Suhag Zamir Hussain, Pal Ashlesha, Naeem Muhammad, Ahmed Imran, Khuwaja Noorulain Altaf, Khakwani Shayan, Mujtaba Ali, Qazi Shamim Ahmad, Nisar Yasir Bin
Research Department, Trust for Vaccines & Immunization, Karachi, Pakistan.
Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan.
J Glob Health. 2025 Mar 28;15:04096. doi: 10.7189/jogh.15.04096.
Pneumonia is a major cause of childhood mortality in Pakistan. In 2019, the Government of Pakistan revised the national Integrated Management of Childhood Illness (IMCI) chart booklet, following the World Health Organization's recommendation for outpatient management with oral antibiotics of children aged 2-59 months with chest indrawing pneumonia. We aimed to assess the outcomes of children aged 2-59 months with chest indrawing pneumonia in programme setting of Pakistan.
This was a prospective observational cohort study in three primary health care facilities in Thatta district, Sindh province. We screened children aged 2-59 months who presented with cough and/or difficult breathing, and recruited those classified with chest indrawing pneumonia according to the IMCI tool. from December 2022 to March 2024. The primary outcome was to assess the case fatality ratio. The secondary outcomes were to calculate the prevalence of antibiotic use, hospital admissions and treatment adherence among these children during the current illness. We followed up on day 15 after enrolment to assess outcomes.
456 children with chest indrawing pneumonia met the study's enrolment criteria. Two (0.4%) died. Four (0.9%) were lost to follow-up and excluded from the analysis. According to parental/caregiver reports, among 452 children followed up on day 15, 435 (96.3%) were cured, 12 (2.7%) did not improve and two (0.4%) worsened and were hospitalised. All patients were treated with oral antibiotics. Oral amoxicillin was prescribed and used by 282 (62.4%) and 236 of those (83.7%) adhered to five or more days of oral amoxicillin treatment. Oral cefixime was prescribed and used by 114 children (25.2%).
Our findings support using the IMCI protocol for treating chest indrawing pneumonia without danger signs in children aged 2-59 months with oral antibiotics on an outpatient basis. It can potentially reduce childhood pneumonia deaths, increase access to treatment, improve treatment coverage, reduce referrals and reduce costs for the health system and families in resource-limited settings.
ISRCTN: 12687253.
肺炎是巴基斯坦儿童死亡的主要原因。2019年，巴基斯坦政府根据世界卫生组织的建议，修订了国家儿童疾病综合管理（IMCI）图表手册，以对2至59个月大、有胸凹陷性肺炎的儿童进行门诊口服抗生素治疗。我们旨在评估巴基斯坦项目环境中2至59个月大、有胸凹陷性肺炎的儿童的治疗结果。
这是一项在信德省塔塔县的三个初级卫生保健机构进行的前瞻性观察队列研究。我们对出现咳嗽和/或呼吸困难的2至59个月大的儿童进行筛查，并根据IMCI工具招募那些被归类为胸凹陷性肺炎的儿童。研究时间为2022年12月至2024年3月。主要结果是评估病死率。次要结果是计算这些儿童在当前疾病期间抗生素使用、住院和治疗依从性的患病率。我们在入组后第15天进行随访以评估结果。
456名有胸凹陷性肺炎的儿童符合研究的入组标准。两名（0.4%）死亡。四名（0.9%）失访并被排除在分析之外。根据父母/照顾者的报告，在第15天随访的452名儿童中，435名（96.3%）治愈，12名（2.7%）没有改善，两名（0.4%）病情恶化并住院。所有患者均接受口服抗生素治疗。282名（62.4%）儿童被开具并使用了口服阿莫西林，其中236名（83.7%）坚持口服阿莫西林治疗五天或更长时间。114名儿童（25.2%）被开具并使用了口服头孢克肟。
我们的研究结果支持在门诊使用IMCI方案，对2至59个月大、无危险体征的胸凹陷性肺炎儿童口服抗生素进行治疗。这有可能降低儿童肺炎死亡率，增加治疗可及性，提高治疗覆盖率，减少转诊，并降低资源有限环境下卫生系统和家庭的成本。
ISRCTN：12687253
