Underdiagnosis of childhood pneumonia in Tanzania, or Erin’s first public health journal publication

When I started at R4D two and a half years ago, one of the programs I was working on asked if I could help take a recent engagement and turn it into a scholarly paper. I’ve worked on lots of papers and enjoy it and so both enthusiastically assented and optimistically asserted we could have a draft out for review in 6 months. I thought I was being pessimistic, if I’m being honest. Surely an idea this far along wouldn’t need that much ushering.

I severely underestimated the effort that it takes to get a bunch of busy professionals to comment on a write-up of old work, to make sure I understood the sampling strategy they’d used and how it might affect my econometrics, and the sheer logistical effort that it is to get 10 people in four countries to agree to a publication strategy.

But by April 2020, we were ready to go!

Only in April 2020, if you weren’t writing about coronavirus, no one wanted to read your public health paper. After a few quick rejections (they literally said they were only focusing on COVID19 papers right now), we landed on a review process at BMJ Open.

The world of public health scholarly work was a new one to me. It was like being in grad school again, learning which papers to cite and in which order, how to write a structured abstract, being told (for probably the fifth time) that sample size went into results–not methods–and other things I’ll probably never understand.

And here we are, a year later, I have my first public health journal publication and honestly, it’s a doozy!

Using a unique combination of an observational and clinical protocol, we show how childhood pneumonia goes severely underdiagnosed at public health facilities in Tanzania. On the order of only 18% of cases are correctly diagnosed. Now, normally, you’d anticipate that this means some 72% of cases go untreated. But they don’t. Half of these cases actually receive the correct antibiotics to treat the condition, even if they aren’t correctly diagnosed.

The corollary, of course, is that antibiotics are also being prescribed to children who don’t have pneumonia, and may not need antibiotics. So we are both underdiagnosing and overtreating the problem. Tanzania has one of the world’s highest burdens of childhood pneumonia, so both of these have huge implications for children affected.

I think we did some neat work, looking at correlates of correct diagnosis and bounding of the effect using simulation. Check it out at BMJ Open.

Many thanks to my R4D co-authors: Taylor Salisbury, Jean Arkedis, Cammie Lee; IDInsight co-authors: Alice Redfern and Allison Connor; and Government of Tanzanian co-authors: Ntuli A Kapologwe, Julius Massaga, Naibu Mkongwa, and Balowa Musa.


Author: ekfletch

I am an independent researcher on issues of gender, labor, violence, education, and children.

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