Non-treatment of children with community health worker-diagnosed fast-breathing pneumonia in rural Malawi: Exploratory subanalysis of a prospective cohort study

Carina King, Tim Colbourn, Limangeni Mankhambo, James Beard, Debbie C. Hay Burgess, Anthony Costello, Rasa Izadnegahdar, Norman Lufesi, Charles Mwansambo, Bejoy Nambiar, Eric S. Johnson, Robert W. Platt, David Mukanga, Eric D. McCollum

Research output: Contribution to journalArticlepeer-review

Abstract

Background Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery. Methods We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2-59months) diagnosed by community health workers with fast-breathing pneumonia using WHO integrated community case management (iCCM) guidelines. Children were followed at days 5 and 14 with a clinical assessment of recovery. We conducted bivariate and multivariable logistic regression for the association between treatment of fast-breathing pneumonia and recovery, adjusting for potential confounders. Results We followed up 847 children, of whom 78 (9%) had not been given antibiotics (non-treatment). Non-treatment cases had higher baseline rates of diarrhoea, non-severe hypoxaemia and fever. Non-recovery (persistence or worsening of symptoms) was 13% and 23% at day 5 in those who did receive and those who did not receive co-trimoxazole. Non-recovery, when defined as worsening of symptoms only, at day 5 was 7% in treatment and 10% in non-treatment cases. For both definitions, combined co-trimoxazole and lumefantrine-artemether (LA) treatment trended towards protection (adjusted OR (aOR) 0.28; 95% CI 0.12 to 0.68/aOR 0.29; 95% CI 0.08 to 1.01). Conclusion We found that children who did not receive co-trimoxazole treatment had worse clinical outcomes; malaria co-diagnosis and treatment also play a significant role in non-recovery. Further research into non-treatment of fast-breathing pneumonia, using a pragmatic approach with consideration for malaria co-diagnosis and HIV status is needed to guide refinement of community treatment algorithms in this region.

Original languageEnglish (US)
Article numbere011636
JournalBMJ open
Volume6
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Fast-Breathing pneumonia
  • iCCM
  • non-treatment
  • sub-Saharan Africa
  • treatment failure

ASJC Scopus subject areas

  • Medicine(all)

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