Managing children with pneumonia symptoms in malaria endemic Uganda

Background: Pneumonia is one of the leading killers of children under five years of age. In sub-Saharan Africa, symptoms of pneumonia often overlap with those of malaria. While many countries have made public commitments to improve malaria management, similar efforts for pneumonia are lacking. The overlap of symptoms between pneumonia and malaria, in combination with more efforts for appropriate malaria management, raises worries that pneumonia cases are being mismanaged. More information is needed on how caretakers and health workers respond to children with pneumonia symptoms. Main objective: To explore caretakers and health care providers understanding and response to children with symptoms of pneumonia in order to identify issues that need to be addressed for improved management of children with acute febrile illness. Methods: A triangulation of a qualitative community study with mothers, traditional healers and health workers (I), two hospital based studies with structured interviews with caretakers of children with symptoms or diagnosis of severe pneumonia (II, IV) and a mixed qualitative-quantitative community study with verbal and social autopsies with caretakers of children deceased in acute febrile illness (III) was done. To compare stated drug use with blood drug concentrations, blood samples were collected on filter papers (IV). Qualitative interviews were analyzed using content analysis (I, III). Blood drug concentrations of sulfamethoxazole, chloroquine and sulfadoxine were analyzed using high performance liquid chromatography methods (IV). Results: Many terminologies were used to refer to symptoms of pneumonia (I). Mothers tended to interpret any febrile condition as malaria and stated differing preferred care-seeking actions for difficult/rapid breathing in their children (I). Severe pneumonia developed two days after first recognition of difficult/rapid breathing (II). Half of the children diagnosed with severe pneumonia had seen another health care provider prior to arrival at a hospital (II). ...