Gelagay Abebaw Addis, Azale Telake, Gezie Lemma Derseh, Tigabu Zemene, Alemu Kassahun
Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
Department of Health Education and Behavioural Sciences, Institute of Public Health, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia.
BMJ Paediatr Open. 2025 May 2;9(1):e003311. doi: 10.1136/bmjpo-2025-003311.
Despite Ethiopia's adoption of the Integrated Management of Newborn and Childhood Illnesses (IMNCI) strategy, pneumonia continues to be the leading infectious cause of death among under-five children. Therefore, this study aimed to determine the proportion of under-five children who had received the accurate diagnostic classification and appropriate treatment for symptoms of pneumonia using the IMNCI guideline and to identify factors associated with guideline adherence.
A cross-sectional study was conducted between March and July 2023 among sick under-five children who visited health centres in the South Gondar zone, northwest Ethiopia. We employed two-stage random sampling. Observation of healthcare providers' clinical assessment, diagnosis and treatment; re-assessing children; interviewing caregivers and healthcare providers; and facility audit were applied to collect the data. Both descriptive and multilevel binary logistic regression analyses were done.
Only 35.6% (95% CI: 33.2, 38.0) of sick children with pneumonia symptoms received the correct classification and treatment. Factors associated with accurate diagnostic classification and appropriate treatment included being a young infant (adjusted OR (AOR): 2.8, 95% CI: 1.4, 5.4), absence of fever (AOR: 1.5, 95% CI: 1.1, 2.0), longer consultation times (AOR: 1.4, 95% CI: 1.1, 1.9), receiving care from healthcare providers who referred to the chart booklet during diagnosis and treatment (AOR: 3.9, 95% CI: 2.8, 5.4), taking the IMNCI training (AOR: 2.4, 95% CI: 1.5, 3.7), lower patient caseloads (AOR: 1.7, 95% CI: 1.1, 2.6) and having regular review meetings on health services quality (AOR: 1.8, 95% CI: 1.3, 2.5).
The proportion of correct classification and treatment of sick children with pneumonia symptoms was low, leading to poor treatment outcomes, irrational use of antibiotics and antimicrobial resistance. Almost all cluster-level associated factors are modifiable. Strengthening accountability, mentoring and implementing tailored strategies are crucial to enhancing healthcare providers' adherence to the IMNCI guidelines.
尽管埃塞俄比亚采用了新生儿和儿童疾病综合管理（IMNCI）策略，但肺炎仍然是五岁以下儿童中主要的感染性死亡原因。因此，本研究旨在确定使用IMNCI指南对患有肺炎症状的五岁以下儿童进行准确诊断分类和适当治疗的比例，并确定与指南依从性相关的因素。
2023年3月至7月，在埃塞俄比亚西北部南贡德尔地区的患病五岁以下儿童中进行了一项横断面研究。我们采用了两阶段随机抽样。通过观察医护人员的临床评估、诊断和治疗；对儿童进行重新评估；采访照顾者和医护人员；以及进行机构审核来收集数据。进行了描述性和多水平二元逻辑回归分析。
只有35.6%（95%置信区间：33.2, 38.0）有肺炎症状的患病儿童得到了正确的分类和治疗。与准确诊断分类和适当治疗相关的因素包括年龄较小（调整后的比值比（AOR）：2.8，95%置信区间：1.4, 5.4）、无发热（AOR：1.5，95%置信区间：1.1, 2.0）、会诊时间较长（AOR：1.4，95%置信区间：1.1, 1.9）、接受在诊断和治疗期间参考图表手册的医护人员的护理（AOR：3.9，95%置信区间：2.8, 5.4）、接受IMNCI培训（AOR：2.4，95%置信区间：1.5, 3.7）、较低的患者工作量（AOR：1.7，95%置信区间：1.1, 2.6）以及定期召开卫生服务质量审查会议（AOR：1.8，95%置信区间：1.3, 2.5）。
有肺炎症状的患病儿童的正确分类和治疗比例较低，导致治疗效果不佳、抗生素使用不合理以及抗菌药物耐药性。几乎所有的群组层面相关因素都是可改变的。加强问责制、指导和实施针对性策略对于提高医护人员对IMNCI指南的依从性至关重要。
