Community-Based Treatment Improves Pneumonia Outcomes

Community case management reduces treatment failure rate in children compared to standard care

FRIDAY, Nov. 11 (HealthDay News) -- Implementation of community case management by lady health workers (LHWs) is associated with decreased treatment failure rates for children with severe pneumonia in Pakistan, according to a study published online Nov. 11 in The Lancet.

Abdul Bari, M.B.B.S., from Save the Children U.S. in Islamabad, Pakistan, and colleagues examined whether community case management by LHWs with oral amoxicillin was equivalent to the current standard of care for children with severe pneumonia. Children, aged 2 to 59 months, with World Health Organization-defined severe pneumonia in 28 clusters in the Haripur district of Pakistan were randomized to receive the intervention or standard care. In the intervention clusters, mothers of 1,857 children were provided with oral amoxicillin with specific usage guidelines by community-based LHWs. In the control clusters, 1,354 children received the first dose of oral cotrimoxazole from the LHWs and were referred to a health facility for standard care. Treatment failure by day six was the primary outcome measured.

The investigators found that by day six, cluster-adjusted treatment failure rates were significantly reduced in the interventions clusters (risk difference, −8.9 percent). There was little difference after adjusting for baseline covariates (risk difference, −7.3 percent). There were two deaths reported in the intervention clusters and one in the control clusters. Most of the risk reduction was accounted for by reduced occurrence of fever and lower chest indrawing on day three (−6.7 percent).

"Community case management could result in a standardized treatment for children with severe pneumonia, reduce delay in treatment initiation, and reduce the costs for families and health care systems," the authors write.

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