dc.contributor.author | Maleche-Obimbo, Elizabeth | |
dc.contributor.author | Waiyego, Mary | |
dc.contributor.author | Wachira, John | |
dc.contributor.author | Muma, Sarah | |
dc.contributor.author | Mugane, Samson | |
dc.contributor.author | Maina, Virginia | |
dc.contributor.author | Kosgei, Caroline | |
dc.contributor.author | Digolo, Lina | |
dc.contributor.author | Kibore, Minnie | |
dc.contributor.author | Agweyu, Ambrose | |
dc.date.accessioned | 2014-12-17T14:35:44Z | |
dc.date.available | 2014-12-17T14:35:44Z | |
dc.date.issued | 2014 | |
dc.identifier.citation | Agweyu A, Kibore M, Digolo L, et al. Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines. Tropical Medicine & International Health 2014;19(11):1310-1320. doi:10.1111/tmi.12368. | en_US |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241029/ | |
dc.identifier.uri | http://hdl.handle.net/11295/77836 | |
dc.description.abstract | Objective
To determine the extent and pattern of treatment failure (TF) among children hospitalised with community-acquired pneumonia at a large tertiary hospital in Kenya.
Methods
We followed up children aged 2–59 months with WHO-defined severe pneumonia (SP) and very severe pneumonia (VSP) for up to 5 days for TF using two definitions: (i) documentation of pre-defined clinical signs resulting in change of treatment (ii) primary clinician's decision to change treatment with or without documentation of the same pre-defined clinical signs.
Results
We enrolled 385 children. The risk of TF varied between 1.8% (95% CI 0.4–5.1) and 12.4% (95% CI 7.9–18.4) for SP and 21.4% (95% CI 15.9–27) and 39.3% (95% CI 32.5–46.4) for VSP depending on the definition applied. Higher rates were associated with early changes in therapy by clinician in the absence of an obvious clinical rationale. Non-adherence to treatment guidelines was observed for 70/169 (41.4%) and 67/201 (33.3%) of children with SP and VSP, respectively. Among children with SP, adherence to treatment guidelines was associated with the presence of wheeze on initial assessment (P = 0.02), while clinician non-adherence to guideline-recommended treatments for VSP tended to occur in children with altered consciousness (P < 0.001). Using propensity score matching to account for imbalance in the distribution of baseline clinical characteristics among children with VSP revealed no difference in TF between those treated with the guideline-recommended regimen vs. more costly broad-spectrum alternatives [risk difference 0.37 (95% CI −0.84 to 0.51)].
Conclusion
Before revising current pneumonia case management guidelines, standardised definitions of TF and appropriate studies of treatment effectiveness of alternative regimens are required. | en_US |
dc.language.iso | en | en_US |
dc.title | Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines | en_US |
dc.type | Article | en_US |
dc.type.material | en | en_US |