Under treatment of pneumonia among children under 5 years of age in a malaria-endemic area: population-based surveillance study conducted in Manhica district- rural, Mozambique

Details

• Alternative Title:
  Int J Infect Dis
• Personal Author:
  Acácio, Sozinho ; Verani, Jennifer R. ; Lanaspa, Miguel ; Fairlie, Tarayn A. ; Nhampossa, Tacilta ; Ruperez, Maria ; Aide, Pedro ; Plikaytis, Brian D ; Sacoor, Charfudin ; Macete, Eusebio ; Alonso, Pedro ; Sigaúque, Betuel
  More +
• Description:
  Background ; Integrated Management of Childhood Illness (IMCI) guidelines were developed to decrease morbidity and mortality, yet implementation varies across settings. Factors associated with poor adherence are not well understood. ; Methods ; We used data from Manhiça District Hospital outpatient department and five peripheral health centers to examine pneumonia management for children <5 years old from January 2008 to June 2011. Episodes of IMCI-defined pneumonia (cough or difficult breathing plus tachypnea), severe pneumonia (pneumonia plus chest wall in-drawing), and/or clinician-diagnosed pneumonia (based on discharge diagnosis) were included. ; Results ; Among severe pneumonia episodes, 96.2% (2,918/3,032) attended in the outpatient department and 70.0% (291/416) attended in health centers were appropriately referred to the emergency department. Age<1 year, malnutrition and various physical exam findings were associated with referral. For non-severe pneumonia episodes, antibiotics were prescribed in 45.7% (16,094/35,224). Factors associated with antibiotic prescription included age <1 year, abnormal auscultatory findings, and clinical diagnosis of pneumonia; diagnosis of malaria or gastroenteritis and pallor were negatively associated with antibiotic prescription. ; Conclusion ; Adherence to recommended management of severe pneumonia was high in a hospital outpatient department, but suboptimal in health centers. Antibiotics were prescribed in fewer than half of non-severe pneumonia episodes, and diagnosis of malaria was the strongest risk factor for incorrect management.
• Subjects:
  • Ambulatory Care
  • Child, Preschool
  • Coinfection
  • Drug Prescriptions
  • Female
  • Guideline Adherence
  • Humans
  • Infant
  • Malaria
  • Male
  More +
• Keywords:
  • Pneumonia
  • Guideline Adherence
• Source:
  Int J Infect Dis. 36:39-45
• Pubmed Central ID:
  PMC6859416
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Place as Subject:
  Mozambique
• Volume:
  36
• Download URL:
  https://stacks.cdc.gov/view/cdc/134186/cdc_134186_DS1.pdf
• File Type:
  [PDF - 256.87 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:19e87a20984a7a55fc3b47cd96cfa3fffc3eb75fcdcc40d77a5c20a374dee53b