Reducing Deaths from Severe Pneumonia in Children in Malawi by Improving Delivery of Pneumonia Case Management
Identifieur interne : 003568 ( Main/Exploration ); précédent : 003567; suivant : 003569Reducing Deaths from Severe Pneumonia in Children in Malawi by Improving Delivery of Pneumonia Case Management
Auteurs : Penelope M. Enarson [France, Afrique du Sud] ; Robert P. Gie [Afrique du Sud] ; Charles C. Mwansambo [Malawi] ; Ellubey R. Maganga [Malawi] ; Carl J. Lombard [Afrique du Sud] ; Donald A. Enarson [France, Afrique du Sud] ; Stephen M. Graham [France, Australie]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Descripteurs français
- KwdFr :
- Admission du patient (), Enfant d'âge préscolaire, Humains, Indice de gravité médicale, Malawi (épidémiologie), Modèles logistiques, Mortalité (tendances), Nourrisson, Nouveau-né, Pneumopathie infectieuse (), Pneumopathie infectieuse (mortalité), Pneumopathie infectieuse (traitement médicamenteux), Prise en charge personnalisée du patient, Programmes gouvernementaux (), Prévention tertiaire (), Santé publique (), Études de suivi, Études prospectives, Évaluation de résultat (soins) ().
- MESH :
- mortalité : Pneumopathie infectieuse.
- tendances : Mortalité.
- traitement médicamenteux : Pneumopathie infectieuse.
- épidémiologie : Malawi.
- Admission du patient, Enfant d'âge préscolaire, Humains, Indice de gravité médicale, Modèles logistiques, Nourrisson, Nouveau-né, Pneumopathie infectieuse, Prise en charge personnalisée du patient, Programmes gouvernementaux, Prévention tertiaire, Santé publique, Études de suivi, Études prospectives, Évaluation de résultat (soins).
- Wicri :
- geographic : Malawi.
English descriptors
- KwdEn :
- Case Management, Child, Preschool, Follow-Up Studies, Government Programs (methods), Humans, Infant, Infant, Newborn, Logistic Models, Malawi (epidemiology), Mortality (trends), Outcome Assessment (Health Care) (methods), Outcome Assessment (Health Care) (statistics & numerical data), Patient Admission (statistics & numerical data), Pneumonia (drug therapy), Pneumonia (mortality), Pneumonia (prevention & control), Prospective Studies, Public Health (methods), Severity of Illness Index, Tertiary Prevention (methods).
- MESH :
- geographic , epidemiology : Malawi.
- drug therapy : Pneumonia.
- methods : Government Programs, Outcome Assessment (Health Care), Public Health, Tertiary Prevention.
- mortality : Pneumonia.
- prevention & control : Pneumonia.
- statistics & numerical data : Outcome Assessment (Health Care), Patient Admission.
- trends : Mortality.
- Case Management, Child, Preschool, Follow-Up Studies, Humans, Infant, Infant, Newborn, Logistic Models, Prospective Studies, Severity of Illness Index.
Abstract
To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management.
A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1st 2000 until 31st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital.
Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335).
The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.
Url:
DOI: 10.1371/journal.pone.0102955
PubMed: 25050894
PubMed Central: 4106861
Affiliations:
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Gie</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg</wicri:regionArea><wicri:noRegion>Tygerberg</wicri:noRegion></affiliation></author><author><name sortKey="Mwansambo, Charles C" sort="Mwansambo, Charles C" uniqKey="Mwansambo C" first="Charles C." last="Mwansambo">Charles C. Mwansambo</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Ministry of Health, Lilongwe, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>Ministry of Health, Lilongwe</wicri:regionArea><wicri:noRegion>Lilongwe</wicri:noRegion></affiliation></author><author><name sortKey="Maganga, Ellubey R" sort="Maganga, Ellubey R" uniqKey="Maganga E" first="Ellubey R." last="Maganga">Ellubey R. Maganga</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>UNICEF Malawi, Lilongwe, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>UNICEF Malawi, Lilongwe</wicri:regionArea><wicri:noRegion>Lilongwe</wicri:noRegion></affiliation></author><author><name sortKey="Lombard, Carl J" sort="Lombard, Carl J" uniqKey="Lombard C" first="Carl J." last="Lombard">Carl J. Lombard</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Biostatistics Unit, South Africa Medical Research Council (MRC), Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Biostatistics Unit, South Africa Medical Research Council (MRC), Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Enarson, Donald A" sort="Enarson, Donald A" uniqKey="Enarson D" first="Donald A." last="Enarson">Donald A. Enarson</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Child Lung Health Division, International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Child Lung Health Division, International Union Against Tuberculosis and Lung Disease, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg</wicri:regionArea><wicri:noRegion>Tygerberg</wicri:noRegion></affiliation></author><author><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Child Lung Health Division, International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Child Lung Health Division, International Union Against Tuberculosis and Lung Disease, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff7"><addr-line>Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Case Management</term><term>Child, Preschool</term><term>Follow-Up Studies</term><term>Government Programs (methods)</term><term>Humans</term><term>Infant</term><term>Infant, Newborn</term><term>Logistic Models</term><term>Malawi (epidemiology)</term><term>Mortality (trends)</term><term>Outcome Assessment (Health Care) (methods)</term><term>Outcome Assessment (Health Care) (statistics & numerical data)</term><term>Patient Admission (statistics & numerical data)</term><term>Pneumonia (drug therapy)</term><term>Pneumonia (mortality)</term><term>Pneumonia (prevention & control)</term><term>Prospective