Community case management of lower chest indrawing pneumonia with oral amoxicillin in children in Kenya

• Published in: Acta Paediatrica Vol. 107; no. S471; pp. 44 - 52
• Main Authors: Onono, Maricianah, Abdi, Mohammed, Mutai, Kennedy, Asadhi, Elijah, Nyamai, Rachel, Okoth, Peter, Qazi, Shamim Ahmad
• Format: Journal Article
• Language: English
• Published: Norway Wiley Subscription Services, Inc 01-12-2018
• Subjects: Amoxicillin; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Antibiotics; Case management; Chest; Chest indrawing; Child, Preschool; Children; Classification; Community health workers; Community Health Workers - statistics & numerical data; Diarrhea; Female; Health Plan Implementation; Humans; Infant; Integrated community case management; Kenya - epidemiology; Malaria; Male; Malnutrition; Medical personnel; Nurses; Occupational health; Penicillin; Pneumonia; Pneumonia - diagnosis; Pneumonia - drug therapy; Pneumonia - epidemiology; Sub‐Saharan Africa; Vector-borne diseases; Workers; Kenya; Pneumonia; Integrated community case management; Community health workers; Sub-Saharan Africa; Chest indrawing
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/apa.14405

Aim
To determine the accuracy and effectiveness of community health workers (CHWs) when compared to trained nurses for management of pneumonia in Kenyan children.
Methods
In Homabay County in western Kenya, children 2–59 months of age with lower chest indrawing pneumonia were identified, classified and treated by CHWs with oral amoxicillin (90 mg/kg per day) for five days at home. Trained nurses visited the child within 24 hours to verify diagnosis; and on day 4 and 14 to assess treatment outcomes.
Results
CHWs identified 1906 children with lower chest indrawing pneumonia. There was an 88.7% concordance in classification and treatment for lower chest indrawing pneumonia by CHWs compared to nurses. Children with moderate malnutrition (OR 1.68; 95% CI: 1.22–2.30), comorbidities such as diarrhoea or malaria (OR 1.55; 95% CI: 1.32–1.81) or an additional day of delay in care seeking (OR 1.06; 95% CI: 1.02–1.10) were more likely to have an incorrect classification of lower chest indrawing by the CHW. Comorbidity (OR 1.66; 95% CI: 1.12–2.48) and fast breathing (OR 4.66; 95% CI: 1.26–17.27) were significantly associated with treatment failure on day 14.
Conclusion
CHWs can correctly manage lower chest indrawing pneumonia even in high‐mortality settings, such as western Kenya, in sub‐Saharan Africa.