Tigabu Zemene, Toni Alemayehu Teklu, Guadu Tadesse, Yilma Tesfahun Melese, Awoke Tadesse, Engdaw Garedew Tadege, Tazebew Ashenafi, Qazi Shamim Ahmad, Nisar Yasir Bin
Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Department of Environmental and Occupational Health, and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
J Glob Health. 2025 Aug 4;15:04217. doi: 10.7189/jogh.15.04217.
Pneumonia is a leading cause of morbidity and mortality in children under five years of age. In 2012, the World Health Organization revised its guidelines for managing childhood pneumonia and recommended oral amoxicillin for the outpatient treatment of chest indrawing pneumonia in children aged 2-59 months. While the Ethiopian government subsequently adopted these revised pneumonia guidelines, the level of their implementation and of the related treatment outcomes remains less known. We aimed to determine the outcomes of this approach at primary healthcare facilities in Ethiopia.
We conducted a prospective, observational cohort study at five health centres in Northern Ethiopia from November 2022 to November 2023. Trained health workers screened all children aged 2-59 months who had cough or difficult breathing and managed them according to the integrated management of childhood illness chart booklet. Children with chest indrawing pneumonia who lived in the study catchment area and whose parents or guardians consented were enrolled. An independent data collector conducted a follow-up visit on day 15 to collect information on their survival status and the treatment received after enrolment. The primary outcome was case fatality risk (CFR), calculated as the proportion of children who died by day 15 after enrolment among all enrolled children.
We screened 3492 children aged 2-59 months, enrolling 345 with chest indrawing pneumonia. All were prescribed oral amoxicillin. The majority (n = 340, 98.6%), received a five-day prescription, while the remaining five were prescribed a seven-day course. We assessed 333 children on day 15 for study outcomes. Twelve (3.5%) were lost to follow-up. Two children died, resulting in a CFR of 0.6 (95% confidence interval = 0.35, 0.85). Most children (n = 315, 94.6%), adhered to the five-day course of amoxicillin, while 18 (5.4%) did not complete the entire course. Thirteen (3.9%) children were taken to a hospital between days two and 15, six received outpatient treatment, and seven were hospitalised. All 13 were alive and well on day 15.
In a programme setting, children aged 2-59 months with chest indrawing pneumonia managed at the primary healthcare facilities on an outpatient basis with oral amoxicillin had low CFR, low hospitalisation rates, and high adherence to treatment.
ISRCTN: 12687253.
肺炎是五岁以下儿童发病和死亡的主要原因。2012年，世界卫生组织修订了儿童肺炎管理指南，建议使用口服阿莫西林对2至59个月大的儿童门诊治疗胸凹陷性肺炎。埃塞俄比亚政府随后采用了这些修订后的肺炎指南，但其实施水平和相关治疗结果仍鲜为人知。我们旨在确定埃塞俄比亚初级卫生保健机构采用这种方法的结果。
2022年11月至2023年11月，我们在埃塞俄比亚北部的五个卫生中心进行了一项前瞻性观察队列研究。经过培训的卫生工作者对所有2至59个月有咳嗽或呼吸困难的儿童进行筛查，并根据《儿童疾病综合管理图表手册》进行管理。居住在研究集水区且父母或监护人同意的胸凹陷性肺炎儿童被纳入研究。一名独立的数据收集员在第15天进行随访，收集有关他们的生存状况和入组后接受治疗的信息。主要结局是病例死亡风险（CFR），计算方法为入组后第15天死亡的儿童在所有入组儿童中所占的比例。
我们筛查了3492名2至59个月大的儿童，其中345名胸凹陷性肺炎儿童入组。所有儿童均开具了口服阿莫西林的处方。大多数（n = 340，98.6%）接受了为期五天的处方，其余五名儿童开具了为期七天的疗程。在第15天，我们对333名儿童进行了研究结局评估。12名（3.5%）儿童失访。两名儿童死亡，CFR为0.6（95%置信区间 = 0.35，0.85）。大多数儿童（n = 315，94.6%）坚持服用了五天的阿莫西林疗程，而18名（5.4%）儿童未完成整个疗程。13名（3.9%）儿童在第2天至第15天期间被送往医院，6名接受了门诊治疗，7名住院治疗。所有13名儿童在第15天均存活且状况良好。
在项目环境中，在初级卫生保健机构接受门诊口服阿莫西林治疗的2至59个月胸凹陷性肺炎儿童的CFR较低、住院率较低且治疗依从性较高。
ISRCTN：12687253
