Jacobs Choolwe, Nkwemu Chipo, Ngambi Bryan Bakele, Silavwe Vichael, Qazi Shamim Ahmad, Nisar Yasir Bin
Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
Department of Strategic Information, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
J Glob Health. 2025 Jul 11;15:04089. doi: 10.7189/jogh.15.04089.
Zambia has a high burden of child pneumonia, with approximately 6000 children under five dying annually from this condition. We aimed to gather evidence about the outcomes two weeks after enrolment for children 2-59 months with chest indrawing pneumonia who were managed in primary health care facilities in Zambia.
This was a prospective cohort study conducted between October 2022 and April 2024 in eight primary health care facilities from Lusaka, Chibombo, and Chongwe districts. Children aged 2-59 months with cough and/or breathing difficulty and lower chest indrawing were enrolled, treated on an outpatient basis according to the Integrated Management of Childhood Illness (IMCI) protocol, and followed up on day 15 after enrolment.
We enrolled 335 children in the study (median age of 17 months, 56.4% female). Among them, 63% were aged 12-59 months, 23.6% had a height-for-age z-score of<-3.0, and 10.5% had a weight-for-age z-score of<-3.0. By day 15, 314 children had follow-up data, all of whom survived. Of these, 77.1% were cured, 22.9% were reported as being 'clinically better', and none failed therapy. Most children were treated with oral amoxicillin (84.1%), with a cure rate of 82.2%. Children treated with cotrimoxazole (60% cure rate) and erythromycin (26.7% cure rate) had lower success rates. A higher proportion of girls (81.4%) were cured compared to boys (71.5%), and children who were fully vaccinated (79.6%) had a higher cure rate than those who were partially or not vaccinated (48.0%). Children of educated parents had higher cure rates than those of uneducated parents.
Children with chest indrawing pneumonia were successfully treated with oral amoxicillin in an outpatient setting, improving access to treatment and reducing costs for both health care systems and families. This approach also helps reduce the risk of healthcare-associated infections. It is essential that health care providers in primary health facilities are trained to use IMCI protocols when managing children under five.
赞比亚儿童肺炎负担沉重，每年约有6000名五岁以下儿童死于该病。我们旨在收集在赞比亚初级卫生保健机构接受治疗的2至59个月患有胸凹陷性肺炎儿童入院两周后的治疗结果证据。
这是一项前瞻性队列研究，于2022年10月至2024年4月在卢萨卡、奇博姆博和琼圭区的八家初级卫生保健机构进行。纳入2至59个月有咳嗽和/或呼吸困难且下胸部凹陷的儿童，根据儿童疾病综合管理（IMCI）方案进行门诊治疗，并在入院后第15天进行随访。
我们纳入了335名儿童进行研究（中位年龄17个月，56.4%为女性）。其中，63%的儿童年龄在12至59个月之间，23.6%的儿童年龄别身高z评分<-3.0，10.5%的儿童年龄别体重z评分<-3.0。到第15天，314名儿童有随访数据，所有儿童均存活。其中，77.1%治愈，22.9%报告为“临床好转”，无治疗失败病例。大多数儿童接受口服阿莫西林治疗（84.1%），治愈率为82.2%。接受复方新诺明治疗（治愈率60%）和红霉素治疗（治愈率26.7%）的儿童成功率较低。与男孩（71.5%）相比，治愈的女孩比例更高（81.4%），完全接种疫苗的儿童（79.6%）治愈率高于部分接种或未接种疫苗的儿童（48.0%）。父母受过教育的儿童治愈率高于父母未受过教育的儿童。
胸凹陷性肺炎儿童在门诊环境中用口服阿莫西林成功治疗，改善了治疗可及性，降低了卫生保健系统和家庭的成本。这种方法还有助于降低医疗相关感染的风险。初级卫生保健机构的医护人员在管理五岁以下儿童时接受使用IMCI方案的培训至关重要。
