Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda
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. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community...
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| Published in | Malaria journal Vol. 12; no. 1; p. 340 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BioMed Central Ltd
22.09.2013
BioMed Central |
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| Online Access | Get full text |
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| Abstract | 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. 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.
To 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.
A 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.
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). 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).
Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes.
ISRCTN52966230. |
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| AbstractList | 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 REGISTRATION ISRCTNISRCTN52966230. BACKGROUND: 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. 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. METHODS: A 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. RESULTS: 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). Children in the intervention areas were also less likely to have temperature >=37.5[degree sign]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). CONCLUSIONS: Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. Trial registrationISRCTN: ISRCTN52966230. Background 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. 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. Objectives To 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. Methods A 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. Results 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). Children in the intervention areas were also less likely to have temperature [greater than or equai to]37.5[degrees]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). Conclusions Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. Trial registration ISRCTN: ISRCTN52966230 Keywords: CHW, ICCM, Health System Research, Prompt treatment, Appropriate treatment, Treatment outcomes, Malaria, Pneumonia, Children, CMDs 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. 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. To 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. A 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. 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). 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). Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. ISRCTN52966230. BACKGROUND: 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. 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. OBJECTIVES: To 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. METHODS: A 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. RESULTS: 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). 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). CONCLUSIONS: Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. TRIAL REGISTRATION: ISRCTN: ISRCTN52966230 Doc number: 340 Abstract Background: 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. 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. Objectives: To 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. Methods: A 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. Results: 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). 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). Conclusions: Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. Trial registration: ISRCTN: ISRCTN52966230 Background: 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. 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. Objectives: To 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. Methods: A 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. Results: 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). Children in the intervention areas were also less likely to have temperature > or =37.5 degree 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). Conclusions: Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. Trial registration: ISRCTN: ISRCTN52966230 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. 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. To 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. A 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. 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). Children in the intervention areas were also less likely to have temperature [greater than or equai to]37.5[degrees]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). Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. |
| ArticleNumber | 340 |
| Audience | Academic |
| Author | Kalyango, Joan N Alfven, Tobias Rutebemberwa, Elizeus Karamagi, Charles Mugenyi, Kevin Peterson, Stefan |
| AuthorAffiliation | 2 Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda 7 Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda 1 Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, SE 17177, Stockholm, Sweden 4 Department of Paediatrics, Sach’s Children’s Hospital, Södersjukhuset, Stockholm, Sweden 3 Department of Pharmacy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda 6 African Field Epidemiology Network (AFENET), P.O Box 12874, Kampala, Uganda 8 Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda 5 International Maternal and Child Health, Department of Women and Children’s Health, Uppsala University, Uppsala, Sweden |
| AuthorAffiliation_xml | – name: 8 Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda – name: 4 Department of Paediatrics, Sach’s Children’s Hospital, Södersjukhuset, Stockholm, Sweden – name: 2 Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda – name: 1 Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, SE 17177, Stockholm, Sweden – name: 3 Department of Pharmacy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda – name: 5 International Maternal and Child Health, Department of Women and Children’s Health, Uppsala University, Uppsala, Sweden – name: 6 African Field Epidemiology Network (AFENET), P.O Box 12874, Kampala, Uganda – name: 7 Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2013 BioMed Central Ltd. 2013 Kalyango et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2013 Kalyango et al.; licensee BioMed Central Ltd. 2013 Kalyango et al.; licensee BioMed Central Ltd. |
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| References | 23136291 - Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):151-3 18545734 - Bull World Health Organ. 2008 May;86(5):332-8 23136276 - Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):36-45 11337227 - Int J Antimicrob Agents. 2001 May;17(5):395-400 10342698 - Int J Epidemiol. 1999 Apr;28(2):319-26 12243918 - Lancet. 2002 Sep 14;360(9336):835-41 23136273 - Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):11-20 20356399 - BMC Infect Dis. 2010;10:85 23136283 - Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):92-6 15177148 - Acta Trop. 2004 Apr;90(2):211-4 23136271 - Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):2-5 23554926 - PLoS One. 2013;8(3):e58789 18335058 - PLoS One. 2008;3(3):e1788 19362361 - Lancet. 2009 May 9;373(9675):1623-31 22951546 - BMJ. 2012;345:e5661 22905758 - Malar J. 2012;11:282 15070633 - BMJ. 2004 Apr 3;328(7443):791 23425576 - BMC Public Health. 2013;13:157 23136285 - Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):105-10 12869089 - Trop Med Int Health. 2003 Aug;8(8):685-92 20877714 - PLoS Med. 2010 Sep;7(9):e1000340 23667338 - PLoS Med. 2013;10(5):e1001421 12885488 - Lancet. 2003 Jul 19;362(9379):233-41 2935_CR15 CG Victora (2935_CR31) 2003; 362 WHO (2935_CR2) 2011 2935_CR18 ML Joloba (2935_CR36) 2001; 17 Pakistan Multicentre Amoxycillin Short Course Therapy (MASCOT) pneumonia study group (2935_CR23) 2002; 360 MK Campbell (2935_CR17) 2012; 345 DH Hamer (2935_CR13) 2012; 87 RJ Hayes (2935_CR24) 1999; 28 2935_CR7 C Kahabuka (2935_CR34) 2013; 8 2935_CR1 ISCAP study group (2935_CR22) 2004; 328 CORE Group, Save the Children, BASICS and MCHIP (2935_CR3) 2010 D Njama (2935_CR32) 2003; 8 RJ Hayes (2935_CR30) 2009 H Campbell (2935_CR37) 2013; 10 T Diaz (2935_CR26) 2013; 13 Department of Health Policy Planning and Management (2935_CR27) 2010 2935_CR25 JN Kalyango (2935_CR11) 2012; 87 K Källander (2935_CR6) 2008; 86 BSC Uzochukwu (2935_CR33) 2008; 3 PD Seidenberg (2935_CR10) 2012; 87 DR Marsh (2935_CR14) 2012; 87 JN Kalyango (2935_CR19) 2012; 11 2935_CR20 P Awor (2935_CR16) 2012; 87 2935_CR21 K Yeboah-Antwi (2935_CR12) 2010; 7 K Källander (2935_CR5) 2004; 90 SG Staedke (2935_CR4) 2009; 373 MA Chinbuah (2935_CR9) 2012; 87 Ministry of Health (Uganda) (2935_CR29) 2010 N Hoa (2935_CR35) 2010; 10 WHO (2935_CR8) 2011 Joint Formulary Committee (2935_CR28) 2007 |
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| Snippet | Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of... Background Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home... Doc number: 340 Abstract Background: Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria... Background: Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home... BACKGROUNDEfforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home... BACKGROUND: Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home... |
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| SubjectTerms | Adult Anti-Bacterial Agents - therapeutic use Antibiotics Bacterial pneumonia Case Management - organization & administration Child, Preschool Children Children & youth Comparative analysis Diagnosis Diseases Drug Utilization - statistics & numerical data Female Follow-Up Studies Health aspects Health care Health care reform Health facilities Health Services Research Hospitals Humans Infant Malaria Malaria - diagnosis Malaria - drug therapy Male Medicin och hälsovetenskap Mortality NGOs Nongovernmental organizations Pneumonia Pneumonia, Bacterial - diagnosis Pneumonia, Bacterial - drug therapy Public health Treatment Outcome Tropical diseases Uganda Zambia |
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| Title | Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda |
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