Caregivers' and healthcare workers' experiences in the management of childhood pneumonia in low- and lower-middle-income countries: a systematic review of qualitative evidence

Abstract

Introduction: Childhood pneumonia is preventable and treatable. Yet, millions of children under five years of age in low-and lower-middle-income countries become sick and die from the illness. These deaths can be averted if caregivers recognise pneumonia symptoms early and seek timely medical care, and if healthcare workers can appropriately diagnose and effectively treat childhood pneumonia. Objectives: The systematic review explored the experiences of caregivers and healthcare workers in the management of pneumonia in children under five in low-and lower-middle-income countries. Methods: The systematic review was conducted in accordance with the JBI (formerly known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence, with meta-aggregation as the method of synthesis. The review considered qualitative studies that explored the experiences of caregivers and healthcare workers in the management of childhood pneumonia in low- and lower-middle-income countries. Only studies published in English were included. The search for relevant studies included both published and unpublished studies and was conducted from 13th to 17th June 2019. The databases searched were PubMed, CINAHL, Embase and Scopus, with no publication date restrictions. All studies that met the inclusion criteria were assessed for methodological rigor by two independent reviewers using the JBI standardised critical appraisal instrument for qualitative research. Data were extracted from studies using the standardised JBI data extraction form. Extracted findings were pooled using the JBI meta-aggregative approach. Results: Eight studies were included in the review. A total of 54 unequivocal/credible findings were aggregated into 12 categories based on their similarity in meaning. From the 12 categories, three synthesised findings (meta-synthesis) were developed (one synthesised finding focused on healthcare workers and two synthesised findings on caregivers). The synthesised findings are as follows: Caregivers can identify common pneumonia symptoms in children under five years of age, including those symptoms leading to severe pneumonia, however some misconceptions, including those of the pneumonia aetiology, still persist. Factors, such as financial constraints, use of home remedies or practitioner-provided interventions, inappropriate purchase and use of medicines, caregivers’ choice of provider, and responsibility for decision-making for the child, impact the treatment of pneumonia in children under five years of age. Healthcare workers experience a number of barriers that impact their ability to manage and treat childhood pneumonia in children under five years of age. These barriers occur across all levels of care, including the systems level, the individual practitioner level and the caregiver level. Conclusions: The review highlights several barriers that impact on caregivers’ and healthcare workers’ ability to adequately manage childhood pneumonia. Implications for practice: The review identifies several barriers that prevent the effective management of childhood pneumonia and offers evidence-based recommendations for health professionals and policy makers. It also provides suggestions for the education of caregivers. Implications for research Further research is required regarding the experiences of caregivers and healthcare workers in the management of childhood pneumonia in developing countries.