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We asked our bloggers to craft some recipes from the different Success® Rice flavors and tell us about it. Bacterial pneumonia, which is one of five major categories of the disease, has an incubation period of one to three days.(1) The other major forms of pneumonia come from viruses, mycoplasmas, chemicals, and other infectious agents such as fungi.
Between 60% and 80% of bacterial pneumonia is caused by the organisms known scientifically as Streptococcus pneumoniae. The antibiotics of penicillin and erythromycin immediately suppress the contagious aspects of the disease, while a vaccination taken beforehand can protect up to 90% of the patients who would otherwise be likely to develop the above mentioned lower respiratory tract infection. Serious cases of bacterial pneumonia can cause a person’s body temperature to rise as high as 105 degrees. Acute respiratory infections (AR!) are one of the major causes of morbidity and mortality in developing countries.
ARI Control Programmes initiated by WHO are developing and promoting effective and rational management of ARI episodes in children by the health care personnel worldwide5. There is limited data available on health care practitioners KAP (knowledge, attitude and practice) regarding AR!
Multan, located in south of Punjab, is a densely populated urban area housing about a million inhabitants.
Keeping in view the standard case management guidelines, the following three measuring instruments were developed and pre- tested to study research questions.
Two research physicians with experience in ART case management of children were hired for data collection. From a sociological view, a low level of general literacy in Pakistan and kick of health education has led to misconceptions about drug use and its benefits.
Economic factors play a role because the doctors running general practice clinics are not prepared to risk any treatment failure for fear of losing their patients. A more recent country-wide survey involving government physicians has also brought, out unnecessary antibiotic use and lack of communication between the doctors and the child caretakers16.
A number of strategies have been suggested and applied with variable amount of success to effect a change in physicians19 practices20,21. Financial support for this research was provided by the Applied Diarrhoeal Disease Research Project at Harvard University by means of a Cooperative Agreement with the United States Agency for International Development (USAID).
This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community. ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities. Read our bloggers posts where they will tell you their guilt free experiences with Lean Pockets.
Everyone has these in their upper respiratory area, but when these same organisms make their way to the lower portion of the respiratory tract and the individual in question is susceptible to infection, it can lead to bacterial pneumonia. People over the age of 65 meanwhile should ideally get a booster shot with pneumonia vaccine elements every six years.
Along with that, profuse sweating, high heart rates, and rapid breathing may also be in evidence.
GPs in Multan were not familiar with national ARI control programme and rational drug use guidelines.
The National ART Control Programme in Pakistan has also started training of doctors in the management of ARI Studies of health facility utilization patterns in the country have shown that self-employed general practitioners (GPs) working in the community see and treat the larger segment of ARI patients2,7-9, These GPs are registered doctors with MBBS (Bachelor of Medicine and Bachelor of Surgery’) qualifications.
A tentative list of 132 names was prepared after obtaining infonnation from local medical association, professional colleagues and pharmaceutical companies.One hundred and ten of these GPs were personally visited by our research physician to enlist theirparticipation in the study. It also recommends to give specific home care advice pertaining to fluids, feeding, home remedies and warning signs of pneumonia to the caretakers of the patients treated at home (Table III). An observational checklist for recording direct clinical observation of GPs while examining children in their clinics. A semi-structured interview data collection instrument which recorded details of GP’s clinical practice and his knowledge of important clinical features in patients suffering fmm ARI. A self-administered questionnaire for the GPs asking about their patient management in different ART diseases.
Number of ARI patients examined by each of them during the observation period varied from one to eight, data was collected for 255 doctor-patient encounters. Points of importance with respect to the standard ARI case management protocol were compared.


