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Home management of acute respiratory infections in a Nigerian district

Globally, over 2 million children die annually from acute respiratory infections (ARIs) especially pneumonia. ARI symptoms (cough and difficult/fast breathing) frequently overlap with those of malaria.  In Nigeria, children with these pneumonia symptoms are frequently overlooked by the home management strategy that seeks to treat all childhood fevers as malaria.

The aim of the study was to determine the prevalence of overlap of fever and ARI symptoms, the timeliness of care-seeking and the type of care sought for ARI with or without fever at community level.

From a district, 420 households with 420 children aged over 5 years who had been sick with cough within 2 weeks of the survey were selected through systematic random sampling and their carer interviewed about the child’s illness. Of the 413 children who had been sick with cough, 21% reported overlapping symptoms of fever, cough and difficult/fast breathing (DFB). Of these, 27% received antimalarials alone. Sixty percent of children with ARI received antibiotics and 59% received care within 24 hours of symptom recognition. Carers of infants and children with DFB were more likely to seek care within 24 hours of symptom recognition (both p <0.001). Most (45%) of the antibiotics used were obtained from patent medicine dealers.

It was concluded that a large percentage of children have malaria and pneumonia symptom overlap; and a significant proportion of these cases are mismanaged as malaria in the community. The role of patent medicine dealers in recognising and appropriately treating ARI should be explored.