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Reduction in total under-five mortality in western Nepal through community-based antimicrobial treatment of pneumonia
M R Pandey1, N M Daulaire, E S Starbuck
1Mrigendra Medical Trust, Kathmandu, Nepal.
Insights
Community health workers effectively reduced child mortality by 28% in Nepal by treating pneumonia at home. This low-cost intervention significantly lowered overall deaths, especially among infants, demonstrating a vital public health strategy.
Area of Science:
- Global Health
- Pediatrics
- Public Health Interventions
Background:
- Pneumonia is a major global cause of child mortality, particularly in developing nations with limited healthcare access.
- Effective, low-cost interventions are crucial for addressing this public health challenge.
Purpose of the Study:
- To evaluate the effectiveness of indigenous community health workers in detecting and treating childhood pneumonia.
- To assess the impact of this community-based intervention on overall child mortality rates.
Main Methods:
- A controlled intervention trial involving 13,404 children under five in Jumla, Nepal.
- Exclusive reliance on community health workers using the World Health Organization strategy for pneumonia detection and a five-day oral co-trimoxazole treatment.
- No other primary care services were provided; hospital referral was not feasible.
Main Results:
- A 28% reduction in the risk of all-cause mortality by the third year of the program (Relative Risk: 0.72).
- A significant trend of decreasing mortality with longer program duration, with the greatest benefit observed in infants.
- Significant reductions in deaths from pneumonia, diarrhea, and measles, indicating a substantial carry-over effect.
Conclusions:
- Indigenous community health workers can effectively detect and treat pneumonia in resource-limited settings.
- Community-based pneumonia treatment programs can significantly reduce overall child mortality, even without comprehensive primary care.
- This model offers a scalable and cost-effective public health solution for high-risk populations.
Abstract:
Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.
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