Insights from community-based research on child pneumonia in Pakistan.

ABSTRACT

PIP: In Karachi squatter settlements and in rural Punjab in Pakistan, in-depth interviews with 35 mothers and grandmothers of young children and 4 self-trained allopathic practitioners were conducted for a medical anthropology study of acute respiratory infections (ARIs), especially pneumonia. Most mothers were familiar with chest indrawing as a danger sign of pneumonia. Most regional languages distinguished between the upper and lower chest, which should make it easier to educate mothers about the seriousness of fast breathing and unusual movement of the lower ribs and the area right below the ribs during breathing (i.e., chest indrawing). Mothers tended to associate fast breathing with fever alone. Utilization rates of government health facilities was very low (e.g., 16% during 1982-1983). Mothers would take their children to government health facilities only if other practitioners failed to successfully treat pneumonia. Most mothers would seek medicine from private (mainly unlicensed) practitioners. Yet, some of these practitioners do not count the child's breathing rates or examine the chest for indrawing. They even consider a fast pulse more dangerous than fast breathing. They overprescribe antibiotics. These findings suggest that the Pakistani government should include mothers and licensed and unlicensed allopathic practitioners in addition to its physicians in ARI education.