Can we predict oral antibiotic treatment failure in children with fast-breathing pneumonia managed at the community level? A prospective cohort study in Malawi

Carina King, Eric McCollum, Limangeni Mankhambo, Tim Colbourn, James Beard, Debbie C Hay Burgess, Anthony Costello, Raza Izadnegahdar, Norman Lufesi, Gibson Masache, Charles Mwansambo, Bejoy Nambiar, Eric Johnson, Robert Platt, David Mukanga

Research output: Contribution to journalArticle

Abstract

Background: Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa. Method: We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping. Results: We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56). Conclusion: This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

Original languageEnglish (US)
Article numbere0136839
JournalPLoS One
Volume10
Issue number8
DOIs
StatePublished - Aug 27 2015

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Malawi
Treatment Failure
cohort studies
pneumonia
breathing
mouth
Pneumonia
Respiration
Cohort Studies
antibiotics
Health
Prospective Studies
Anti-Bacterial Agents
community health workers
malaria
Malaria
Referral and Consultation
Biomarkers
Logistics
Statistics

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Can we predict oral antibiotic treatment failure in children with fast-breathing pneumonia managed at the community level? A prospective cohort study in Malawi. / King, Carina; McCollum, Eric; Mankhambo, Limangeni; Colbourn, Tim; Beard, James; Burgess, Debbie C Hay; Costello, Anthony; Izadnegahdar, Raza; Lufesi, Norman; Masache, Gibson; Mwansambo, Charles; Nambiar, Bejoy; Johnson, Eric; Platt, Robert; Mukanga, David.

In: PLoS One, Vol. 10, No. 8, e0136839, 27.08.2015.

Research output: Contribution to journalArticle

King, C, McCollum, E, Mankhambo, L, Colbourn, T, Beard, J, Burgess, DCH, Costello, A, Izadnegahdar, R, Lufesi, N, Masache, G, Mwansambo, C, Nambiar, B, Johnson, E, Platt, R & Mukanga, D 2015, 'Can we predict oral antibiotic treatment failure in children with fast-breathing pneumonia managed at the community level? A prospective cohort study in Malawi', PLoS One, vol. 10, no. 8, e0136839. https://doi.org/10.1371/journal.pone.0136839
King, Carina ; McCollum, Eric ; Mankhambo, Limangeni ; Colbourn, Tim ; Beard, James ; Burgess, Debbie C Hay ; Costello, Anthony ; Izadnegahdar, Raza ; Lufesi, Norman ; Masache, Gibson ; Mwansambo, Charles ; Nambiar, Bejoy ; Johnson, Eric ; Platt, Robert ; Mukanga, David. / Can we predict oral antibiotic treatment failure in children with fast-breathing pneumonia managed at the community level? A prospective cohort study in Malawi. In: PLoS One. 2015 ; Vol. 10, No. 8.
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abstract = "Background: Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa. Method: We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping. Results: We assessed 1,542 cases of which 769 were included (32{\%} ineligible; 19{\%} defaulted). The treatment failure rate was 15{\%} at day 5 and relapse was 4{\%} at day 14. Concurrent malaria diagnosis (OR: 1.62; 95{\%} CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95{\%} CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56). Conclusion: This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.",
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AU - Mankhambo, Limangeni

AU - Colbourn, Tim

AU - Beard, James

AU - Burgess, Debbie C Hay

AU - Costello, Anthony

AU - Izadnegahdar, Raza

AU - Lufesi, Norman

AU - Masache, Gibson

AU - Mwansambo, Charles

AU - Nambiar, Bejoy

AU - Johnson, Eric

AU - Platt, Robert

AU - Mukanga, David

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N2 - Background: Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa. Method: We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping. Results: We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56). Conclusion: This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

AB - Background: Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa. Method: We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping. Results: We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56). Conclusion: This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

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