Studies</term><term>Public Health (methods)</term><term>Severity of Illness Index</term><term>Tertiary Prevention (methods)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Admission du patient ()</term><term>Enfant d'âge préscolaire</term><term>Humains</term><term>Indice de gravité médicale</term><term>Malawi (épidémiologie)</term><term>Modèles logistiques</term><term>Mortalité (tendances)</term><term>Nourrisson</term><term>Nouveau-né</term><term>Pneumopathie infectieuse ()</term><term>Pneumopathie infectieuse (mortalité)</term><term>Pneumopathie infectieuse (traitement médicamenteux)</term><term>Prise en charge personnalisée du patient</term><term>Programmes gouvernementaux ()</term><term>Prévention tertiaire ()</term><term>Santé publique ()</term><term>Études de suivi</term><term>Études prospectives</term><term>Évaluation de résultat (soins) ()</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Malawi</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Government Programs</term><term>Outcome Assessment (Health Care)</term><term>Public Health</term><term>Tertiary Prevention</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Pneumopathie infectieuse</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Outcome Assessment (Health Care)</term><term>Patient Admission</term></keywords><keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Mortalité</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Pneumopathie infectieuse</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Mortality</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Malawi</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Case Management</term><term>Child, Preschool</term><term>Follow-Up Studies</term><term>Humans</term><term>Infant</term><term>Infant, Newborn</term><term>Logistic Models</term><term>Prospective Studies</term><term>Severity of Illness Index</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Admission du patient</term><term>Enfant d'âge préscolaire</term><term>Humains</term><term>Indice de gravité médicale</term><term>Modèles logistiques</term><term>Nourrisson</term><term>Nouveau-né</term><term>Pneumopathie infectieuse</term><term>Prise en charge personnalisée du patient</term><term>Programmes gouvernementaux</term><term>Prévention tertiaire</term><term>Santé publique</term><term>Études de suivi</term><term>Études prospectives</term><term>Évaluation de résultat (soins)</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Malawi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management.</p></sec><sec><title>Methods</title><p>A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1<sup>st</sup> 2000 until 31<sup>st</sup> December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital.</p></sec><sec><title>Findings</title><p>Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335).</p></sec><sec><title>Conclusions</title><p>The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Liu, L" uniqKey="Liu L">L Liu</name></author><author><name sortKey="Johnson, Hl" uniqKey="Johnson H">HL Johnson</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Perin, J" uniqKey="Perin J">J Perin</name></author><author><name sortKey="Scott, S" uniqKey="Scott S">S Scott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reed, C" uniqKey="Reed C">C Reed</name></author><author><name sortKey="Madhi, Sa" uniqKey="Madhi S">SA Madhi</name></author><author><name sortKey="Klugman, Kp" uniqKey="Klugman K">KP Klugman</name></author><author><name sortKey="Kuwanda, L" uniqKey="Kuwanda L">L Kuwanda</name></author><author><name sortKey="Ortiz, Jr" uniqKey="Ortiz J">JR 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uniqKey="Wilson L">L Wilson</name></author><author><name sortKey="Phiri, A" uniqKey="Phiri A">A Phiri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chisti, Mj" uniqKey="Chisti M">MJ Chisti</name></author><author><name sortKey="Terbruegge, M" uniqKey="Terbruegge M">M Terbruegge</name></author><author><name sortKey="La Vincente, S" uniqKey="La Vincente S">S La Vincente</name></author><author><name sortKey="Graham, Sm" uniqKey="Graham S">SM Graham</name></author><author><name sortKey="Duke, T" uniqKey="Duke T">T Duke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rice, Al" uniqKey="Rice A">AL Rice</name></author><author><name sortKey="Sacco, L" uniqKey="Sacco L">L Sacco</name></author><author><name sortKey="Hyder, A" uniqKey="Hyder A">A Hyder</name></author><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Australie</li><li>France</li><li>Malawi</li></country><region><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Melbourne</li><li>Paris</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Enarson, Penelope M" sort="Enarson, Penelope M" uniqKey="Enarson P" first="Penelope M." last="Enarson">Penelope M. Enarson</name></region><name sortKey="Enarson, Donald A" sort="Enarson, Donald A" uniqKey="Enarson D" first="Donald A." last="Enarson">Donald A. Enarson</name><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Enarson, Penelope M" sort="Enarson, Penelope M" uniqKey="Enarson P" first="Penelope M." last="Enarson">Penelope M. Enarson</name></noRegion><name sortKey="Enarson, Donald A" sort="Enarson, Donald A" uniqKey="Enarson D" first="Donald A." last="Enarson">Donald A. Enarson</name><name sortKey="Gie, Robert P" sort="Gie, Robert P" uniqKey="Gie R" first="Robert P." last="Gie">Robert P. Gie</name><name sortKey="Lombard, Carl J" sort="Lombard, Carl J" uniqKey="Lombard C" first="Carl J." last="Lombard">Carl J. Lombard</name></country><country name="Malawi"><noRegion><name sortKey="Mwansambo, Charles C" sort="Mwansambo, Charles C" uniqKey="Mwansambo C" first="Charles C." last="Mwansambo">Charles C. Mwansambo</name></noRegion><name sortKey="Maganga, Ellubey R" sort="Maganga, Ellubey R" uniqKey="Maganga E" first="Ellubey R." last="Maganga">Ellubey R. Maganga</name></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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