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Title: Under treatment of pneumonia among children under 5 years of age in a malaria-endemic area: population-based surveillance study conducted in Manhica district- rural, Mozambique
Author: Acácio, Sozinho
Verani, Jennifer R.
Lanaspa, Miguel
Fairlie, Tarayn A.
Nhampossa, Tacilta
Rupérez, María
Aide, Pedro Carlos Paulino
Plikaytis, Brian D.
Sacoor, Charfudin
Macete, Eusébio
Alonso, Pedro
Sigaúque, Betuel
Keywords: Pneumònia
Malalties infeccioses en els infants
Communicable diseases in children
Issue Date: 4-May-2015
Publisher: Elsevier
Abstract: BACKGROUND: Integrated Management of Childhood Illness (IMCI) guidelines were developed to decrease morbidity and mortality, yet implementation varies across settings. Factors associated with poor adherence are not well understood. METHODS: We used data from Manhica District Hospital outpatient department and five peripheral health centers to examine pneumonia management for children <5 years old from January 2008 to June 2011. Episodes of IMCI-defined pneumonia (cough or difficult breathing plus tachypnea), severe pneumonia (pneumonia plus chest wall in-drawing), and/or clinician-diagnosed pneumonia (based on discharge diagnosis) were included. RESULTS: Among severe pneumonia episodes, 96.2% (2,918/3,032) attended in the outpatient department and 70.0% (291/416) attended in health centers were appropriately referred to the emergency department. Age<1 year, malnutrition and various physical exam findings were associated with referral. For non-severe pneumonia episodes, antibiotics were prescribed in 45.7% (16,094/35,224). Factors associated with antibiotic prescription included age <1 year, abnormal auscultatory findings, and clinical diagnosis of pneumonia; diagnosis of malaria or gastroenteritis and pallor were negatively associated with antibiotic prescription. CONCLUSION: Adherence to recommended management of severe pneumonia was high in a hospital outpatient department, but suboptimal in health centers. Antibiotics were prescribed in fewer than half of non-severe pneumonia episodes, and diagnosis of malaria was the strongest risk factor for incorrect management.
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It is part of: International Journal of Infectious Diseases, 2015, vol. 36, p. 39-45
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ISSN: 1201-9712
Appears in Collections:Articles publicats en revistes (ISGlobal)

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