Health Workers’ Practices in Assessment and Management of Children with Respiratory Symptoms in Primary Care Facilities in Uganda: A FRESH AIR Descriptive Study Rebecca Nantanda PhD, 1, * Joakim Bloch MD, 2, * Marianne Stubbe Østergaard PhD, 3 Bruce J. Kirenga PhD, 1,4 James K. Tumwine PhD, 5 Grace Ndeezi PhD, 5 Susanne Reventlow D.M.Sc, 2,3 Anja Poulsen PhD, 2 and Jesper Kjærgaard PhD 2 1 Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala þ256, Uganda 2 The Global Health Unit, Department of Paediatrics and Adolescent Medicine, Danish National Hospital “Rigshospitalet”, Copenhagen 2100, Denmark 3 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen 1165, Denmark 4 Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala þ256, Uganda 5 Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala þ256, Uganda *Shared first-author. Correspondence: Rebecca Nantanda, Makerere University Lung Institute, College of Health Sciences, Makerere University, PO Box 7749, Kampala þ256, Uganda. Tel: þ256-777723332. E-mail <rnantanda@gmail.com>. ABSTRACT Introduction: Globally, acute lower respiratory infections are the leading cause of mortality among children under 5 years. Following World Health Organization primary care guidelines, pneumonia is diagnosed based on cough/difficult breathing and fast breathing. We aimed to describe the practices of healthcare workers in primary care health facilities in Uganda in the management of young chil- dren with respiratory symptoms especially regarding asthma as opposed to pneumonia. Methods: Health workers were observed during clinical consultations with children 1–59 months of age presenting with cough and/or difficult breathing at recruitment. Afterward, an exit interview with the caregiver was conducted. Health center availability of clinical guidelines, equipment and supplies for management of children with respiratory symptoms was assessed systematically. Results: A total of 218 consultations with 50 health workers at six health centers were included. Median consultation time was 4 min. Health workers asked history relevant to distinguishing asthma from pneumonia in 16% of consultations. The respiratory rate was counted in 10%. Antibiotics were prescribed to 32% of all the children and to 39% of children diagnosed with pneumonia. Caregivers reported being informed of findings and possible diagnosis in 5% of cases. Medicine and equipment needed for diagnosing and treating asthma were generally unavailable. Conclusion: Clinical practices among Ugandan health workers in primary care are insufficient to distinguish between main causes of respiratory symptoms, especially asthma as opposed to V C The Author(s) [2021]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com  1 Journal of Tropical Pediatrics, 2021, 00, 1–10 doi: 10.1093/tropej/fmab042 Original Paper Downloaded from https://academic.oup.com/tropej/article/67/2/fmab042/6296314 by guest on 10 June 2022