Experiences From an Implementation Model of ARI Diagnostic Device in Pneumonia Case Management Among Under-5 Children in Peripheral Healthcare Centers in India

Overview

Journal Clin Med Insights Pediatr

Publisher Sage Publications

Specialty Pediatrics

Date 2021 Nov 22

PMID 34803419

Authors

Harish Kumar

Enisha Sarin

Prasant Saboth

Avinash Jaiswal

Nidhi Chaudhary

Jaya Swarup Mohanty

Nitin Bisht

Shailendra Singh Tomar

Anil Gupta

Ranjan Panda

Rachana Patel

Arvind Kumar

Sachin Gupta

Varun Alwadhi

Affiliations

Soon will be listed here.

Abstract

Objectives: To address pneumonia, a major killer of under-5 children in India, a multimodal pulse oximeter was implemented in Health and Wellness Centers. Given the evidence of pulse oximetry in effective pneumonia management and taking into account the inadequate skills of front-line healthcare workers in case management, the device was introduced to help them readily diagnose and treat a child and to examine usability of the device.

Design: The implementation was integrated with the routine OPD of primary health centers for 15 months after healthcare workers were provided with an abridged IMNCI training. Monthly facility data was collected to examine case management with the diagnostic device. Feedback on usefulness of the device was obtained.

Setting: Health and Wellness Centers (19) of 7 states were selected in consultation with state National Health Mission based on patient footfall.

Participants: Under-5 children presenting with ARI symptoms at the OPD.

Results: Of 4846 children, 0.1% were diagnosed with severe pneumonia and 23% were diagnosed with pneumonia. As per device readings, correct referrals were made of 77.6% of cases of severe pneumonia, and 81% of pneumonia cases were correctly given antibiotics. The Pulse oximeter was highly acceptable among health workers as it helped in timely classification and treatment of pneumonia. It had no maintenance issue and battery was long-lasting.

Conclusion: Pulse oximeter implementation was doable and acceptable among health workers. Together with IMNCI training, PO in primary care settings is a feasible approach to provide equitable care to under-5 children.

References

McCollum E, King C, Deula R, Zadutsa B, Mankhambo L, Nambiar B . Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi. Bull World Health Organ. 2016; 94(12):893-902. PMC: 5153930. DOI: 10.2471/BLT.16.173401. View

Graham H, Bakare A, Gray A, Ayede A, Qazi S, McPake B . Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation. BMJ Glob Health. 2018; 3(3):e000812. PMC: 6035503. DOI: 10.1136/bmjgh-2018-000812. View

Emdin C, Mir F, Sultana S, Kazi A, Zaidi A, Dimitris M . Utility and feasibility of integrating pulse oximetry into the routine assessment of young infants at primary care clinics in Karachi, Pakistan: a cross-sectional study. BMC Pediatr. 2015; 15:141. PMC: 4590255. DOI: 10.1186/s12887-015-0463-z. View

Mayhew M, Ickx P, Newbrander W, Stanekzai H, Alawi S . Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance. Int J Health Policy Manag. 2015; 4(3):143-52. PMC: 4357981. DOI: 10.15171/ijhpm.2015.17. View

Hasan Farooqui H, Selvaraj S, Mehta A, Heymann D . Community level antibiotic utilization in India and its comparison vis-à-vis European countries: Evidence from pharmaceutical sales data. PLoS One. 2018; 13(10):e0204805. PMC: 6192587. DOI: 10.1371/journal.pone.0204805. View

Schellenberg J, Adam T, Mshinda H, Masanja H, Kabadi G, Mukasa O . Effectiveness and cost of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania. Lancet. 2004; 364(9445):1583-94. DOI: 10.1016/S0140-6736(04)17311-X. View

Tesfaye S, Gebeyehu Y, Loha E, Johansson K, Lindtjorn B . Pulse oximeter with integrated management of childhood illness for diagnosis of severe childhood pneumonia at rural health institutions in Southern Ethiopia: results from a cluster-randomised controlled trial. BMJ Open. 2020; 10(6):e036814. PMC: 7311017. DOI: 10.1136/bmjopen-2020-036814. View

Liu L, Chu Y, Oza S, Hogan D, Perin J, Bassani D . National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000-15: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health. 2019; 7(6):e721-e734. PMC: 6527517. DOI: 10.1016/S2214-109X(19)30080-4. View

Bojalil R, Kirkwood B, Bobak M, Guiscafre H . The relative contribution of case management and inadequate care-seeking behaviour to childhood deaths from diarrhoea and acute respiratory infections in Hidalgo, Mexico. Trop Med Int Health. 2007; 12(12):1545-52. DOI: 10.1111/j.1365-3156.2007.01963.x. View

10.

Bell B, Schellevis F, Stobberingh E, Goossens H, Pringle M . A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014; 14:13. PMC: 3897982. DOI: 10.1186/1471-2334-14-13. View

11.

Kallander K, Tomson G, Nsabagasani X, Sabiiti J, Pariyo G, Peterson S . Can community health workers and caretakers recognise pneumonia in children? Experiences from western Uganda. Trans R Soc Trop Med Hyg. 2006; 100(10):956-63. DOI: 10.1016/j.trstmh.2005.11.004. View

12.

Floyd J, Wu L, Hay Burgess D, Izadnegahdar R, Mukanga D, Ghani A . Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings. Nature. 2015; 528(7580):S53-9. DOI: 10.1038/nature16043. View

13.

Spence H, Baker K, Wharton-Smith A, Mucunguzi A, Matata L, Habte T . Childhood pneumonia diagnostics: community health workers' and national stakeholders' differing perspectives of new and existing aids. Glob Health Action. 2017; 10(1):1290340. PMC: 5496071. DOI: 10.1080/16549716.2017.1290340. View

14.

Mohan P, Kishore B, Singh S, Bahl R, Puri A, Kumar R . Assessment of implementation of integrated management of neonatal and childhood illness in India. J Health Popul Nutr. 2012; 29(6):629-38. PMC: 3259726. DOI: 10.3329/jhpn.v29i6.9900. View

15.

Goossens H, Ferech M, Vander Stichele R, Elseviers M . Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005; 365(9459):579-87. DOI: 10.1016/S0140-6736(05)17907-0. View

16.

. Subnational mapping of under-5 and neonatal mortality trends in India: the Global Burden of Disease Study 2000-17. Lancet. 2020; 395(10237):1640-1658. PMC: 7262604. DOI: 10.1016/S0140-6736(20)30471-2. View

17.

Hailemariam S, Gebeyehu Y, Loha E, Johansson K, Lindtjorn B . Inadequate management of pneumonia among children in South Ethiopia: findings from descriptive study. BMC Health Serv Res. 2019; 19(1):426. PMC: 6595689. DOI: 10.1186/s12913-019-4242-7. View

18.

Blanc J, Locatelli I, Rarau P, Mueller I, Genton B, Boillat-Blanco N . Retrospective study on the usefulness of pulse oximetry for the identification of young children with severe illnesses and severe pneumonia in a rural outpatient clinic of Papua New Guinea. PLoS One. 2019; 14(4):e0213937. PMC: 6464326. DOI: 10.1371/journal.pone.0213937. View

19.

Mathur R, Swaminathan S . National ethical guidelines for biomedical & health research involving human participants, 2017: A commentary. Indian J Med Res. 2018; 148(3):279-283. PMC: 6251259. DOI: 10.4103/0971-5916.245303. View

20.

Shah S, Bachur R, Simel D, Neuman M . Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review. JAMA. 2017; 318(5):462-471. DOI: 10.1001/jama.2017.9039. View