Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04493047 |
| Other study ID # |
16/136/109 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
April 1, 2018 |
| Est. completion date |
March 30, 2021 |
Study information
| Verified date |
July 2020 |
| Source |
University of Edinburgh |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
In Pakistan, pneumonia and recurrent wheeze in children under five pose significant threats
to children's health. Despite being preventable, more than 90,000 children die each year due
to pneumonia in Pakistan, making it one of the top five countries in the world, with the
highest pneumonia related childhood mortality. The predisposing factors which lead to these
illnesses include lack of hygiene, lack of immunization, overcrowding, household air
pollution, smoking, and poverty. Prompt recognition and timely initiation of treatment is
imperative in children under five with pneumonia and recurrent wheeze and failure to do so
can lead to complications and death. In children under five, among the causes of death due to
these diseases, one is delayed care seeking. It has been identified that around 38% of deaths
due to respiratory illnesses occur in households due to this delayed care seeking which is
defined as delay in care sought for an illness outside home.
Description:
In most of the low middle income countries, carer gender plays an important role in decisions
to seek care. Although in majority of households, the primary caregivers of children under
five are the mothers of those children, decisions with respect to care are often made by
fathers or mothers in law which is a problem as they do not cater to the child in a timely
manner either by not being there or being ignorant of basic management of the illness.
Another contributing factor could be lack of time to take the child for healthcare as the
mothers are usually occupied in their household chores and the fathers are busy working. And
in rare cases where either the mother of a child dies at childbirth (500 per 100,000 live
births) and when fathers are working away from home, it is the secondary caregiver who is
responsible for care seeking of that child. Additionally, due to poverty, most caregivers
cannot afford the cost of travel and secondary care for the child delaying care seeking until
the child is severely ill. The inaccessibility of adequate healthcare within close proximity
may delay care seeking. However a major contributing factor to this delay is impaired carer
perception of the seriousness of the condition. The importance of caregivers' ability to
recognize and seek appropriate care for their children is also one of the recommended key
activities in the World Health Organization's (WHO)and UNICEF's Global Action Plan for the
Control of Pneumonia and Diarrhea [11]. WHO and UNICEF have, therefore, emphasized the
development of innovative, sustainable and cost-effective strategies/interventions to improve
child health. It is important to devise a strategy whereby patients' symptoms are identified
timely and immediate care given at their doorstep. Experimental studies provide the strongest
evidence that illness perceptions can modify behaviors and care-seeking, and several studies
have shown that interventions designed to change illness perceptions can improve health
outcomes.
The inaccessibility of adequate healthcare within close proximity may delay care seeking.
However a major contributing factor to this delay is impaired carer perception of the
seriousness of the condition. Although well-proven life-saving tools are available to stop
mortality due to preventable illnesses like pneumonia and recurrent wheeze, the existing
health systems in Pakistan are passive. One of the most impact strategies can be timely
healthcare seeking through community health workers who have been a powerful force to promote
healthy behaviors and extend the reach to the health system by acting as a bridge between the
community and the system. Community-based packaged interventions delivered through CHWs have
been shown to improve care seeking for childhood illnesses. In Pakistan, these CHWs are
referred to as Lady Health Workers (LHWs) enrolled under the National Program for Family
Planning and Primary Healthcare. On average each LHW covers 100-150 households by making
monthly visits and providing basic health services and education. These LHWs could,
therefore, be a useful mode as evidence has shown that health interventions integrating
(CHWs) can lead to positive behavior changes and lower morbidity and mortality rates, while
moving services and information closer to the communities where they are actually needed.
Thus, our study will explore care-seeking for childhood pneumonia among caregivers of
children under five through a qualitative approach and devise a Care Model to actively find
cases through LHWs and promote appropriate care seeking behavior.
Primary Objective
• To determine the feasibility of using an android based mobile application by LHWs to
educate caregivers of children under five on prevention of pneumonia in rural Islamabad.
