January 2012 - August 2014
This study explored the rational use of antibiotics at community level in Zambia, by community health workers (CHW) and caregivers, for treatment of pneumonia to inform future implementation of integrated community case management (iCCM). iCCM helps to ensure remote and marginalised populations have access to care for three key childhood diseases; malaria, pneumonia and diarrhoea, helping to reduce child mortality. However, in conjunction with maximising access to treatment, the effectiveness of existing medicines must be preserved through the rational use of antibiotics, to minimise the development and spread of drug resistance.
The study was a mixed methods cross-sectional study. It involved observation of CHW consultations, including innovative methodology to assess the accuracy of measuring the respiratory rate of children with suspected pneumonia, and to assess whether treatment guidelines for prescribing antibiotics were followed. In addition, caregivers whose children were prescribed antibiotics for suspected pneumonia were followed up to determine adherence to treatment regimens, using questionnaire and pill counts. Key informant interviews and focus group discussions were also conducted with CHWs and caregivers to explore community perceptions and factors influencing the rational use of antibiotics in this context. The findings support existing literature that CHWs are capable of measuring respiratory rates and providing appropriate treatment for children suffering from pneumonia.