NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Pneumonia case management practices in Pakistan

This project is based at Maternal, Neonatal and Child Health Research Network (MNCHRN) in Pakistan

Overview

  • Project title: Pneumonia case management practices in selected communities in Pakistan; a qualitative study
  • Acute or chronic:  Acute
  • Based at:  MNCHRN
  • Start date:  01 May 2018
  • End date:  31 August 2019
  • Principal investigator:  Tabish Hazir
  • Project team:  Hana Mahmood, Syed Yahya Sheraz, Saira Bint Mujahid, Hira Kiani, Omair Sheikh

Background

Standard pneumonia case management guidelines form the cornerstone of the WHO-UNICEF pneumonia control programme. Over the last thirty years, thousands of health care providers across Pakistan have been trained in the case management guidelines. It is therefore only realistic to expect these guidelines are followed by the health care providers in the community and health facilities and, as a result, to expect that the mortality due to pneumonia should have fallen since their introduction.

Pneumonia in children under five in Pakistan is supposed to be followed uniformly across all sectors. However, statistics available through large nationally representative DHS surveys tell a different story. Given unchanged mortality statistics, there is a concern that training has not been able to change the pneumonia case management practices amongst health care providers.

There is limited data within Pakistan which reflects the status of the current pneumonia case management practices throughout the health system. Therefore, we aim to carry out an assessment of pneumonia case management practices at three levels of health care – community, first level care facility and practitioner level.

Aim and impact

We are generating data on the current pneumonia case management practices at the three levels of health care across Pakistan, through disguised observations made by staff specially trained to assess these practices using WHO case management guidelines as gold standard.

Our results show that pneumonia case management practices are highly variable across the three levels of health care.

  • At a community level, none of the Lady Health Workers observed asked about danger signs or exposed the chest, with 98% misdiagnosing pneumonia. All Lady Health Workers prescribed antibiotics to all patients, irrespective of their diagnosis.
  • At first level care facilities, 80% did not use WHO classification for diagnosing pneumonia. All those observed at first level health care facilities prescribed antibiotics to all patients, irrespective of their diagnosis.
  • At practitioner level (including GPs and specialists), 58% of those observed in the private sector and 64% of those observed in the public sector did not use WHO classification for diagnosing pneumonia. No two health care providers gave the same treatment despite the same classification.

There is a need to conduct a country wide quantitative survey to validate these findings.

The results of this study have helped to establish the factual status of pneumonia-related practices across Pakistan and can help us to develop better designed policies and interventions in future. In particular, those that can help improve the existing training methodologies of health care providers in order to reduce pneumonia-related morbidity and mortality in Pakistan.

Key developments

  • Write up of the results has been initiated, with publications planned.
  • The findings will be presented on World Pneumonia Day (12 November 2019) through a seminar with Lady Health Workers and the Pakistan Paediatric Association.
  • The study was presented at the 1st Early Childhood Development Conference in September 2019 in Islamabad, Pakistan, visited by the Health Minister and Minister of Planning Commission.
  • The project was projected in front of the National Sustainable Development Goals (SDG) Task Force on 29 July 2019.