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Formative Research Report [English]
This document contains the findings of formative research which was conducted in Uttar Pradesh and Bihar to understand and assess community`s recognition of pneumonia and its danger signs, when and where do they seek health care and what was their perception regarding risk due to delayed treatment.
Recognition of Danger Signs of Childhood Pneumonia in the Community
In UP and Bihar “pneumonia” was a popular illness category connoting serious childhood respiratory illness.
Fast breathing is not recognised by many caregivers when presented visually as a standalone sign of illness.
Fast breathing is recognised more commonly when presented with chest in-drawing and difficult breathing
Chest in-drawing is recognized, but not commonly monitored by removing a child’s clothing.
Local terms for clinical pneumonia, more often focus on chest in-drawing than fast breathing. Chest in-drawing appeared to eclipse fast breathing as a local indicator of “pneumonia” severity.
Not appreciating the severity of fast breathing, an early sign of pneumonia, delays the pursuit of medical care (as confirmed by actual cases studies)
The term “pneumonia” is used widely enough such that other local terms may not be necessary to index.
Newly designed IEC materials should emphasize fast breathing as an early sign of “pneumonia” severity requiring prompt medical care.
Use of Home Remedies and Self-Medication
Home remedies and self medication delayed the pursuit of medical care.
Home remedies used for signs of pneumonia (fast breathing and chest in-drawing)
Caregivers often self-treat with oral antibiotics, antipyretics, anti tussives, bronchodilators, corticosteroids and injectible antibiotics.
In actual cases, most children had been given medicines at home and half of them had been initially treated by an RMP or a traditional healer. There was a median delay in medical care-seeking of 2 days (range 1-8 days) after caregivers identified illness symptoms as serious.
There is a need to promote prompt and appropriate care-seeking and discourage self-medication
Availability of Transport
Poor availability of transport was one of the factors delaying health care seeking outside one’s village.
Community was not adequately aware about Free public ambulance services
Community Needs to be made aware about 108 Samajwadi Swasthya Sewa and 102 National Ambulance Scheme)
Case Management by Community Health Workers (CHWs) [ANMs and ASHAs]
All CHWs identified “pneumonia” as a common childhood illness.
Most CHWs were not aware that fast breathing was an early sign of pneumonia.
ANMs seldom gave medicines to patients specific for pneumonia and never administered injectible antibiotics.
ANMs were rarely consulted for childhood pneumonia.
Community did seek information from ASHAs on childhood illnesses, but ASHAs had limited knowledge about the signs of childhood pneumonia and its management.
There is a need to train all ANMs as per the new guidelines and ensure the availability of paediatric antibiotics to increase trust in government health care.
Presence of ASHAs in the community could be leveraged such that they could play a valuable role in outreach education on childhood pneumonia.
Case Management by Rural Medical Providers (RMPs)
RMPs were the most preferred source of care for most cases of childhood pneumonia.
Community preferred seeking consultation from village-based RMP for mild to moderate pneumonia, private qualified block-based doctor (BBD) for severe pneumonia and a town-based private hospital/BBD for very severe pneumonia.
RMPs said that they prescribed oral antibiotics and some reported that they prescribed injectible antibiotics (including second and third generation antibiotics, like cephalosporins), anti tussives, corticosteroids and bronchodilators
RMPs frequently treat cases of childhood pneumonia but have poor knowledge of danger signs which delays referral of serious cases.
Since RMPs were a preferred source of care, strategies to define their role in community wide pneumonia programs needed to be explored further.
Community Perceptions about Quality of Care at Government Hospitals
Negative perceptions about quality of care at government hospitals were related to limited availability of necessary medicines and diagnostic tests, the perception that medicines available were of poor quality, overcrowding and referral of critical patients to distant government hospitals.
Trust in the public health system needed to be enhanced through system strengthening and quality improvement.
Trust in both the diagnostic and treatment skills of health staff and the quality of medications they administer needed to be enhanced.
Facilities at the public hospitals needed to be more responsive to the needs of the community.