To Document Pneumonia Case Management Practices in Selected Communities in Pakistan; A Qualitative Study.

1. AimTo document case management practices for under-five pneumonia at community level, first level care facility (FLCF) and specialist level across Pakistan.2. Method32 structured disguised observations were done using an observation tool based on standard WHO pneumonia- case management guidelines from each of four administrative units and federal capital of Pakistan across the LHW level, FLCF and tertiary level. Thus, a total of 160 observations were made.3. ResultsAt community level, 100% LHW’s did not ask for danger signs and did not expose chest, 98% misdiagnosed pneumonia and 100% prescribed antibiotics irrespective of diagnosis. At FLCF level, 0.6% inquired about danger signs, 98% did not expose chest, 80% did not use WHO classification for diagnosing pneumonia and 100% prescribed antibiotics irrespective of diagnosis. At GPs and specialist level in private sector, 28 % inquired about at least one danger sign, 82% exposed chest, 58% did not use WHO classification for diagnosis, and 17% wrongly prescribed antibiotics. Whereas in public sector 7% inquired about at least one danger sign,78% exposed chest, 64% did not use WHO classification for diagnosis and 28% wrongly prescribed antibiotics.4. ConclusionStandard case management guidelines are not being followed at any level of health care system in the communities studied. There is need to conduct countrywide quantitative survey to validate these findings in order to revise pneumonia control strategies and policies in Pakistan. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest This research was commissioned by National Institute of Health Research using Official Development Assistance (ODA) funding. The views expressed in this publication are those of the author(s) and not necessarily those of NHS, the National Institute of Health Research, or development of Health. References and Clinical Trial Registry Information Salim Sadruddin , Ibad ul Haque Khan , Abdul Bari , Attaullah Khan , Ijaz Ahmad , Shamim A. Qazi.(2015). Effect of community mobilization on appropriate care seeking for pneumonia in Haripur, Pakistan. The Journal of Global Health. doi: 10.7189/jogh.05.010405.Ahmed, A., Tanveer, M., Khan, G. M., & Hanif, K. (2017). Prescribing and Utilization Trends of Anti-Asthmatic Drugs amongst Children in a Tertiary Care Hospital in Lahore, Pakistan. Journal of Pharmacy Practice and Community Medicine, 3(2).Khan, A. A., Tanzil, S., Jamali, T., Shahid, A., Naeem, S., Sahito, A., ... & Fatmi, Z. (2014). Burden of asthma among children in a developing megacity: childhood asthma study, Pakistan. Journal of Asthma, 51(9), 891-899.World Health Organization.(2016). Pneumonia. Aavilable at: http://www.who.int/mediacentre/factsheets/fs331/en/