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Correct diagnostic classification and treatment of pneumonia symptoms in under-five children, northwest Ethiopia: a
Abebaw Addis Gelagay1, Telake Azale2, Lemma Derseh Gezie3
1Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia abebaw.addis@gmail.com.
Insights
Adherence to Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines for childhood pneumonia in Ethiopia is low, impacting treatment outcomes. Improving adherence requires strengthening accountability and tailored strategies for healthcare providers.
Area of Science:
- Child Health
- Infectious Diseases
- Public Health Policy
Background:
- Pneumonia remains a leading infectious cause of death in Ethiopian children under five.
- Ethiopia has implemented the Integrated Management of Newborn and Childhood Illnesses (IMNCI) strategy to address this.
- Despite efforts, significant gaps in accurate diagnosis and treatment persist.
Purpose of the Study:
- To assess the proportion of under-five children receiving accurate pneumonia diagnosis and treatment per IMNCI guidelines.
- To identify factors influencing healthcare provider adherence to IMNCI guidelines for pneumonia management.
Main Methods:
- A cross-sectional study was conducted in northwest Ethiopia from March to July 2023.
- Data collected through observation, child re-assessment, caregiver and provider interviews, and facility audits.
- Two-stage random sampling and multilevel binary logistic regression analyses were employed.
Main Results:
- Only 35.6% of children with pneumonia symptoms received correct classification and treatment.
- Factors associated with adherence included young infant age, absence of fever, longer consultation times, and chart booklet use.
- Healthcare provider training, lower caseloads, and regular review meetings also positively correlated with adherence.
Conclusions:
- Low adherence to IMNCI guidelines for childhood pneumonia contributes to poor outcomes and antimicrobial resistance.
- Most identified barriers to adherence are modifiable.
- Enhancing accountability, mentoring, and implementing targeted strategies are essential for improving guideline adherence.
Introduction:
Despite Ethiopia's adoption of the Integrated Management of Newborn and Childhood Illnesses (IMNCI) strategy, pneumonia continues to be the leading infectious cause of death among under-five children. Therefore, this study aimed to determine the proportion of under-five children who had received the accurate diagnostic classification and appropriate treatment for symptoms of pneumonia using the IMNCI guideline and to identify factors associated with guideline adherence.
Methods:
A cross-sectional study was conducted between March and July 2023 among sick under-five children who visited health centres in the South Gondar zone, northwest Ethiopia. We employed two-stage random sampling. Observation of healthcare providers' clinical assessment, diagnosis and treatment; re-assessing children; interviewing caregivers and healthcare providers; and facility audit were applied to collect the data. Both descriptive and multilevel binary logistic regression analyses were done.
Results:
Only 35.6% (95% CI: 33.2, 38.0) of sick children with pneumonia symptoms received the correct classification and treatment. Factors associated with accurate diagnostic classification and appropriate treatment included being a young infant (adjusted OR (AOR): 2.8, 95% CI: 1.4, 5.4), absence of fever (AOR: 1.5, 95% CI: 1.1, 2.0), longer consultation times (AOR: 1.4, 95% CI: 1.1, 1.9), receiving care from healthcare providers who referred to the chart booklet during diagnosis and treatment (AOR: 3.9, 95% CI: 2.8, 5.4), taking the IMNCI training (AOR: 2.4, 95% CI: 1.5, 3.7), lower patient caseloads (AOR: 1.7, 95% CI: 1.1, 2.6) and having regular review meetings on health services quality (AOR: 1.8, 95% CI: 1.3, 2.5).
Conclusions:
The proportion of correct classification and treatment of sick children with pneumonia symptoms was low, leading to poor treatment outcomes, irrational use of antibiotics and antimicrobial resistance. Almost all cluster-level associated factors are modifiable. Strengthening accountability, mentoring and implementing tailored strategies are crucial to enhancing healthcare providers' adherence to the IMNCI guidelines.
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