Introduction Globally, acute lower respiratory infections are the leading cause of mortality among children under 5 years. Following World Health Organization primary care guidelines, pneumonia is diagnosed based on cough/difficult breathing and fast breathing. We aimed to describe the practices of healthcare workers in primary care health facilities in Uganda in the management of young children with respiratory symptoms especially regarding asthma as opposed to pneumonia. Methods Health workers were observed during clinical consultations with children 1–59 months of age presenting with cough and/or difficult breathing at recruitment. Afterward, an exit interview with the caregiver was conducted. Health center availability of clinical guidelines, equipment and supplies for management of children with respiratory symptoms was assessed systematically. Results A total of 218 consultations with 50 health workers at six health centers were included. Median consultation time was 4 min. Health workers asked history relevant to distinguishing asthma from pneumonia in 16% of consultations. The respiratory rate was counted in 10%. Antibiotics were prescribed to 32% of all the children and to 39% of children diagnosed with pneumonia. Caregivers reported being informed of findings and possible diagnosis in 5% of cases. Medicine and equipment needed for diagnosing and treating asthma were generally unavailable. Conclusion Clinical practices among Ugandan health workers in primary care are insufficient to distinguish between main causes of respiratory symptoms, especially asthma as opposed to pneumonia, in children under five. Irrational use of antibiotics is widespread. Clear communication with caregivers is lacking. This could be due to lack of relevant competencies, medicines, time and supplies. Lay summary Globally, the most frequent cause of death for children under five is infections in the lower airways. The World Health Organization recommends that in local health clinics this is defined as cough/difficult breathing and fast breathing. This article focuses on the practices of local health workers in Uganda and how they in practice diagnose and treat children under five with these symptoms. In addition, we try to estimate how much the caregivers of the children understand from the consultation. This is done by observing the healthcare workers (HCWs) and by interviewing the caregivers. In general, we found that the consultations were too short, that too few of the health workers looked for important signs for lower airways disease such as fast breathing and that antibiotics were prescribed in too many of the consultations. Also, the length and quality of the consultations and the supplies at the local health clinics were not sufficient to diagnose and treat asthma, which can often be mistaken for an infection. We believe that it is an important problem that too few children with asthma are being diagnosed correctly and that antibiotics are being prescribed too frequently, the latter being an important cause of antibiotic resistance. Relevant action must be taken to improve this.

中文翻译：

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乌干达初级保健机构中卫生工作者在评估和管理有呼吸系统症状的儿童方面的实践：新鲜空气描述性研究

简介 在全球范围内，急性下呼吸道感染是 5 岁以下儿童死亡的主要原因。根据世界卫生组织初级保健指南，肺炎是根据咳嗽/呼吸困难和呼吸急促来诊断的。我们的目的是描述乌干达初级保健医疗机构的医护人员在管理有呼吸道症状的幼儿时的做法，尤其是哮喘而不是肺炎。方法 在招募时出现咳嗽和/或呼吸困难的 1-59 月龄儿童的临床咨询期间，观察卫生工作者。之后，与看护人进行了离职面谈。卫生中心提供临床指南，系统地评估了用于管理有呼吸道症状儿童的设备和用品。结果共纳入 6 个卫生中心 50 名卫生工作者的 218 次咨询。中位咨询时间为 4 分钟。卫生工作者在 16% 的咨询中询问了与区分哮喘和肺炎相关的病史。呼吸频率以10%计。32% 的儿童和 39% 的被诊断患有肺炎的儿童使用了抗生素。护理人员报告在 5% 的病例中被告知发现和可能的诊断。诊断和治疗哮喘所需的药物和设备普遍缺乏。结论 乌干达初级保健卫生工作者的临床实践不足以区分呼吸道症状的主要原因，尤其是哮喘与肺炎，在五岁以下的儿童中。抗生素的不合理使用很普遍。缺乏与护理人员的清晰沟通。这可能是由于缺乏相关的能力、药物、时间和供应。总结 在全球范围内，五岁以下儿童最常见的死亡原因是下呼吸道感染。世界卫生组织建议在当地卫生诊所将其定义为咳嗽/呼吸困难和呼吸急促。本文重点介绍乌干达当地卫生工作者的实践，以及他们如何在实践中诊断和治疗出现这些症状的 5 岁以下儿童。此外，我们试图估计孩子的看护人从咨询中了解多少。这是通过观察医护人员 (HCW) 和采访护理人员来完成的。一般来说，我们发现咨询时间太短，寻找呼吸急促等下呼吸道疾病的重要迹象的卫生工作者太少，并且在太多咨询中开出了抗生素。此外，当地卫生诊所的咨询时间和质量以及用品不足以诊断和治疗哮喘，这常常被误认为是感染。我们认为，正确诊断哮喘儿童太少和抗生素处方过于频繁是一个重要问题，后者是抗生素耐药性的重要原因。必须采取相关行动来改善这一点。太少的卫生工作者寻找下呼吸道疾病的重要迹象，例如呼吸急促，并且在太多的咨询中开出了抗生素。此外，当地卫生诊所的咨询时间和质量以及用品不足以诊断和治疗哮喘，这常常被误认为是感染。我们认为，正确诊断哮喘儿童太少和抗生素处方过于频繁是一个重要问题，后者是抗生素耐药性的重要原因。必须采取相关行动来改善这一点。太少的卫生工作者寻找下呼吸道疾病的重要迹象，例如呼吸急促，并且在太多的咨询中开出了抗生素。此外，当地卫生诊所的咨询时间和质量以及用品不足以诊断和治疗哮喘，这常常被误认为是感染。我们认为，正确诊断哮喘儿童太少和抗生素处方过于频繁是一个重要问题，后者是抗生素耐药性的重要原因。必须采取相关行动来改善这一点。我们认为，正确诊断哮喘儿童太少和抗生素处方过于频繁是一个重要问题，后者是抗生素耐药性的重要原因。必须采取相关行动来改善这一点。我们认为，正确诊断哮喘儿童太少和抗生素处方过于频繁是一个重要问题，后者是抗生素耐药性的一个重要原因。必须采取相关行动来改善这一点。