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Children with severe pneumonia may benefit from community intervention
Bari A. Lancet. 2011;doi:10.1016/S0140-6736(11)61140-9.
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Community case management of severe pneumonia was linked to improved outcomes in a cohort of children in Pakistan, according to recent results.
According to background information on the study, oral trimethoprim-sulfamethoxazole and referral are recommended for severe pneumonia. In many low-resource areas, difficulties with referral compliance are reported, which results in low access to appropriate treatment. Therefore, researchers assessed whether community case management by lady health workers (LHWs) with oral amoxicillin in children with severe pneumonia was similar to current standard of care.
Eligible children were aged 2 to 59 months, had WHO-defined severe pneumonia and were living within the assigned 28 clusters of the Haripur district of Pakistan.
Children were randomly assigned to intervention or control. Children in the intervention cluster were assigned community-based LHWs who provided mothers with amoxicillin (80-90 mg/kg per day or 375 mg twice a day for infants aged 2-11 months and 625 mg twice a day for those aged 12-59 months) and specific guidance for use of the drug. Controls were administered the first dose of oral TMP-SMX by an LHW (sulfamethoxazole 200 mg plus trimethoprim 40 mg for children aged 2-11 months; sulfamethoxazole 300 mg plus trimethoprim 60 mg for children aged 12 months to 5 years) and then referred to a health facility for standard of care.
The primary outcome measure was defined as treatment failure by day 6, according to the study.
The final analysis involved 1,857 children in the intervention cluster and 1,354 children in the control cluster.
Children in the intervention group experienced reduced cluster-adjusted treatment failure rates compared with controls, 9% vs. 18% (risk difference=–8.9%; 95% CI, –12.4 to –5.4). After adjusting for baseline covariates, the risk difference was –7.3% (95% CI, –10.1 to –4.5). The researchers reported that risk reduction was observed in the occurrence of fever and lower chest indrawing on day 3 (–6.7%, 95% CI, –10 to –3.3).
There were two fatalities in the control group and one in the intervention group.
Low rates of diarrhea (n=4) and skin rash (n=1) were reported in the intervention group, and there were three cases of diarrhea in the control group.
“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 researchers wrote.
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