Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings
Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings
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DOI：
10.2471/blt.07.048512
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发表时间：
2008-05-01
期刊：
影响因子：
--
通讯作者：
Duke, Trevor
中科院分区：
文献类型：
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作者：
Graham, Stephen M;English, Mike;Duke, Trevor
有效的病例管理是减少儿童肺炎相关发病率和死亡率的重要战略。有基于可靠证据的指导方针，但使用不当。本综述概述了在大多数儿童肺炎死亡发生的环境中儿童肺炎管理的现行指南，并确定了在各种环境和不同“高危”群体中改善管理的挑战。这些措施包括适当选择抗生素，与其他条件的临床重叠，及时和适当的转诊住院治疗，以及治疗失败的管理。新生儿和感染艾滋病毒或严重营养不良儿童的管理更为复杂。合并症对肺炎预后的影响意味着肺炎病例管理必须纳入改善整体儿科护理的策略。减少卫生设施中肺炎相关死亡的最大潜力是更广泛地实施围绕几项核心活动建立的现行指南：培训，抗生素和氧气。这就需要对人力资源和设备进行投资，以便对低氧血症进行最佳管理。肺炎病例管理质量的提高可以成为儿童保健实践全面改善的工具。
Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia, It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child healthcare practices.