Acute respiratory infections in children under five years. Control project in Bagamoyo District, Tanzania

Abstract

Control of acute respiratory infections (ARI) in children under five years of age has been implemented as an integrated part of Primary Health Care in rural Bagamoyo District in Tanzania. Community supported Village Health Workers visited each family at their homes every six to eight weeks, giving health education on recognition and prevention of ARI, treating children with pneumonia on the spot with oral Cotrimoxazole or referring them to the next higher level of care. Within a two-year period the total under five mortality has been reduced by 27.2% from 40.1 to 29.2/1000 children aged under five per year. The disease-specific mortality rate for pneumonia has been reduced by 30.1% from 14.3 to 10.0/1000 under-five per year, contributing 40% to the overall mortality reduction. It is concluded that an active health service outreach programme, within Primary Health Care, can efficiently reduce high child mortality rates from ARI and other diseases. A similar approach will be used to tackle other problems such as diarrhoeal diseases, malnutrition, malaria and child spacing.

PIP: A goal of a pilot project in Tanzania's Bagamoyo District was to achieve a 30% reduction in mortality due to acute respiratory infection (ARI) in children under 5 years of age in the 1983-86 period. The project utilized village health workers who were trained to refer seriously ill children to dispensaries and to educate mothers on the early recognition of signs and symptoms of infection. To differentiate the impact of the ARI control program from other effects, the district's villages were randomly divided into intervention and control villages; however, control villages received a deployment of trained village health workers in the 2nd year of the project, thereby changing them into phase II intervention areas. In the 1st year (June 1983-June 1984), there were 260 deaths from ARI among children under 5 years (mortality rate, 32.4/1000) in the intervention area compared with 325 deaths (mortality rate, 40.1/1000) in the control area--a significant difference of 19.2%. In the 2nd year (July 1984-June 1985), there were 266 deaths in the intervention area (29.2/1000) and 347 deaths (35.0/1000) in the control area, for a difference of 9.9%. 51% of the deaths recorded in the 2 years for which data are available involved males; 54% occurred during the 1st year of life. The most significant direct causes of death were pneumonia (35%), malaria (23%), diarrhea (14%), and malnutrition (9%), while important indirect causes were measles (12%) and convulsions (10%). Only 33% of deaths in the control area compared with 54% in the intervention area were treated with antibiotics. To strengthen the success of the intervention program, control of diarrheal diseases and malnutrition are being added.