Abstract
BackgroundEfforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community case management of common childhood illnesses is now recommended but its effect on promptness of appropriate pneumonia treatment is unclear.ObjectivesTo determine the effect of integrated malaria and pneumonia management on receiving prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes as well as determine associated factors.MethodsA follow-up study was nested within a cluster-randomized trial that compared under-five mortality in areas where community health workers (CHWs) treated children with malaria and pneumonia (intervention areas) and where they treated children with malaria only (control areas). Children treated by CHWs were enrolled on the day of seeking treatment from CHWs (609 intervention, 667 control) and demographic, illness, and treatment seeking information was collected. Further information on illness and treatment outcomes was collected on day four. The primary outcome was prompt and appropriate antibiotics for pneumonia symptoms and the secondary outcome was treatment outcomes on day four.ResultsChildren in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03). Children in the intervention areas were also less likely to have temperature ≥37.5°C on day four (RR = 0.29, 95%CI = 0.11-0.78). The decrease in fast breathing between day one and four was greater in the intervention (9.2%) compared to the control areas (4.2%, p-value = 0.01).ConclusionsIntegrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes.Trial registrationISRCTN: ISRCTN52966230
Highlights
Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy
Children in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03)
The children were enrolled from all clusters of the cluster-randomized trial but in varying numbers (17–138 children per cluster) depending on the number of children that were treated by the community health workers (CHWs) during the study period
Summary
Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. Global mortality in children less than five years reduced from 12 million deaths in 1990 to 6.9 million deaths in 2011 [1], the number of deaths is still high and many countries are at risk of not achieving Millennium Development Goal four [2] This is more so in Africa and South Asia where about 80% of the deaths are concentrated and the reduction in mortality is lower than elsewhere. The main causes of mortality in these regions include neonatal conditions, malaria, pneumonia, and diarrhoea, with malnutrition being an important contributing factor These conditions could be addressed with low cost interventions but children do not access the effective interventions promptly [1]. In order to improve access, community-based treatment of illnesses has been recommended [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
