Community intervention to promote rational treatment of acute respiratory infection in rural Nepal.
OBJECTIVE
To evaluate a community education program about treatment of acute respiratory infection (ARI).


METHODS
First, community case definitions for severe and mild ARI were developed. The intervention was then evaluated using a controlled before-and-after design. Household surveys collected data about ARI treatment in 20 clusters, each based around a school and health facility. Treatment indicators included percentages of cases attending health facilities and receiving antibiotics. The intervention consisted of an education program in schools culminating in street theater performances, discussions with mothers after performances and training for community leaders and drug retailers by paramedics. The intervention was conducted in mid-2003. Indicators were measured before the intervention in Nov/Dec 2002 and again in Dec 2003/Jan 2004.


RESULTS
Two thousand and seven hundred and nineteen households were surveyed and 3654 under-fives were identified, of whom 377 had severe ARI. After implementing the intervention, health post (HP) attendance rose by 13% in under-fives with severe ARI and fell by 9% in under-fives with mild ARI (test of interaction, P = 0.01). Use of prescribed antibiotics increased in under-fives with severe ARI by 21% but only by 1% in under-fives with mild ARI (test of interaction, P = 0.38). Irrespective of ARI severity, the use of non-prescribed antibiotics dropped by 5% (P = 0.002), and consultation with female community health volunteers (FCHVs)and use of safe home remedies increased by 6.7% (P not estimated) and 5.7% (P = 0.008) respectively.


CONCLUSIONS
The intervention was implemented using local structures and in difficult circumstances, yet had a moderate impact. Thus it has the potential to effect large scale changes in behaviour and merits replication elsewhere.
Holloway
Kathleen A
KA
Department of Essential Medicines & Pharmaceutical Policy, WHO, Geneva, Switzerland. hollowayk@who.int
Karkee
Shiba B
SB
Tamang
Ashalal
A
Gurung
Yam Bahadur
YB
Kafle
Kumud K
KK
Pradhan
Ramesh
R
Reeves
Barnaby C
BC
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009390:Nepal; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012423:Rural Health / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration*; D012574:Schools
D000900:Anti-Bacterial Agents