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MEASURING COVERAGE IN MNCH: CHALLENGES WITH MONITORING THE PROPORTION OF YOUNG CHILDREN WITH PNEUMONIA WHO RECEIVE ANTIBIOTIC TREATMENT

Wednesday, 12th of June 2013

• MEASURING COVERAGE IN MNCH: CHALLENGES WITH MONITORING THE PROPORTION OF YOUNG CHILDREN WITH PNEUMONIA WHO RECEIVE ANTIBIOTIC TREATMENT

Full text, with graphics, is at http://www.ploscollections.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001421

 

Abstract

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.

Citation: Campbell H, el Arifeen S, Hazir T, OKelly J, Bryce J, et al. (2013) Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment. PLoS Med 10(5): e1001421. doi:10.1371/journal.pmed.1001421

Academic Editor: David Osrin, Wellcome Trust Senior Research Fellow in Clinical Science, UCL Reader in International Child Health, Honorary Consultant, Great Ormond Street Hospital for Children, United Kingdom

Published: May 7, 2013

Copyright: © 2013 Campbell et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was conducted under the auspices of the Child Health Epidemiology Reference Group (CHERG) for WHO and UNICEF, with financial support from The Bill & Melinda Gates Foundation through their grant to the US Fund for UNICEF. The funders had no role in study design, data collection and analysis, or preparation of the manuscript. The funders supported the decision to publish.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: DHS, Demographic and Health Surveys; MICS, Multiple Indicator Cluster Surveys

Provenance: Submitted as part of a sponsored Collection; externally reviewed.

This paper is part of the PLOS Medicine “Measuring Coverage in MNCH” Collection.