Cargando…
Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia
BACKGROUND: Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an eva...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646205/ https://www.ncbi.nlm.nih.gov/pubmed/23667339 http://dx.doi.org/10.1371/journal.pmed.1001422 |
_version_ | 1782268578472394752 |
---|---|
author | Hazir, Tabish Begum, Khadija el Arifeen, Shams Khan, Amira M. Huque, M. Hamidul Kazmi, Narjis Roy, Sushmita Abbasi, Saleem Rahman, Qazi Sadeq-ur Theodoratou, Evropi Khorshed, Mahmuda Shayema Rahman, Kazi Mizanur Bari, Sanwarul Kaiser, M. Mahfuzul Islam Saha, Samir K. Ahmed, A. S. M. Nawshad Uddin Rudan, Igor Bryce, Jennifer Qazi, Shamim Ahmad Campbell, Harry |
author_facet | Hazir, Tabish Begum, Khadija el Arifeen, Shams Khan, Amira M. Huque, M. Hamidul Kazmi, Narjis Roy, Sushmita Abbasi, Saleem Rahman, Qazi Sadeq-ur Theodoratou, Evropi Khorshed, Mahmuda Shayema Rahman, Kazi Mizanur Bari, Sanwarul Kaiser, M. Mahfuzul Islam Saha, Samir K. Ahmed, A. S. M. Nawshad Uddin Rudan, Igor Bryce, Jennifer Qazi, Shamim Ahmad Campbell, Harry |
author_sort | Hazir, Tabish |
collection | PubMed |
description | BACKGROUND: Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh. METHODS AND FINDINGS: Caregivers of 950 children under 5 y with pneumonia and 980 with “no pneumonia” were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated. Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry. CONCLUSIONS: Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time. Please see later in the article for the Editors' Summary |
format | Online Article Text |
id | pubmed-3646205 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-36462052013-05-10 Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia Hazir, Tabish Begum, Khadija el Arifeen, Shams Khan, Amira M. Huque, M. Hamidul Kazmi, Narjis Roy, Sushmita Abbasi, Saleem Rahman, Qazi Sadeq-ur Theodoratou, Evropi Khorshed, Mahmuda Shayema Rahman, Kazi Mizanur Bari, Sanwarul Kaiser, M. Mahfuzul Islam Saha, Samir K. Ahmed, A. S. M. Nawshad Uddin Rudan, Igor Bryce, Jennifer Qazi, Shamim Ahmad Campbell, Harry PLoS Med Research Article BACKGROUND: Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh. METHODS AND FINDINGS: Caregivers of 950 children under 5 y with pneumonia and 980 with “no pneumonia” were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated. Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry. CONCLUSIONS: Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time. Please see later in the article for the Editors' Summary Public Library of Science 2013-05-07 /pmc/articles/PMC3646205/ /pubmed/23667339 http://dx.doi.org/10.1371/journal.pmed.1001422 Text en © 2013 Hazir et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Hazir, Tabish Begum, Khadija el Arifeen, Shams Khan, Amira M. Huque, M. Hamidul Kazmi, Narjis Roy, Sushmita Abbasi, Saleem Rahman, Qazi Sadeq-ur Theodoratou, Evropi Khorshed, Mahmuda Shayema Rahman, Kazi Mizanur Bari, Sanwarul Kaiser, M. Mahfuzul Islam Saha, Samir K. Ahmed, A. S. M. Nawshad Uddin Rudan, Igor Bryce, Jennifer Qazi, Shamim Ahmad Campbell, Harry Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia |
title | Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia |
title_full | Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia |
title_fullStr | Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia |
title_full_unstemmed | Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia |
title_short | Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia |
title_sort | measuring coverage in mnch: a prospective validation study in pakistan and bangladesh on measuring correct treatment of childhood pneumonia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646205/ https://www.ncbi.nlm.nih.gov/pubmed/23667339 http://dx.doi.org/10.1371/journal.pmed.1001422 |
work_keys_str_mv | AT hazirtabish measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT begumkhadija measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT elarifeenshams measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT khanamiram measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT huquemhamidul measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT kazminarjis measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT roysushmita measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT abbasisaleem measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT rahmanqazisadequr measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT theodoratouevropi measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT khorshedmahmudashayema measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT rahmankazimizanur measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT barisanwarul measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT kaisermmahfuzulislam measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT sahasamirk measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT ahmedasmnawshaduddin measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT rudanigor measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT brycejennifer measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT qazishamimahmad measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia AT campbellharry measuringcoverageinmnchaprospectivevalidationstudyinpakistanandbangladeshonmeasuringcorrecttreatmentofchildhoodpneumonia |