Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda

Malaria Journal

Research

Kevin Mugenyi¹  Charles Karamagi²  Elizeus Rutebemberwa³  Joan N Kalyango⁴  Tobias Alfven⁵  Stefan Peterson⁶ 

[1]African Field Epidemiology Network (AFENET), P.O Box 12874, Kampala, Uganda

[2]Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

[3]Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

[4]Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

[5]Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, SE 17177, Stockholm, Sweden

[6]Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

[7]Department of Pharmacy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

[8]Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, SE 17177, Stockholm, Sweden

[9]Department of Paediatrics, Sach’s Children’s Hospital, Södersjukhuset, Stockholm, Sweden

[10]Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, SE 17177, Stockholm, Sweden

[11]International Maternal and Child Health, Department of Women and Children’s Health, Uppsala University, Uppsala, Sweden

[12]Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

关键词: CHW;    ICCM;    Health System Research;    Prompt treatment;    Appropriate treatment;    Treatment outcomes;    Malaria;    Pneumonia;    Children;    CMDs;   

DOI  :  10.1186/1475-2875-12-340

 received in 2013-06-06, accepted in 2013-09-18,  发布年份 2013

来源: Springer

【 摘 要 】

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

【 授权许可】

CC BY   
© Kalyango et al.; licensee BioMed Central Ltd. 2013