Resources and Geographic Access to Care for Severe Pediatric Pneumonia in Four Resource-limited Settings.

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Simkovich, Suzanne M ORCID: 0000-0003-2462-0856, Underhill, Lindsay J ORCID: 0000-0002-1511-812X, Kirby, Miles A ORCID: 0000-0003-3468-9793, Crocker, Mary E ORCID: 0000-0002-0587-1249, Goodman, Dina ORCID: 0000-0001-9997-4603, McCracken, John P ORCID: 0000-0002-0714-2971, Thompson, Lisa M ORCID: 0000-0002-8001-2057, Diaz-Artiga, Anaité ORCID: 0000-0002-2508-8710, Castañaza-Gonzalez, Adly, Garg, Sarada S et al (show 8 more authors) , Balakrishnan, Kalpana ORCID: 0000-0002-5905-1801, Thangavel, Gurusamy ORCID: 0000-0001-9161-0338, Rosa, Ghislaine ORCID: 0000-0002-8776-4200, Peel, Jennifer L ORCID: 0000-0001-5155-1580, Clasen, Thomas F ORCID: 0000-0003-4062-5788, McCollum, Eric D ORCID: 0000-0002-1872-5566, Checkley, William ORCID: 0000-0003-1106-8812 and HAPIN Investigators, (2022) Resources and Geographic Access to Care for Severe Pediatric Pneumonia in Four Resource-limited Settings. American journal of respiratory and critical care medicine, 205 (2). pp. 183-197.

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Abstract

<b>Rationale:</b> 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. <b>Objectives:</b> 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. <b>Measurements and Main Results:</b> 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 <i>P</i> < 0.001). <b>Conclusions:</b> 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.

Item Type:	Article
Uncontrolled Keywords:	HAPIN Investigators, Humans, Pneumonia, Oximetry, Geography, Poverty, Adolescent, Child, Child, Preschool, Infant, Infant, Newborn, Rural Population, Child Health Services, Rural Health Services, Health Services Accessibility, Rwanda, Guatemala, Peru, India, Female, Male
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	10 Feb 2023 18:07
Last Modified:	17 Mar 2024 15:14
DOI:	10.1164/rccm.202104-1013oc
Open Access URL:	https://doi.org/10.1164/rccm.202104-1013OC
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3168359