Most of them said and were observed to ask about fever and cough, but fewer asked about difficulty in breathing and ver few counted respiratory rates or looked for chest indrawing.Most depended on their stethoscopes during examination. Observations indicate that the usual clinical practices of the GPs in Multandifferfrom the standard ARI case managetnent guidelines. It is a common belief that taking medicines improves the health of both the sick and the healthy people.
Competitive business makes themfeel constrained to accede to the patient’s desire of an immediate improvement in his symptoms and early recovery. Similar prescribing behaviour of the doctors seems to be widely prevalent in other countries of the region2,15 and in rest of the developing world17-19, A study of drug utilization pattern in Sri Lanka showed that average number of drugs per consultation was 3.415.
Generally, educational methods have been more successful as compared to the administrative and regulatoiy measures20. They rarely asked about symptoms describing severity of disease while taking patient histories and did not look for signs of severe pneumonia during physical examinations.
We conducted this study to investigate the way in which GPs in Multan diagnosed and treated children under the age of five, presenting with ARI. Specific items included: presenting complaints described by the caretaker or asked by the doctor, clinical examination performed by the doctor, home care advice given by doctor and duration of doctor-patient interaction. All the children under five years of age presenting with ART to the doctor during this period were included in the study. For the purposes of this comparative analysis, the first patient which came to the doctor during the observation session, if fulfilling the entty criteria, was selected. Treatment and advice for 23 cough and cold doctor-patient encounters is shown in Thble V The majority of children were treated with oral and injectable antibiotics in addition tantipyretics and antihistamines.
As a result, they excessively use antibiotics and other symptomatic relief drugs such as cough remedies and antipyretics. A survey in Indonesia has shown that 85% of the ARI patients seen by general practitioners and pediatricians were prescribed antibiotics and on an average. If the subjects are deficient in knowledge and skills are needed, teaching and training of the requisite skills would be necessary. Epidemiology and etiology of acute reapirstory infections, particularly pneumonia, in developing countries WHO technical paper. Acute respiratory infections in children: A case management intervention in Abbottabad district of Pakistan.
Antibiotic utilization in the treatment of acute respiratory infection in children under 10 years seen in private practires.
Principles of educational outreach (academic detailing) to improve clinical decision making. The first is most common among senior citizens, which leads some to also get influenza shots every year.
Most patients diagnosed as URTI (upper respiratory tract infection) received oral antibiotics and those with pneumonia received injectable antibiotics, Other drugs prescribed included cough syrups, antihis­tamines and antipyretics. Most clinics have dispensing corners where prescribed medicines are dispensed to patients in the form of tablets, powders and mixtures and injections administered. The specific goals of the study were (1) to assess the knowledge and skills of the GPs regarding ART management, (2) to compare the way in which the doctors actually evaluated and treated children with standard case management guidelines.
The GP’s clinical behaviour was recorded on observational checklist while he was examining the child. Thirty-eight doctors (55%) worked fulltime in their clinics (morning and evening), while 3 1 (45%) were employed elsewhere in the morning hours and worked in their clinics during the evening only. Very few patients were provided home care advice.Table VI compares treatment and home care advice forpatients withpneumonia. Most of the GPs in the city were not familiar with the recent developlnents in the ARI case management. The clinics of sonic of the GPs were crowded with a large number of patients waiting for them. If significant knowledge and required skills are there with lack of adequate perform­ance, bringing changes in work environment facilitating the appropriate behaviours would be required22. The second and third are much rarer, and really only crop up when there is some kind of localized influenza epidemic.
The average number of drugs prescribed per patient was 3,4, The doctors were deficient in providing home care advice for sick children to the caretakers. One-fourth to one-third of under-five mortality in developing countries has been shown to be attributable to AR!
At the end of the consultation, they asked the GP about his diagnosis for the child and the treatment prescribed.


Eighteen GPs (26%) also provided simple laboratory services, such as routine blood and urine examinations. Most were prescribed antibiotic injections and there was marked variation between reported and observed prescribing practices.
There was no formal training programme for the continuing education of doctors in general practice.
Such beliefs are reinforced by the very large number of unqualified and unregistered practitioners practicing medicine all over Pakistan. The patients were coming to the doctor’s table one by one as he was hurriedly writing prescriptions for them.
Any simplified model would be inadequate to explain the observed prescrib­ing behaviour of the GPs in our study. Permission was asked for two research physicians to observe the doctor taking the history and examining the patients. This was necessary as the GPs in Multan usually wrote their prescriptions in codes deciphered by employees who dispense the medicines accordingly. Only two GPs in our sample, had attended the recently starfed ARI case management training courses.
The doctors’ prescribing practices are also influenced by this public attitude towards drugs. This situation did not allow the doctor to talk to the patients or even to do an adequate physical examination. More research is needed to understand the interplay of economic, social and cultural forces which promote non-scientific prescribing behaviour of the health providers23. Well if a football field is a gram, then each nanogram is one blade of grass.  What's that you say? A combination of biomedical and social factors help to perpetuate this irrational prescribing behaviour of the GPs. Most of these deaths are due to pneumonia and arc preventable with adequate antibio,tic treatment4. At the end of the session, the doctor was requested to answer a few questions (semi-structured interview) and to complete a written self-administered questionnaire. Their practice load varied considerably, by self reports they saw from 4 to 70 patients a day (median 20, mean24+4). This lack of appropriate knowledge and skills is probably the major factor behind inappropriate management of ARI cases. The parents are satisfied by the doctors’ mere use of stethoscope, believing that their child has been adequately examined13. There is a need of educational programmes for the doctors with emphasis on rational prescribing and better communication with the patients. While many children with ART lack the benefit of essential antibiotic treatment, others are victims of indiscriminate and inappropriate use of antibiotics5.
Data collection was started in Januaiy, 1993, initially with those GPs who were considered to enjoy more busy practices by an estimate of waiting crowd in the clinic at the time of initial contact. But in addition, the difference between reported and observed practice among GPs could be due to social, financial and time constraints. Similarly, an injection and a bottle of medicine makes them believe that they are getting proper treatment. Research studies in Pakistan and other developing countries have shown that training of health personnel in the rational and effective management of ARI episodes can help to reduce mortalit due to ARI in the community5,6.
By the end of March, 1993, winter had ended and the number of ARI patients dropped significantly. Overall, doctor is considered as a provider of medicine and not someone who gives medical advice11. These prescribing practices persist because they seem to satisfy the needs of both the patient and the doctor14,15. Any measures taken to change the prescribing behaviour of the GPs should be planned in consultation with them20,25.
As it was not feasible to continue the study longer or during the next ARI season, these 69 GPs by default became our study sample.
In addition, parents and caretakers of children need to be made more infonued about the dangers of excessive and unnecessary usage of drugs, so that an environment of demand can be generated for more rational prescribing by the doctors11.



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