TY - JOUR
T1 - Resources and Geographic Access to Care for Severe Pediatric Pneumonia in Four Resource-limited Settings
AU - Simkovich, Suzanne M.
AU - Underhill, Lindsay J.
AU - Kirby, Miles A.
AU - Crocker, Mary E.
AU - Goodman, Dina
AU - McCracken, John P.
AU - Thompson, Lisa M.
AU - Diaz-Artiga, Anaité
AU - Castañaza-Gonzalez, Adly
AU - Garg, Sarada S.
AU - Balakrishnan, Kalpana
AU - Thangavel, Gurusamy
AU - Rosa, Ghislaine
AU - Peel, Jennifer L.
AU - Clasen, Thomas F.
AU - McCollum, Eric D.
AU - Checkley, William
N1 - Funding Information:
and Melinda Gates Foundation; Claudia L. Thompson, National Institute of Environmental Health Science; Mark J. Parascandola, National Cancer Institute; Danuta M. Krotoski, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Joshua P. Rosenthal, Fogarty International Center; Conception R. Nierras, NIH Office of Strategic Coordination Common Fund; Antonello Punturieri; and Barry S. Schmetter, NHLBI.
Funding Information:
Supported by the U.S. NIH (cooperative agreement 1UM1HL134590; multiple principal investigators: W.C., T.F.C., J.L.P.) in collaboration with the Bill and Melinda Gates Foundation (OPP1131279). Participating NIH organizations include the NHLBI, National Institute of Environmental Health Sciences, National Cancer Institute, National Institute of Child Health and Human Development, Fogarty International Center, and the NIH Common Fund. S.M.S. was supported by funding from the NHLBI (1F32HL143909-01, K12HL137942). L.J.U. was supported by the Fogarty International Center (University of North Carolina at Chapel Hill–Johns Hopkins University–Morehouse School of Medicine–Tulane University Fogarty Global Health Fellowship training grant D43TW009340; multiple principal investigators: P. Buekens, W.C., B. Chi, and K. Kondwani) funded by the U.S. NIH through the following Institutes and Centers: the Fogarty International Center, National Institute of Neurological Disorders and Stroke, National Institute of Mental Health, NHLBI, and National Institute of Environmental Health Sciences. D.G. was supported by the Harvard Cardiovascular Epidemiology Research Training Program (T32HL098048). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. NIH or Department of Health and Human Services.
Publisher Copyright:
© 2022 by the American Thoracic Society.
PY - 2022/1/15
Y1 - 2022/1/15
N2 - Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41±19 minutes in J-GUA, 99±64 minutes in P-PER, 40±19 minutes in K-RWA, and 31±19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P<0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
AB - Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41±19 minutes in J-GUA, 99±64 minutes in P-PER, 40±19 minutes in K-RWA, and 31±19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P<0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
KW - Health service accessibility
KW - Low- and middle-income country
KW - Pneumonia
KW - Pneumonia
KW - Pulse oximetry
UR - http://www.scopus.com/inward/record.url?scp=85123812585&partnerID=8YFLogxK
U2 - 10.1164/rccm.202104-1013OC
DO - 10.1164/rccm.202104-1013OC
M3 - Article
C2 - 34662531
AN - SCOPUS:85123812585
VL - 205
SP - 183
EP - 197
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 2
ER -