Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT03756259 |
| Other study ID # |
AC 18109 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
December 15, 2018 |
| Est. completion date |
December 31, 2019 |
Study information
| Verified date |
May 2019 |
| Source |
University of Edinburgh |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
Pneumonia and recurrent wheeze contribute extensively to under five childhood morbidity and
mortality in Pakistan. Among the avoidable causes of death due to these diseases, delayed
care seeking is a major one whereby around 38% of deaths due to acute respiratory illnesses
occur in households. Of these cases which die due to delayed care seeking, majority are taken
for healthcare after 2 days of initiation of symptoms with around 30% been given antibiotics
at home before seeking healthcare. Around 32% of these cases die at home, 48% in hospitals,
9% en route, and the 11% in clinics or health centres.This could be due to lack of time, lack
of funds for healthcare, lack of decision making on the part of the mother or improper carer
perception of the seriousness of the condition. Thus there are various cultural, social,
personal and religious factors which affect the care seeking behaviors of caregivers for
these illnesses. Understanding these aspects of delayed care seeking is critical to develop
effective intervention strategies to reduce disease related mortality. We, therefore, aim to
establish an understanding of perception of under-five pneumonia and recurrent wheeze among
caregivers of children under five along with associated factors of delayed care seeking in
selected communities in Pakistan. The results of this study will permit us to design an
effectiveness study which can be used by program managers and policy makers to develop
program strategies to reduce childhood deaths due to delayed care seeking for these diseases.
Description:
Background: 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. Similarly, children
account for 20%-30% of the 2 million Pakistani asthma patients. 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. This delay is referred to as the time taken by the caregiver to seek
healthcare later than what would have been optimal.
In most of the Low middle income countries (LMICs), 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. He/she could be an aunt/uncle or
neighbour. But in such cases often the child is neglected due to other priorities of the
secondary caregivers.
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. Here, healthcare providers tend to wait for patients to come to them but the later
the patients with acute respiratory illness come, the more likely they are to die. World
Health Organization (WHO) and United Nations International Children's Emergency Fund (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 patient's symptoms are identified timely and immediate care given at their doorstep.
Experimental studies provide the strongest evidence that illness perceptions can modify
behaviours and care-seeking, and several studies have shown that interventions designed to
change illness perceptions can improve health outcomes. Locally adapted behaviour change
communication may reduce the incidence of severe pneumonia and could be a key component in
national child-health strategies.
One of the most impactful strategies can be timely healthcare seeking through community
health workers who have been a powerful force to promote healthy behaviours 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 on health and wellbeing. These LHWs could,
therefore, be a useful mode of active pneumonia and recurrent wheeze case finding and
information sharing to counsel against development of acute respiratory infections as
evidence has shown that health interventions integrating Community Health Workers (CHWs) can
lead to positive behaviour changes and lower morbidity and mortality rates, while moving
services and information closer to the communities where they are actually needed.
Objective: Our study will explore healthcare care-seeking for childhood pneumonia and
recurrent wheeze among caregivers of children under five through a qualitative approach.
Further, we aim to devise a Care Model to actively find cases through LHWs and promote
appropriate care seeking behaviour among the caregivers.
