A prospective validation study in South-West Nigeria on caregiver report of childhood pneumonia and antibiotic treatment using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questions
A prospective validation study in South-West Nigeria on caregiver report of childhood pneumonia and antibiotic treatment using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questions
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使用人口与健康调查 (DHS) 和多指标类集调查 (MICS) 问题，在尼日利亚西南部针对儿童肺炎和抗生素治疗的护理人员报告进行了一项前瞻性验证研究
DOI：
10.7189/jogh.08-020806
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发表时间：
2018
影响因子：
7.2
通讯作者：
H. Campbell
中科院分区：
文献类型：
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作者：
A. Ayede;A. Kirolos;Kayode Raphael Fowobaje;L. Williams;A. Bakare;Oladapo B. Oyewole;Oluwaseun B Olorunfemi;Oluwaseun Kuna;Nkechi T Iwuala;Abolanle Oguntoye;Simeon O Kusoro;Mofeyisade E Okunlola;S. Qazi;H. Nair;A. Falade;H. Campbell
儿童肺炎是全世界五岁以下儿童死亡的最大单一传染性原因。人口与健康调查和多指标类集调查提供了关于资源匮乏环境中患病儿童寻求护理的健康信息。尽管人口与健康调查和多指标类集调查的主要目的不是确定儿童肺炎，但令人关切的是，人口与健康调查和多指标类集调查中报告的“急性呼吸道感染症状”往往被其他群体解释为儿童肺炎的“替代”。使用DHS 5和MICS 5调查工具，本研究旨在评估护理人员报告的“急性呼吸道感染症状”如何准确反映五岁以下儿童的肺炎发作和抗生素使用情况。方法2015年8月至2017年3月，从尼日利亚伊巴丹的四家研究医院招募了0至59个月的咳嗽和/或呼吸困难儿童。研究医生使用世界卫生组织（WHO）的标准标准对儿童进行评估，以确定他们是否患有肺炎。两周或八周后，对“肺炎”和“非肺炎”类别中的302名匹配儿童进行了在家随访，使用DHS 5和MICS 5调查中的问题来评估护理人员回忆肺炎的准确性。结果DHS 5和MICS 5诊断小儿肺炎的特异性分别为87.4（95%置信区间（CI）= 83.1-91.0）和86.1（95% CI = 81.7-89.8），敏感度分别为37.1（95% CI = 31.6-42.8）和37.1（95% CI = 31.6-42.8）。对抗生素治疗的正确回忆较差（Kappa统计值= 0.064），但使用药丸板后有所改善（Kappa统计值= 0.235）。结论：DHS 5和MICS 5调查问题的设计目的不是为了识别儿童肺炎，这项研究证实，他们不能准确地区分儿童肺炎发作咳嗽/感冒在5岁以下的儿童。使用目前的DHS和MICS调查无法准确评估适当使用抗生素治疗的肺炎发作比例。如果这些结果被用来指导规划决策，很可能会鼓励过度使用和不适当的抗生素处方咳嗽/感冒发作。应劝阻继续使用这些家庭数据监测接受抗生素治疗的肺炎儿童比例的国际机构这样做，因为这些数据可能误导国家和全球方案。在一些人口与健康调查中使用了药丸板，应在全国人口调查中推广使用，以提高抗生素召回的准确性。
Background Childhood pneumonia is the single largest infectious cause of death in children under five worldwide. Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) provide health information on care sought for sick children in resource poor settings. Despite not being primarily designed to identify childhood pneumonia, there are concerns that reported episodes of “symptoms of acute respiratory infection” in DHS and MICS are often interpreted by other groups as a “proxy” for childhood pneumonia. Using DHS5 and MICS5 survey tools, this study aimed to assess how accurately caregivers report of “symptoms of acute respiratory infection” reflect pneumonia episodes and antibiotic use in children under five. Methods Children aged 0 to 59 months presenting with cough and/or difficult breathing were recruited from four study hospitals in Ibadan, Nigeria from August 2015 to March 2017. Children were assessed using World Health Organization (WHO) standard criteria by study physicians to identify whether they had pneumonia. Three hundred and two matched children in each category of ‘pneumonia’ and “no pneumonia” were followed up at home, either two or eight weeks later, using questions from DHS5 and MICS5 surveys to assess the accuracy of caregiver recall of pneumonia. Results The specificity of DHS5 and MICS5 questions for identifying childhood pneumonia were 87.4 (95% confidence interval (CI) = 83.1-91.0) and 86.1 (95% CI = 81.7–89.8) respectively and the sensitivity of questions were 37.1 (95% CI = 31.6-42.8) and 37.1 (95% CI = 31.6-42.8). Correct recall of antibiotic treatment was poor (kappa statistic = 0.064) but improved with the use of medicine pill boards (kappa statistic = 0.235). Conclusions DHS5 and MICS5 survey questions are not designed to identify childhood pneumonia and this study confirms that they do not accurately discern episodes of childhood pneumonia from cough/cold in children under five. The proportion of pneumonia episodes appropriately treated with antibiotics cannot be accurately assessed using current DHS and MICS surveys. If these results are used to guide programmatic decisions, it is likely to encourage overuse and inappropriate prescribing of antibiotics for episodes of cough/cold. International agencies who continue to use these household data to monitor the proportion of children with pneumonia who receive antibiotic treatment should be discouraged from doing this as these data are likely to mislead national and global programmes. Medicine pill boards are used in a number of DHS surveys and should be promoted for wider use in national population surveys to improve the accuracy of antibiotic recall.