Designing an approach to Lower Respiratory Tract Infections.
Candace Moore
No University Affiliation
Nursing
Introduction:
Ethiopia is highly affected by communicable diseases like many countries less economically developed countries. These diseases accounted for over 60% of total death and 63% of DALYs in Ethiopia 2010. Out of these communicable diseases lower respiratory infections play a major role in the mortality and morbidity of the people. These diseases contribute about 14 % and almost 11% of towards all communicable death and DALYs respectively ((( Source from summative assignment))). The risk of developing acute lower respiratory infection was found to be very high in children under the age of five. Out of the different respiratory infections pneumonia was the cause for the majority of mortality and morbidity in these younger children. In rural Ethiopia the incidence of lower respiratory infection for children under give was even higher. 40% of urban Ethiopian children were admitted to hospital due to pneumonia and they had a 20% mortality rate. According to Muhe (1997) The main risk factors associated with lower respiratory infections were poverty, overcrowding, poor sanitation and malnutrition, particularly deficiencies of vitamin D and Calcium . Lower respiratory infections have burdened the economy of Ethiopia through national health care expenses and high child mortality rates as the number one killer of children under five in the communicable diseases category. Socially, families are forced to have higher numbers of children due to high child mortality rates. In order to address this problem the government should focus on providing accessible health care services. At a local level, nurses can be trained to provide very young children with nutritional supplements of Vitamin D and calcium. Health teachings about sanitation and hygiene can also be done at local levels level through primary health care centers and rural community health centers.
Background
Lower respiratory diseases are one of the many major health concerns of less developed countries in Africa and around the world. A research conducted by the World Health Organization in 2011 showed that 27% of under five children were taken to hospital due to the aforementioned diseases. Out of the above hospitalized children only 6.8% of them were able to receive antibiotic therapy (((ASSIGNMENT # 2))). The investigation in to the cause behind Ethiopian child mortality also showed that almost 18% of children died due to Acute lower respiratory diseases. According to the World Health Organization’s statistics this death rate is more than the child death rate caused by HIV/AIDS, Diarrhoea, Malaria and measles all together. Out of all the respiratory diseases Pneumonia plays a significant role in killing children in Ethiopia. According to The WHO report 27% of post neonatal death between the age of 1month to 59 months for the year 2012 was caused by Pneumonia. This share exceeds the sum of deaths caused by Injuries, malaria, HIV/AIDS, Pertussis and Measels for the same age group. In order to fight this rampant disease macro level decisions need to form policies that focuses on opening of nurse run clinics in rural areas, where the people are hard hit. Almost 80% of Ethiopian population lives in the rural areas. In rural Ethiopia the proportion of physicians and nurses to population goes as low as 0.5 doctor to 10,000 and 2 nurses and midwifes to 10,000 people (((WHO Assignemnt # 2))). The fact that government health care expenditure is limited only to 3.8% of the GDP and the peoples out of pocket expenditure by goes as high as 80.6% signifies the need for a major transformation in the way budgets are allocated and health services are provided (((WHO Assignemnt # 2))). At the micro level providing nutritional supplements rich in Vitamin D and calcium and health teachings about hygiene are proven ways of boosting children's' immunity to respiratory infections. Research done in the rural Ethiopia pointed out that from 500 cases of child pneumonia admission 210 of the children presented with Vitamin D and Calcium deficiency. According to Muhe (1997)These deficiencies were traced back to a lack of awareness about exposure of children to sun, poor nutritional intake and poverty.
Like many other developing countries, Ethiopia is mainly challenged by different types of communicable diseases as the primary causes of deaths and DALY's. Lower respiratory infection results in 14.08% of deaths and 10.27% of DALY's. Diarrheal diseases (5.91% death and 6.23% DALY's) and Malaria (5.7% death and 5.89% DALY's). Respiratory infection was chosen as a topic for this paper as it is the number one communicable diseases killing Ethiopian children. This disease manly affects children under five years of age who do not have developed immunity to fight off infection. Most importantly, respiratory infections can be managed and treated with micro level policy changes by providing rural health services and awareness raising through well equipped nurses (Chan & Lake, 2013). As front line health workers it is part of nurses' responsibility to inquire and bring about a tangible changes towards these diseases.
Out of the many social determinants of health the most significant contributing factors towards respiratory infection were poor income and social status, unhealthy child development and lack of health services. In general health conditions have been seen to improve in urban areas, but the socioeconomic conditions for children under five were seen deteriorating from 2000 to 2011 (Skaftun, & Norheim, 2014). The WHO report shows that there is a major regional variation in child health. The death rate per 1000 life births in the population of children under five in the capital city Addis Ababa was 53 whereas, these numbers almost triple in rural areas like Afar (127/1000) and Benshangul (169/1000).
