24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50%) were urgently referred; most delayed ≥ 2 days before accessing referral care. Conclusion The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa."/>
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Table 1 Mothers' reported symptoms prompting care seeking and referral reasons recorded by Drug Distributors

From: Community referral in home management of malaria in western Uganda: A case series study

Symptom Mothers' reporting (n = 101) DD's reporting (n = 101)
  n (%)* n (%)*
Fever 94 (93%) -
No recovery/persisting fever - 32 (32%)
General illness symptoms 86 (85%) 2 (2%)
Cough 67 (66%) 9 (9%)
Not able to eat/breast feed 55 (54%) 4 (4%)
Vomiting 36 (36%) 11 (11%)
Fast breathing 24 (32%)† -
'Ekyikenyera' 30 (30%) 4 (4%)
Diarrhoea 25 (25%) 6 (6%)
Convulsion 14 (14%) 15 (15%)
Over/under age - 5 (5%)
Unable to sit or stand - 2 (2%)
Loss of consciousness - 1 (1%)
Other conditions# 16 (16%) 24 (24%)
  1. *Many children had more than one symptom and received more than one diagnosis by the DD, therefore percentages add up to more than 100%
  2. †The local terms for fast breathing and difficult breathing were added to the questionnaire at a later stage; hence the percentages are based on a smaller denominator (n = 76)
  3. The local illness 'Ekyikenyera' includes symptoms of grunting, stridor and chest indrawing3
  4. #Chickenpox (7), conjunctivitis (4), wounds/burns (3), undefined illness (4)