Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study


Autoři: Jesper Kjærgaard aff001;  Marilena Anastasaki aff002;  Marianne Stubbe Østergaard aff003;  Elvira Isaeva aff004;  Azamat Akylbekov aff005;  Nhat Quynh Nguyen aff006;  Susanne Reventlow aff003;  Christos Lionis aff002;  Talant Sooronbaev aff007;  Le An Pham aff008;  Rebecca Nantanda aff009;  James W. Stout aff010;  Anja Poulsen aff001
Působiště autorů: Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital “Rigshospitalet”, Copenhagen, Denmark aff001;  Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece aff002;  The Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark aff003;  National Center of Maternity and Childhood Care, Bishkek, Kyrgyzstan aff004;  National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan aff005;  Family Medicine Department, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam aff006;  Kyrgyz Thoracic Society, Respiratory, Critical Care and Sleep Medicine Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan aff007;  Vietnamese Association Family Medicine, Center for training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam aff008;  Department of Paediatrics, Mulago Hospital and Makere University, Kampala, Uganda aff009;  University of Washington, Seattle, Washington, United States of America aff010
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0221389

Souhrn

Background

Respiratory disease and, specifically, pneumonia, is the major cause of mortality and morbidity in young children. Diagnosis of both pneumonia and asthma in primary care rests principally on clinical signs, history taking, and bronchodilator responsiveness. This study aimed to describe clinical practices in diverse global primary care settings concerning differential diagnosis of respiratory disease in young children, especially between pneumonia and asthma.

Methods

Health professionals in Greece, Kyrgyzstan, Vietnam, and Uganda were observed during consultations with children aged 2–59 months, presenting with cough and/or difficult breathing. Data were analyzed descriptively and included consultation duration, practices, diagnoses and availability/use of medications and equipment. The study is part of the European Horizon 2020 FRESH AIR project.

Results

In total, 771 consultations by 127 health professionals at 74 facilities in the four countries were observed. Consultations were shorter in Vietnam and Uganda (3 to 4 minutes) compared to Greece and Kyrgyzstan (15 to 20 minutes). History taking was most comprehensive in Greece. Clinical examination was more comprehensive in Vietnam and Kyrgyzstan and less in Uganda. Viral upper respiratory tract infections were the most common diagnoses (41.7% to 67%). Pneumonia was diagnosed frequently in Uganda (16.3% of children), and rarely in other countries (0.8% to 2.9%). Asthma diagnosis was rare (0% to 2.8%). Antibiotics were prescribed frequently in all countries (32% to 69%). Short acting β-agonist trials were seldom available and used during consultations in Kyrgyzstan (0%) and Uganda (1.8%), and often in Greece (38.9%) and Vietnam (12.6%).

Conclusions

Duration and comprehensiveness of clinical consultations observed in this study seemed insufficient to guide respiratory diagnosis in young children. Appropriate treatment options may further not be available in certain studied settings. Actions aiming at educating and raising professional awareness, along with developing easy-to-use tools to support diagnosis and a general strengthening of health systems are important goals.

Klíčová slova:

Antibiotics – Asthma – Coughing – Pneumonia – Primary care – Uganda – Vietnam – Greece


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Článek vyšel v časopise

PLOS One


2019 Číslo 11