Reducing deaths from severe pneumonia in children in Malawi by improving delivery of pneumonia case management.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Case Management*; Pneumonia/*prevention & control ; Public Health/*methods ; Tertiary Prevention/*methods; Child, Preschool ; Follow-Up Studies ; Government Programs/methods ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Malawi/epidemiology ; Mortality/trends ; Outcome Assessment, Health Care/methods ; Outcome Assessment, Health Care/statistics & numerical data ; Patient Admission/statistics & numerical data ; Pneumonia/drug therapy ; Pneumonia/mortality ; Prospective Studies ; Severity of Illness Index

Objective: To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management.
Methods: A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1st 2000 until 31st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital.
Findings: Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9.8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2-59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0.70 (95%CI: 0.50-0.98); p = 0.036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0.97 (95%CI: 0.72-1.30); p = 0.8). No benefit was observed for neonates (OR 0.83 (95%CI: 0.56-1.22); p = 0.335).
Conclusions: The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2-59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.

Lancet. 2012 Jun 9;379(9832):2151-61. (PMID: 22579125)
Lancet. 2007 Apr 28;369(9571):1440-1451. (PMID: 17467514)
Int J Tuberc Lung Dis. 2005 Jul;9(7):727-32. (PMID: 16013766)
Int J Epidemiol. 2010 Apr;39 Suppl 1:i155-71. (PMID: 20348118)
Trans R Soc Trop Med Hyg. 2004 Sep;98(9):544-52. (PMID: 15251404)
Bull World Health Organ. 1984;62(5):749-53. (PMID: 6334573)
PLoS Med. 2009 Nov;6(11):e1000137. (PMID: 19901978)
Tuber Lung Dis. 1995 Apr;76(2):95-9. (PMID: 7780108)
Pediatr Infect Dis J. 2011 Jan;30(1):33-8. (PMID: 21173674)
Am J Public Health. 2008 Jan;98(1):44-54. (PMID: 18048779)
PLoS One. 2012;7(9):e44250. (PMID: 22970189)
Expert Rev Respir Med. 2010 Apr;4(2):211-20. (PMID: 20406087)
Clin Infect Dis. 2008 Apr 1;46(7):963-9. (PMID: 18444810)
PLoS One. 2012;7(1):e27793. (PMID: 22238570)
Emerg Infect Dis. 2012 Feb;18(2):272-8. (PMID: 22305090)
BMC Pediatr. 2013 Jan 31;13:16. (PMID: 23368791)
Bull World Health Organ. 2000;78(10):1207-21. (PMID: 11100616)
Lancet. 2009 Sep 12;374(9693):893-902. (PMID: 19748398)
Lancet. 2000 Jan 29;355(9201):369-73. (PMID: 10665557)
Ann Trop Paediatr. 2007 Dec;27(4):261-7. (PMID: 18053342)
Lancet. 2008 Oct 11;372(9646):1328-33. (PMID: 18708248)
Bull World Health Organ. 2008 May;86(5):344-8. (PMID: 18545736)
PLoS One. 2012;7(11):e47622. (PMID: 23139752)
J Infect Dis. 2007 Mar 15;195(6):895-904. (PMID: 17299721)
Int J Tuberc Lung Dis. 2001 Jan;5(1):12-23. (PMID: 11263511)
Lancet. 2009 Jan 17;373(9659):267-9. (PMID: 19150705)
Trop Med Int Health. 2009 Oct;14(10):1173-89. (PMID: 19772545)

Date Created: 20140723 Date Completed: 20151204 Latest Revision: 20240326

20240326

PMC4106861

10.1371/journal.pone.0102955

25050894