Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment.
Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment.
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DOI：
10.1371/journal.pmed.1001421
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发表时间：
2013
期刊：
影响因子：
15.8
通讯作者：
Qazi SA
中科院分区：
文献类型：
--
作者：
Campbell H;El Arifeen S;Hazir T;O'Kelly J;Bryce J;Rudan I;Qazi SA
肺炎仍然是全球儿童死亡的主要原因，提高抗生素治疗率是关键的控制策略。通过人口与健康调查和多指标类集调查等大型住户调查监测在提高抗生素治疗全球覆盖率方面取得的进展，这些调查根据护理人员对肺炎的两周回忆来估计肺炎的抗生素治疗率。然而，这些调查工具确定了报告肺炎症状的儿童，并且由于社区环境中两周内肺炎的患病率较低，这些儿童中的大多数没有真正的肺炎，因此无法提供肺炎病例的准确分母以监测抗生素治疗率。在这篇综述中，我们表明，调查工具的性能可以提高通过增加调查回忆期或通过提高整体判别力或特异性。然而，即使检测特异性为95%（检测灵敏度为80%），报告肺炎症状的儿童中真正患有肺炎的比例也只有22%（调查工具的阳性预测值）。因此，尽管人口与健康调查和多指标类集调查关于报告有肺炎和其他儿童疾病症状的儿童寻求护理的比率的调查数据仍然有效和重要，但人口与健康调查和多指标类集调查的数据无法对肺炎儿童的抗生素治疗率作出有效的估计。
Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%), the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool). Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.
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影响因子：
168.9
作者：
Liu, Li;Johnson, Hope L.;Black, Robert E.
通讯作者：
Black, Robert E.
影响因子：
5.4
作者：
Goldman, N;Pebley, AR;Gragnolati, M
通讯作者：
Gragnolati, M
影响因子：
15.8
作者：
Campbell H;El Arifeen S;Hazir T;O'Kelly J;Bryce J;Rudan I;Qazi SA
通讯作者：
Qazi SA
DOI：
10.2471/blt.08.053348
发表时间：
2008-05-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Greenwood, Brian
通讯作者：
Greenwood, Brian
影响因子：
5.4
作者：
MULL, DS;MULL, JD;ANJUM, M
通讯作者：
ANJUM, M