Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study
Abstract Background Pneumonia and possible serious bacterial infection (PSBI) are leading causes of death among under-five children. The World Health Organization (WHO) issued global recommendations for the case management of childhood pneumonia and PSBI when referral is not feasible with oral amoxi...
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doaj-07dd1da2de2f46909bf0fd40a2ba21962020-11-25T01:27:49ZengBMCBMC Health Services Research1472-69632020-02-0120111210.1186/s12913-020-4982-4Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative studyMahfuzur Rahman0Jaclyn Delarosa1Sharmin Khan Luies2Kazi Robiul Alom3Manjari Quintanar-Solares4Ishrat Jabeen5Tahmeed Ahmed6Elizabeth Abu-Haydar7Haribondhu Sarma8International Centre for Diarrhoeal Disease ResearchPATH, 2201 Westlake AvenueInternational Centre for Diarrhoeal Disease ResearchDepartment of Anthropology, University of RajshahiPATH, 2201 Westlake AvenueInternational Centre for Diarrhoeal Disease ResearchInternational Centre for Diarrhoeal Disease ResearchPATH, 2201 Westlake AvenueInternational Centre for Diarrhoeal Disease ResearchAbstract Background Pneumonia and possible serious bacterial infection (PSBI) are leading causes of death among under-five children. The World Health Organization (WHO) issued global recommendations for the case management of childhood pneumonia and PSBI when referral is not feasible with oral amoxicillin. However, few governments to date have incorporated child-friendly amoxicillin dispersible tablets (DT) into their national treatment guidelines and policies. We aimed to understand the key drivers to the implementation of WHO recommendations for childhood pneumonia and PSBI using amoxicillin DT in Bangladesh. Methods A qualitative study was conducted from October 2017 to March 2018 in two districts of Bangladesh. Interviews were completed with 67 participants consisting of government officials and key stakeholders, international development agencies, health service providers (HSPs), and caregivers of young children diagnosed and treated with amoxicillin for pneumonia or PSBI. Data were analyzed thematically. Results Policies and operational planning emerged as paramount to ensuring access to essential medicines for childhood pneumonia and PSBI. Though amoxicillin DT is included for National Newborn Health Programme and Integrated Management of Childhood Illnesses in the Operational Plan of the Directorate General of Health Services, inclusion in Community-Based Healthcare Project and Directorate General of Family Planning policies is imperative to securing national supply, access, and uptake. At the sub-national level, training on the use of amoxicillin DT as a first line intervention is lacking, resulting in inadequate management of childhood pneumonia by HSPs. Advocacy activities are needed to create community-wide demand among key stakeholders, HSPs, and caregivers not yet convinced that amoxicillin DT is the preferred formulation for the management of childhood pneumonia and PSBI. Conclusion Challenges in policy and supply at the national level and HSP preparedness at the sub-national levels contribute to the slow adoption of WHO recommendations for amoxicillin DT in Bangladesh. A consultation meeting to disseminate study findings was instrumental in driving the development of recommendations by key stakeholders to address these challenges. A comprehensive and inclusive evidence-based strategy involving all divisions of the Ministry of Health and Family Welfare will be required to achieve national adoption of WHO recommendations and country-wide introduction of amoxicillin DT in Bangladesh.http://link.springer.com/article/10.1186/s12913-020-4982-4Childhood pneumoniaPossible serious bacterial infectionOral amoxicillinDispersible tabletsWHO recommendationsBangladesh |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mahfuzur Rahman Jaclyn Delarosa Sharmin Khan Luies Kazi Robiul Alom Manjari Quintanar-Solares Ishrat Jabeen Tahmeed Ahmed Elizabeth Abu-Haydar Haribondhu Sarma |
spellingShingle |
Mahfuzur Rahman Jaclyn Delarosa Sharmin Khan Luies Kazi Robiul Alom Manjari Quintanar-Solares Ishrat Jabeen Tahmeed Ahmed Elizabeth Abu-Haydar Haribondhu Sarma Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study BMC Health Services Research Childhood pneumonia Possible serious bacterial infection Oral amoxicillin Dispersible tablets WHO recommendations Bangladesh |
author_facet |
Mahfuzur Rahman Jaclyn Delarosa Sharmin Khan Luies Kazi Robiul Alom Manjari Quintanar-Solares Ishrat Jabeen Tahmeed Ahmed Elizabeth Abu-Haydar Haribondhu Sarma |
author_sort |
Mahfuzur Rahman |
title |
Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study |
title_short |
Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study |
title_full |
Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study |
title_fullStr |
Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study |
title_full_unstemmed |
Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study |
title_sort |
understanding key drivers and barriers to implementation of the who recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (dt) in bangladesh: a qualitative study |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2020-02-01 |
description |
Abstract Background Pneumonia and possible serious bacterial infection (PSBI) are leading causes of death among under-five children. The World Health Organization (WHO) issued global recommendations for the case management of childhood pneumonia and PSBI when referral is not feasible with oral amoxicillin. However, few governments to date have incorporated child-friendly amoxicillin dispersible tablets (DT) into their national treatment guidelines and policies. We aimed to understand the key drivers to the implementation of WHO recommendations for childhood pneumonia and PSBI using amoxicillin DT in Bangladesh. Methods A qualitative study was conducted from October 2017 to March 2018 in two districts of Bangladesh. Interviews were completed with 67 participants consisting of government officials and key stakeholders, international development agencies, health service providers (HSPs), and caregivers of young children diagnosed and treated with amoxicillin for pneumonia or PSBI. Data were analyzed thematically. Results Policies and operational planning emerged as paramount to ensuring access to essential medicines for childhood pneumonia and PSBI. Though amoxicillin DT is included for National Newborn Health Programme and Integrated Management of Childhood Illnesses in the Operational Plan of the Directorate General of Health Services, inclusion in Community-Based Healthcare Project and Directorate General of Family Planning policies is imperative to securing national supply, access, and uptake. At the sub-national level, training on the use of amoxicillin DT as a first line intervention is lacking, resulting in inadequate management of childhood pneumonia by HSPs. Advocacy activities are needed to create community-wide demand among key stakeholders, HSPs, and caregivers not yet convinced that amoxicillin DT is the preferred formulation for the management of childhood pneumonia and PSBI. Conclusion Challenges in policy and supply at the national level and HSP preparedness at the sub-national levels contribute to the slow adoption of WHO recommendations for amoxicillin DT in Bangladesh. A consultation meeting to disseminate study findings was instrumental in driving the development of recommendations by key stakeholders to address these challenges. A comprehensive and inclusive evidence-based strategy involving all divisions of the Ministry of Health and Family Welfare will be required to achieve national adoption of WHO recommendations and country-wide introduction of amoxicillin DT in Bangladesh. |
topic |
Childhood pneumonia Possible serious bacterial infection Oral amoxicillin Dispersible tablets WHO recommendations Bangladesh |
url |
http://link.springer.com/article/10.1186/s12913-020-4982-4 |
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