Abstract
Implementing the World Health Organization (WHO) recommendations on home-based management of pneumonia with chest indrawing is challenging in many settings. In Papua New Guinea, 120 children presenting with the WHO definition of pneumonia were screened for danger signs, comorbidities and hypoxaemia using pulse oximetry; 117 were appropriate for home care. We taught mothers about danger signs and when to return, using structured teaching materials and a video. The children were given a single dose of intramuscular benzylpenicillin, then sent home on oral amoxicillin for 5 days, with follow-up at Days 2 and 6. During the course of treatment, five (4%) of the 117 children were admitted and 15 (13%) were lost to follow-up. There were no deaths. Treating children with pneumonia with chest indrawing but no danger signs is feasible as long as safeguards are in place—excluding high-risk patients, checking for danger signs and hypoxemia and providing education for mothers and follow-up.
Highlights
Acute lower respiratory infections are the commonest cause of hospital admission in most lowand middle-income countries
Implementing the World Health Organization (WHO) recommendations on home-based management of pneumonia with chest indrawing is challenging in many settings
In Papua New Guinea, 120 children presenting with the WHO definition of pneumonia were screened for danger signs, comorbidities and hypoxaemia using pulse oximetry; 117 were appropriate for home care
Summary
Acute lower respiratory infections (which include bacterial pneumonia and viral bronchiolitis) are the commonest cause of hospital admission in most lowand middle-income countries. Trials in several countries have demonstrated the safety of home treatment for pneumonia with chest indrawing The WHO has promoted the community case management of pneumonia with chest indrawing [5, 6]. Many countries do not have strong outpatient services or adequate follow-up mechanisms to ensure the safety of this management. There were many exclusion criteria, meaning that safety and VC The Author(s) [2018].
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