In relation to respiratory infection in Ethiopia, the determinant, unhealthy child development, comes about through poor child nutritional status and poor hygiene. In the year 2011 the World Health Organization reported about malnutrition that of all under five year old children 44% of them were stunted, 10% were wasted and 29% were underweight and most of these physical drawbacks were attributed to unhealthy child development as a result of poor dietary intake. (WHO, 2013). (((http://www.who.int/maternal _child _adolescent/epid emiology/profiles/ neonata l_child/eth.pdf?ua=1))). The effect of hygiene on respiratory infections was also studied by the Center for Disease Control and Prevention which unveiled a 50% reduction in the respiratory infection of children who received weekly hand washing promotion and free soap supplies as compared to those who did not (CDC, 2011). (((http://www.cdc.gov/globalhealth /programs/wash.htm)). The lack of health care services was a primary concern inhibiting the effort towards halting respiratory infections. Hence, research done in northern Ethiopia, in the city of Mekelle, showed that respiratory infections were well managed with biomedical methods through self-medication. Due to the lack of accessible health care services in the northern part of the country teaching parents about the administration of medication was found effective in managing children respiratory infection like pneumonia (Eticha & Mesfin, 2014).
Ethiopia’s Population is close to 91,729,000 with a Per capita income of $870 and with a life expectancy at birth for women (57 years) and men (54 years) respectively (CDC, 2013). (((http://www. cdc.gov/ globalhealth /countries /ethiopia/))) 2013))). The median age is very low, which reflects that the population distribution is wider at the base implying higher proportion of younger people than elderly. On the positive side though, fertility rate is currently declining which is resulting in lower population growth rate (-2.6) There has been a slight improvement in the number of elderly above 60 and minor decline in the number of under 15 youth. The crude death rate has also improved to be close to 7.5% (((WHO , YEARRR))). These facts signify a positive demographic transition which is basically proved by lower rate of death, declining proportion of youth and higher proportion of older populations.
Comparing the years 1990 and 2010, Ethiopia has shown a major decline (almost 10%) in communicable deaths and almost 11% decline in DALY’s from communicable diseases. On the other hand, non-communicable death and DALY’s have increased by 11.12% and 11.77% respectively. Both the death rate and DALY’s from injury have also shown a decrement of about 1%. These facts in general demonstrate a slow but positive move towards an epidemiological transition which is defined by the prevalence of lower rates of communicable diseases at the cost of increasing non-communicable diseases. Lower respiratory diseases were found to be causing most of the deaths and DAILYS from communicable diseases. COPD and Hemorrhagic strokes were the leading cause of non-communicable DAILYS and death respectively. Looking at nutritional transition in children under five years old, there seems to be slow but positive transition. Comparing the years 2000 and 2011, the number of stunted children has declined from 58% to 44% and the number of underweight children has improved from 41% to 29%.
The general health issue of lower respiratory tract infections identified by this paper is a major global issue as it is faced by many developing countries in Africa in a large magnitude. On top of the magnitude and the number of countries it affects, lower respiratory infection mainly burdens children under five years of age, who are the most vulnerable part of countries' population. The root causes leading to this health problem make it a global topic since these causes are issues faced by many developing nations like Ethiopia. Global problems like poverty , lack of accessible health care services and unhealthy child development caused by poor nutrition seem to play the key role as the cause of respiratory infections. Globally lower respiratory infection contributed about 4.65% of total DALYs and about 5.3% of death in the year 2010. This same diseases causes 7.58% of DALYs and 9.26% of total death in sub-Saharan Africa where Ethiopia is located (((http://vizhub.healthdata.org/gbd-compare/))). Hence efforts need to be made in order to curb the effect of these diseases by studying them as a global health topic.
Conclusion and recommendation
Overall, lower respiratory infections were found to be major health issues in Ethiopia. It is imperative that health care providers study these diseases at a global level. Respiratory infections mainly burden children under five years of age who live in rural areas. Rural peoples' lack of awareness about healthy nutritional diet, poor access to health care services and poverty were found to be the main cause of respiratory infections in Ethiopia. This paper has identified training local rural nurses to specifically deal with lower respiratory infection in children through early detection of signs and to provide medication and nutritional supplements as the best recommendation (((Ahmedtaha, Yami & Mohammed , (2014).)). This recommendation was selected considering the nature of the country's geographical and demographic structure. Ethiopia is a very vast poor nation mainly composed of young children with majority of the people living in remote rural areas. Therefore, setting up hospitals to increase accessibility of health care will be very costly and unrealistic. Hence, training nurses to travel around the rural areas and assess children for the risk of respiratory infection and provide medications for those in need is vital. These nurses can raise awareness about sunlight exposure, hygiene and advocate for vitamin D and calcium containing nutritional diet for children. This is a vital micro level intervention to boost children immunity against respiratory infection.
References
Ethiopia: Health Profile (n.d.), World Health Organization . Retrieved from http://www.who.int/gho/countries/eth.pdf (11/24/2014)
Muhe L, Lulseged S, Mason KE, Simoes EA. (1997) Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet. 1997 Jun 21;349(9068):1801-4.
