scholar]
  20. Lindblade KA, Johnson AJ, Arvelo W, Zhang X, Jordan HT, Reyes L, Fry AM, Padilla N, , 2011. Low usage of government healthcare facilities for acute respiratory infections in Guatemala: implications for influenza surveillance. BMC Public Health 11: 1. [Google Scholar]
  21. Benova L, Campbell OM, Ploubidis GB, , 2015. Socio-economic inequalities in curative health-seeking for children in Egypt: analysis of the 2008 demographic and health survey. BMC Health Serv Res 15: 1. [Google Scholar]
  22. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D, , 2012. Comparative performance of private and public healthcare systems in low-and middle-income countries: a systematic review. PLoS Med 9: e1001244. [Google Scholar]
  23. Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D, , 2013. What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One 8: e54978. [Google Scholar]
  24. Noordam AC, Carvajal-Velez L, Sharkey AB, Young M, Cals JW, , 2015. Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality. PLoS One 10: e0117919. [Google Scholar]
  25. Owais A, Sultana S, Stein AD, Bashir NH, Awaldad R, Zaidi AK, , 2011. Why do families of sick newborns accept hospital care? A community-based cohort study in Karachi, Pakistan. J Perinatol 31: 586592. [Google Scholar]
  26. Choi Y, El Arifeen S, Mannan I, Rahman S, Bari S, Darmstadt G, Black R, Baqui A, , 2010. Can mothers recognize neonatal illness correctly? Comparison of maternal report and assessment by community health workers in rural Bangladesh. Trop Med Int Health 15: 743753. [Google Scholar]
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  • Received : 10 Aug 2018
  • Accepted : 08 Jul 2019
  • Published online : 03 Sep 2019

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