Acute respiratory infections in young urban children
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A study on the knowledge, beliefs and attitude of mothers concerning acute respiratory infections (ARI) was conducted in Kanyama, a Lusaka urban community. Six key informants, a male traditional healer, a female traditional healer who is also a traditional birth attendant and grandmother, a female community health worker who is also a grandmother and 3 grandmothers were interviewed in depth. Twenty nine mothers seeking care at the health centre for children with ARI, 30 mothers at home who were carers of small children, 9 pharmacy workers or drug sellers and 14 practitioners (at the local clinic, private community clinics, traditional healers and University Teaching Hospital staff) were the other sources of information. The information from these other informants was collected using questionnaires, checklists and structured interviews.There are a variety of terminologies used to describe ARI in young children. The terms used were in Nyanja and Bemba - the two languages widely spoken in Kanyama. The respiratory conditions in children which were thought to be of a serious nature were "midulo" (infantile pneumonia), "tulaso" (childhood pneumonia), "chifuba chifwasa" (bronchitis), "chifuba cho yendelela"(whooping cough) and "chifuba cha kalombo ka HIV" (cough associated with HIV infection). Bronchitis had a 100 per cent rating on severity i.e. all the respondents agreed that it was severe. Childhood pneumonia and infantile pneumonia (infantile pneumonia here refering to illness in an infant 1-2 months of age), had a 79 per cent and 64 per cent rating respectively. This would indicate that mothers rate pneumonia in small babies to be less serious than in older children. Mothers recognise difficult breathing more than they do fast breathing. In about 61 per cent of the responses in the video interview, difficult breathing was mentioned for the children having both difficult and fast breathing. The information was unprompted. Fast breathing, alone on the other hand was recognised in only 30 per cent of the responses. There were a variety of terms used to describe fast breathing. Both difficult and fast breathing were considered serious, and an indication for care seeking at a health facility. Mothers also tended to seek care for less serious symptoms especially in neonates. The seriousness of measles infection requires that the knowledge and practice of this illness by mothers, be corrected. All the key informants believed that symptoms in measles infection worsen upon handling by a health worker who has recently had sexual intercourse, and that the worser the rash, the worser the illness. Home management of children did not include an increase in the frequency of feeds but the nutritional content of the feeds was unproved. Keeping the child warm was a well known measure. Mothers gave aspirin and aspirin containing drugs to children for alleviation of fever. Cough mixtures, nasal decongestants, steam inhalations with menthol are also home measures used in the treatment of ARI. Fathers are the main decision makers as to when and where to seek care outside the home. 63 per cent of the respondents said that the father to the child was the decision maker. The University Teaching Hospital because of its presumed wider and better diagnostic and treatment capacity was the main source of care. It received a 97 per cent rating as a source of care. Mothers expect to get cough mixture, nasal drops and injections from the health facility. Intravenous fluids were also mentioned for small babies. The average expected improvement time was 2.3 days . Health workers generally feel that maternal delay in care seeking is significant medically, and the reasons put forward were ignorance of symptoms, economic reasons and lack of diligence in some cases. As far as the treatment of pneumonia is concerned, 50% would give either injectable or oral antibiotic. The importance of frequent breastfeeding, small frequent feeds, increase in fluid intake and not overwrapping infants was not alluded to for the most part. The pharmacists and drug sellers for the most part advice mothers with children suffering from ARI to consult a health worker before they purchase drugs. There is need for mothers to be informed about the importance of small frequent feeds in children with pneumonia, since they often do not tolerate normal quantities of feed. In educating carers on home management therefore, health workers need to emphasize the importance of frequent feeding (breastfeeding or otherwise) and other measures including increased fluid intake and the dangers of overwrapping infants. More education is required on the causation and presentation of infantile pneumonia. It must be emphasized that the same type of kalombo (something causing illness) causes both infantile and childhood illness but that the severity differs. The concept of kalombo should be used to describe the causation of various other infective diseases. As far as care seeking is concerned, the fact that care was sought mainly at the teaching hospital may well mean that the mothers' confidence in the peripheral clinics needs to be boosted. Pertaining to health workers knowledge, they need to be familiar with the local terminologies used to describe the illnesses, signs and symptoms of ARI, in order to communicate effectively with carers of small children. They also need to have an evaluation of their knowledge and management of ARI.
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