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Higher childhood pneumonia admission threshold remains in Lao PDR: an observational study
Ruth Lim1, Molina Chaummanivong2, Chansathit Taikeophithoun2
1Asia-Pacific Health Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia ruthie.lim@gmail.com.
Insights
Childhood pneumonia hospitalisation in Lao PDR aligns more with older guidelines, not the current 2014 WHO IMCI standards. Outpatient antibiotic prescribing compliance was also low, indicating a need for improved adherence to current management protocols.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- The World Health Organization (WHO) updated its Integrated Management of Childhood Illness (IMCI) guidelines for pneumonia in 2014.
- These updated guidelines were implemented in the Lao People's Democratic Republic (Lao PDR) in 2015.
- Adherence to these revised guidelines in clinical practice remains to be fully evaluated.
Purpose of the Study:
- To assess adherence to the 2014 WHO IMCI guidelines for childhood pneumonia hospitalisation in Lao PDR.
- To evaluate compliance with current outpatient management protocols for pneumonia.
- To identify predictors of hospitalisation for children with pneumonia.
Main Methods:
- A prospective observational study was conducted from January 2017 to December 2018.
- Data were collected from 594 children aged 2-59 months diagnosed with pneumonia in four hospitals in Vientiane, Lao PDR.
- Key outcomes included diagnosis accuracy, hospitalisation rates, management practices, and follow-up according to current guidelines.
Main Results:
- Pneumonia was correctly diagnosed in 97% of non-severe and 43% of severe cases. Non-severe pneumonia with lower chest wall indrawing was over-diagnosed as severe in 15% of cases.
- Hospitalisation rates were high, particularly for non-severe pneumonia with lower chest wall indrawing (86%). Outpatient oral antibiotic prescribing was near-universal (99%), but only 30% received the correct antibiotic and duration.
- Predictors for hospitalisation included younger age (2-5 months), public transport to the hospital, and lack of piped drinking water in households.
Conclusions:
- Childhood pneumonia hospitalisation practices in Lao PDR largely reflect the older 2005 WHO IMCI guidelines rather than the current 2014 guidelines.
- Compliance with outpatient antibiotic prescribing recommendations was notably low.
- Findings highlight a gap between updated WHO guidelines and current clinical practice in Lao PDR, necessitating targeted interventions.
Objectives:
WHO Integrated Management of Childhood Illness (IMCI) guidelines changed pneumonia hospitalisation criteria in 2014, which was implemented in Lao People's Democratic Republic (Lao PDR) in 2015. We determined adherence to: current (2014) IMCI guidelines for children presenting to hospitals with pneumonia, current outpatient management guidelines and identified hospitalisation predictors.
Design:
Prospective observational study (January 2017 to December 2018).
Setting:
Outpatient and emergency departments of four hospitals in Vientiane, Lao PDR.
Patients:
594 children aged 2-59 months diagnosed with pneumonia.
Main Outcome Measures:
Number of children diagnosed, hospitalised, managed, administered preventive measures and followed-up accordant with current guidelines.
Results:
Non-severe and severe pneumonia were correctly diagnosed in 97% and 43% of children, respectively. Non-severe pneumonia with lower chest wall indrawing (LCI) was diagnosed as severe in 15%. Hospitalisation rates were: 80% for severe pneumonia, 86% and 3% for non-severe pneumonia with and without LCI, respectively. Outpatient oral antibiotic prescribing was high (99%), but only 30% were prescribed both the recommended antibiotic and duration. Appropriate planned follow-up was 89%. Hospitalisation predictors included age 2-5 months (compared with 24-59 months; OR 3.95, 95% CI 1.90 to 8.24), public transport to hospital (compared with private vehicle; OR 2.60, 95% CI 1.09 to 6.24) and households without piped drinking water (OR 4.67, 95% CI 2.75 to 7.95).
Conclusions:
Hospitalisation practice for childhood pneumonia in Lao PDR remains more closely aligned with the 2005 WHO IMCI guidelines than the currently implemented 2014 iteration. Compliance with current outpatient antibiotic prescribing guidelines was low.
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