![]() The mobile clinics operate five days a week, often extending into the weekend, offering comprehensive primary care services and consistent treatment for conditions that heavily plague this region such as malaria, tuberculosis, and HIV, all free of charge for their patients. ![]() GAIA is a nonprofit organization which aims to increase healthcare accessibility amongst rural communities based in southern Malawi through the use of mobile clinics that rotate between the many villages throughout this region. Īddressing these issues are in the forefront of the concerns for providers working for the Global AIDS Interfaith Alliance (GAIA) in Mulanje, Malawi. As 85% of the Malawian population resides in rural areas, improving the capacity of mobile clinics to diagnose and treat NMF amongst these hard-to-reach communities is crucial. Characteristics inherent in mobile clinics, namely their lack of geographical permanence, may increase providers’ over-reliance on antibiotics due to concerns of patients’ febrile symptoms worsening during the time it takes for the clinic to return to a given community. ![]() While studies regarding the use of pulse oximeters and/or IMCI continued education courses are expanding in hospital settings, little is known about the impact of implementing either intervention on antibiotic prescriptive rates in alternative sources of health care delivery, such as mobile clinics. Despite being a standard tool in most developed healthcare systems, the pulse oximeter is not widely available in Malawian health facilities, a constraint that is especially exacerbated in rural areas. Two such diagnostic resources include 1) portable pulse oximeters and 2) the Integrated Management of Childhood Illness (IMCI) continued education courses. In the context of low-resource settings, this diagnostic methodology should ideally be cost-effective, function independently of electricity, require minimal training, and provide results that are easy to interpret. To address the issue of inaccurate diagnoses, additional testing is needed to help providers differentiate febrile patients with or without pneumonia, so that they can determine when antibiotics can be safely distributed or withheld. Due to the vague presentation of febrile illness in pediatric patients, Malawian providers tend to over-rely on the prescription of antibiotics for all NMF diagnoses, thus furthering the development of antimicrobial resistance. Not only does the inaccurate diagnosis of pneumonia lead to adverse patient outcomes, but it also poses a major public health concern due to the subsequent overuse of antibiotic prescriptions. While the gold standard of pneumonia diagnosis usually involves the use of chest x-rays and/or sputum tests, the luxury of this diagnostic equipment is rarely afforded to those living in low-resource settings. Defined as an of the alveoli, pneumonia typically presents with cough, fatigue, chest tightness, fever, sweating, and shortness of breath. It is estimated that one in five pediatric deaths due to pneumonia could be avoided if providers showed stronger adherence to existing diagnostic guidelines and interventions. Of the many causes of NMF in Malawi, pneumonia accounts for 13% of deaths amongst children under the age of five, and is thus essential to accurately diagnose and treat. Within this region, non-malarial fever (NMF) is critical to address in Malawi, particularly amongst patients under the age of five. ![]() While the diagnosis and treatment of malaria has greatly improved due to the advent of rapid diagnostic tests, non-malarial causes of fever still represent a significant burden of disease throughout sub-Saharan Africa. Integrated Management of Childhood Illness GAIA, This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: The anonymized dataset has been uploaded as Supporting Information (Dataset S2).įunding: This study was funded by the Global AIDS Interfaith Alliance and the Institute of Global Health Sciences of the University of California, San Francisco.Ĭompeting interests: The authors have declared that no competing interests exist. Received: Accepted: NovemPublished: November 19, 2020Ĭopyright: © 2020 Sylvies et al. Gurgel, Federal University of Sergipe, BRAZIL Citation: Sylvies F, Nyirenda L, Blair A, Baltzell K (2020) The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: A mixed-methods study.
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