Close
Project Summary
Pneumonia is the second leading cause of death amongst children听globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community, and prompt听referral could lower mortality. A number of clinical markers have 听been independently associated with oral antibiotic failure in听childhood pneumonia. This study aimed to develop a prognostic听model for fast-breathing pneumonia treatment failure in sub-Saharan Africa.听
We prospectively followed a cohort of children (2-59 months),听diagnosed by community health workers (CHWs) with fast-breathing pneumonia using World Health Organisation integrated听community case management guidelines. Cases were followed at听days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the听prognostic model using eight pre-defined parameters, using听multivariable logistic regression, validated through bootstrapping.听
We assessed 1,542 cases of which 769 were included (32%听ineligible; 19% defaulted). The treatment failure rate was 15% at听day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis听(OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88;听95% CI: 1.09, 3.26) were associated with treatment failure. The听model demonstrated poor calibration and discrimination (c-statistic:听0.56). 听
This study suggests that it may be difficult to reliably predict听treatment failure using clinical markers alone among children with听WHO fast-breathing pneumonia prescribed co-trimoxazole,听although malaria and moderate malnutrition were important risk听factors. Further work is needed to identify more accurate and听reliable referral algorithms for use by CWHs.