Observational studyPaediatrics and international child health2014
Determining the quality of IMCI pneumonia care in Malawian children.
Observational study in Paediatrics and international child health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07631377 (The LalelaLung Study), which is not on this map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The LalelaLung Study: Digital Stethoscope Clinical Evaluation
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Which children with chest-indrawing pneumonia can be safely treated at home, and under what conditions is it safe to do so? A systematic review of evidence from low- and middle-income countries.Journal of global health · 2022Pooled it
- Trial
- Trial
- Beyond pulse oximetry: lessons from the AIRE project on translating innovation into improved child survival.BMJ global health · 2026Article
- Clinical Evaluation of Pediatric Pulse Oximeters in South Africa: Protocol for a Cluster Randomized Controlled Trial.JMIR research protocols · 2026Article
- Health care worker-reported barriers and potential facilitators of acute lower respiratory infection care deliver for children at Mchinji District Hospital in Malawi.IJID regions · 2026Article
- Outcome and management of 2-59-month-old Nigerian children with chest indrawing pneumonia at primary-level healthcare facilities: a prospective cohort study.Journal of global health · 2026Observational
- Multimodal pulse oximeters to support the integrated management of childhood illnesses: A usability and diagnostic accuracy assessment from a multi-country hybrid type 2 study.PLOS global public health · 2026Article
- Evaluating the performance of a video expert panel in assessing respiratory rate from recorded videos for the diagnosis of non-severe paediatric pneumonia.BMJ open respiratory research · 2025Article
- Development and implementation of a digital clinical decision support system to increase the quality of primary healthcare delivery in a refugee setting in Chad.BMC primary care · 2025Article
- The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.Global health action · 2024Article
- Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?BMC infectious diseases · 2023Article
- Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status.Bulletin of the World Health Organization · 2022Article
- Hypoxemia, hypoglycemia and IMCI danger signs in pediatric outpatients in Malawi.PLOS global public health · 2022Article
- Correct diagnosis of childhood pneumonia in public facilities in Tanzania: a randomised comparison of diagnostic methods.BMJ open · 2021Observational
- Bayesian network models with decision tree analysis for management of childhood malaria in Malawi.BMC medical informatics and decision making · 2021Article
- Primary Care Case Management of Febrile Children: Insights From the ePOCT Routine Care Cohort in Dar es Salaam, Tanzania.Frontiers in pediatrics · 2021Article
- Integrated Management of Childhood Illnesses (IMCI): a mixed-methods study on implementation, knowledge and resource availability in Malawi.BMJ paediatrics open · 2021Article
- Article
- A mixed-methods quasi-experimental evaluation of a mobile health application and quality of care in the integrated community case management program in Malawi.Journal of global health · 2019Article
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundAlthough pneumonia is the leading cause of child mortality worldwide, little is known about the quality of routine pneumonia care in high burden settings like Malawi that utilize World Health Organization's Integrated Management of Childhood Illnesses (IMCI) guidelines. Due to severe human resource constraints, the majority of clinical care in Malawi is delivered by non-physician clinicians called Clinical Officers (COs).
aimTo assess the quality of child pneumonia care delivered by Malawian COs in routine care conditions.
methodsAt an outpatient district-level clinic in Lilongwe, Malawi, 10 COs caring for 695 children who presented with fever, cough, or difficulty breathing were compared to IMCI pneumonia diagnostic and treatment guidelines.
resultsFewer than 1% of patients received an evaluation by COs that included all 16 elements of the history and physical examination. The respiratory rate was only determined in 16.1% of patients presenting with cough or difficulty breathing. Of the 274 children with IMCI-defined pneumonia, COs correctly diagnosed 30%, and administered correct pneumonia care in less than 25%. COs failed to hospitalize 40.8% of children with severe or very severe pneumonia.
conclusionsIMCI pneumonia care quality at this Malawian government clinic is alarmingly low. Along with reassessing current pneumonia training and supervision approaches, novel quality improvement interventions are necessary to improve care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.