Globally, pneumonia is the leading cause of death among children under five. Each year, pneumonia kills more children than AIDS, malaria, and measles combined. With effective treatment and prevention interventions that target caregivers and providers, 1.6 million deaths from pneumonia can be avoided each year. PSI has developed easy-to-use pre-packaged therapy kits to treat pneumonia in children under five, and made them available in six countries through private clinics and community-based health workers as permitted by national policy. PSI also implements communication campaigns to promote prevention strategies, such as the importance of handwashing and exclusive breastfeeding, raises awareness about the availability of effective pneumonia treatment, and improves the ability of caretakers to recognize pneumonia symptoms, promptly seek care and complete the treatment course.
Behavior Change Communication for Pneumonia Prevention
PSI uses behavior change techniques and communications to promote pneumonia prevention. As part of PSI’s community case management efforts, community health workers are trained to provide pneumonia prevention messages to caregivers of children under five. The messages focus on exclusive breastfeeding for the first six months, reduction of indoor air pollution and hand-washing with soap, which have respectively been shown to lead to 15-23 percent, 75 percent and 50 percent reductions in pneumonia morbidity.*
* UNICEF, WHO, Pneumonia: The Forgotten Killer of Children, September 2006.
To ensure access to the appropriate case management, PSI educates caregivers on the importance of prompt care seeking behavior when a child presents with cough and rapid breathing and distributes prepackaged therapy for pneumonia (PPT). In line with WHO guidelines, the PPT kit contains the appropriate dose of oral antibiotic (either pediatric Amoxicillin or Cotrimoxazole) for a one-course treatment of a pneumonia episode. The quality assured antibiotic is a dispersible, flavored formulation, and packaged in strength and dosage suitable for two age groups of children (2-11 months and 1-5 years). The pre-packaged treatments are designed for easy administration by the caregiver at home; instructions are in local languages and reinforced by simple illustrations so that the dosing is clear to high and low literacy caregivers alike.
PSI works in accordance with national country guidelines to provide treatment through community-based outreach and private-sector clinics to treat pneumonia. Where possible, community health workers are used to distribute pneumonia PPT. In line with the integrated management of childhood illness (IMCI) protocol, PSI works with local partners to improve quality of pneumonia case management by training community health workers and medical providers on pneumonia diagnosis and treatment as well as providing supervision and medical detailing. Furthermore, to motivate demand for quality care and increase care seeking behavior, comprehensive communication campaigns targeted to caregivers and providers are conducted in countries where pneumonia interventions are implemented: Congo, Madagascar, Malawi, Myanmar and Uganda.
Handwashing with soap at key times has been shown to decrease the incidence of diarrhea in the general population by 48%*, making it the most cost-effective of ALL major disease control interventions**. Even though studies suggest that soap is available in more than 95% of households, handwashing with soap is not a common practice. PSI programs work to increase the practice of handwashing with soap at key times among caregivers of children under five, primary school children, and vulnerable populations including people living with HIV/AIDS. Formative research is used to understand the most important factors that influence adoption of handwashing with soap behaviors. This consumer insight is used by PSI to develop marketing strategies that include dissemination of key messages through a variety of communication channels such as mass media campaigns, community level events and interpersonal communications.
*Cairncross S, Hunt c, Boisson S et al. Water, sanitation and hygiene for the prevention of diarrhea. International Journal of Epidemiology 2010; 39:i193-i205.
**World Bank/WHO Disease Control Priorities Project
PSI contributes to global efforts to reduce child mortality by two thirds in 2015 compared to 1990 levels, by implementing integrated case management (ICM) programs that focus on treatment of pneumonia, diarrhea, malaria, and severe acute malnutrition. PSI is focused on improving access to effective treatment, enhancing quality of care, and increasing informed demand among caregivers to seek prompt and effective treatment from trained providers. To increase access, PSI works through pharmacy networks, franchised and non-franchised private clinics, and community health workers (CHWs) to reach caregivers of children under five with the quality services and commodities they need. By leveraging the most appropriate channel to reach caregivers, PSI will provide high quality, cost effective integrated health services that address the main causes of childhood morbidity and mortality in a given country.
Integrated Community Case Management (iCCM) is an ICM strategy to prevent child deaths in settings where access to facility based care is limited. PSI works with Ministries of Health to develop iCCM programs that involve clinical diagnosis and treatment provided by trained and supervised community health workers who promote timely treatment seeking, encourage appropriate home care, and facilitate referrals to facilities. In addition to improving access to care, PSI’s iCCM interventions focus on preventing child deaths by increasing quality of and demand for iCCM services. Children with danger signs are referred to health facilities. iCCM may include the treatment of malaria (with ACTs), pneumonia (with antibiotics) and diarrhea (with ORS and zinc). When CHWs diagnose uncomplicated malaria, pneumonia or diarrheal disease, treatment is provided free of charge. An iCCM intervention typically includes training and supervision of CHWs, appropriate treatment, and behavior change communications targeting mothers and caregivers. PSI implements iCCM programs in Malawi, Mali, DRC, South Sudan, Madagascar, and Cameroon, with funding support from CIDA, Global Fund, and other donors.