title: The Use of Guidelines for Lower Respiratory Tract Infections in Tanzania: A Lesson from Kilimanjaro Clinicians.
abstract: BACKGROUND
  Evaluations of the guidelines for the management of Lower Respiratory Tract Infections (LRTI) Sub-Saharan Africa, particularly in Tanzania is scant.
  
  
  OBJECTIVE
  The aim of the study was to assess the usefulness of the current Tanzanian treatment guideline for the management lower respiratory tract infection.
  
  
  METHODS
  A descriptive cross sectional study in 11 hospitals of different levels in the Kilimanjaro region Data were collected from May 2012 to July 2012 by semi-structured interview for clinicians using 2 dummy cases for practical assessment. Data were analyzed by STATA v11 (StataCorp, TX, USA). Qualitative narratives from the interviews were translated, transcribed then coded by colors into meaningful themes.
  
  
  RESULTS
  A variety of principles for diagnosing and managing LRTI were demonstrated by 53 clinicians of Kilimanjaro. For the awareness, 67.9% (36/53) clinicians knew their responsibility to use Standard Treatment Guideline for managing LRTI. The content derived from Standard Treatment Guideline could be cited by 11.3% of clinicians (6/53) however they all showed concern of gaps in the guideline. Previous training in the management of patients with LRTI was reported by 25.9% (14/53), majority were pulmonary TB related. Correct microorganisms causing different forms of LRTI were mentioned by 11.3% (6/53). Exact cause of Atypical pneumonia and Q fever as an example was stated by 13.0% (7/53) from whom the need of developing the guideline for LRTI was explicitly elaborated.
  
  
  CONCLUSIONS
  The current guidelines have not been used effectively for the management of LRTI in Tanzania. There is a need to review its content for the current practical use.
authors.affiliation: Kilimanjaro Christian Medical Center, Kilimanjaro Clinical Research Institute, Zanzibar, Tanzania; Programme Manager - Reproductive Maternal Newborn Child Health, Nutrition and WASH, Save the Children, Zanzibar, Tanzania.
authors.forename: B
authors.initials: B
authors.lastname: Mbwele
authors.affiliation: Nijmegen Institute for International Health (NIIH, UMC Nijmegen), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Slot
authors.affiliation: Nijmegen Institute for International Health (NIIH, UMC Nijmegen), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Q
authors.initials: Q
authors.lastname: De Mast
authors.affiliation: Vijiji International, Kilimani Tower, Mawenzi Road, Moshi, Tanzania.
authors.forename: P
authors.initials: P
authors.lastname: Kweka
authors.affiliation: Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: M
authors.initials: M
authors.lastname: Msuya
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hulscher
keywords: Atypical pneumonia; Clinicians; Community acquired; Lower respiratory tract infections; Q fever; Quality of health care; Sub-Saharan Africa; Tanzania; pneumonia