Abstract Ref Number = APCP237
IMPLEMENTATION OF THE WHO RECOMMENDATIONS FOR THE CASE MANAGEMENT OF CHILDHOOD PNEUMONIA AND PSBI WITH AMOXICILLIN DT IN BANGLADESH
Mahfuzur Rahman,Jaclyn Delarosa,Manjari Quintanar Solares,Elizabeth AbuHaydar,Sharmin Khan Luies,Tahmeed Ahmed,Kazi Robiul Alom,Methelda DRozario,Haribondhu Sarma
icddrb PATH, Westlake Avenue, Suite Seattle, WA USA International Centre for Diarrhoeal Disease Research, Bangladesh Department of Anthropology, University of Rajshahi, Rajshahi, Bangladesh UN Women, Bangladesh International Centre for Diarrhoeal Disease Research, Bangladesh and Research School of Population Health, the Australian National University
Background : Pneumonia and possible serious bacterial infection (PSBI) are leading causes of deaths among under-five children. The World Health Organization (WHO) released guidelines for the integrated management of childhood illnesses (IMCI) which re-classified the treatment of childhood pneumonia at healthcare facilities with amoxicillin dispersible tablet (DT) and for managing PSBI where referral is not feasible. We aimed to understand the key drivers to the implementation of the WHO guidelines that are expected to lead to decreased under-five mortality from these major causes of death.
Material : We conducted a qualitative study from October 2017 to March 2018 in two districts of Bangladesh. A total of 65 interviews with the officials from directorate general of health service and directorate general of family planning, and development agencies; health service providers (HSPs) and caregivers of children and infants with pneumonia or PSBI were interviewed. Data were analyzed thematically.
Results : The Ministry of Health and Family Welfare (MOHFW) revised IMCI protocol following the WHO recommendations for the case management of childhood pneumonia and PSBI. The MOHFW included amoxicillin DT to the operational plan (OP) of IMCI programme. However, it was not included in the essential drug list and it was not procured, making it less available and accessible. Advocacy activities supported by development partners contributed to the capacity building of HSPs in applying new treatment guidelines. However, training in the use of amoxicillin DT as a first line intervention was still lacking that engendered barriers to adequately diagnose and treat childhood pneumonia by the HSPs.
Conclusions : While significant progress has been made, key barriers at the national and sub-national levels exist and contribute to the slow adoption of the WHO recommendation. To expedite the adoption process, a comprehensive and inclusive strategy that brings together all arms of the MOHFW is needed to effectively address these barriers.
Keywords: amoxicillin DT childhood pneumonia WHO guideline Bangladesh