Evidence map›Paper›PMID 35012490›Full record

ArticleBMC pediatrics2022

Chest radiography in children aged 2-59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis.

Tisungane Mvalo, Eric D McCollum, Elizabeth Fitzgerald, Portia Kamthunzi, Robert H Schmicker, Susanne May, Melda Phiri, Claightone Chirombo, Ajib Phiri, Amy Sarah Ginsburg

3 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC pediatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT02678195 phase4completednot on this map

Double-blind Randomized Controlled Clinical Trial of 3 Days Versus 5 Days Amoxicillin Dispersible Tablets for Chest-indrawing Childhood Pneumonia Among Children 2-59 Months of Age Presenting to Kamuzu Central Hospital in Lilongwe, Malawi

TypeinterventionalSponsorSave the ChildrenRan2016 to 2019Enrolled3,000ConditionsPneumoniaArmsAmoxicillin, Placebo
NCT02760420 phase4completednot on this map

Double-blind Randomized Controlled Clinical Trial of 3 Days of Amoxicillin Disperable Tablet (DT) Versus Placebo for Fast Breathing Childhood Pneumonia Among Children 2-59 Months of Age Presenting to Kamuzu Central Hospital in Lilongwe, Malawi

TypeinterventionalSponsorSave the ChildrenRan2016 to 2019Enrolled1,126ConditionsPneumoniaArmsAmoxicillin, Placebo
NCT02960919 completednot on this map

Prospective, Observational Study of Clinical Outcomes Among Children 2 to 59 Months of Age With Childhood Pneumonia and Other Co-morbidities in Lilongwe, Malawi Who Have Been Excluded From Pneumonia Clinical Trials

TypeobservationalSponsorSave the ChildrenRan2016 to 2018Enrolled1,001ConditionsPneumoniaArmsoral amoxicillin or parenteral ampicillin/ penicillin and gentamicin, parenteral ampicillin/ penicillin, gentamicin
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Tisungane MvaloLilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi. tmvalo@unclilongwe.org.
Eric D McCollumGlobal Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Elizabeth FitzgeraldLilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi.
Portia KamthunziLilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi.
Robert H SchmickerUniversity of Washington Clinical Trial Center, Seattle, Washington, USA.
Susanne MayUniversity of Washington Clinical Trial Center, Seattle, Washington, USA.
Melda PhiriLilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi.
Claightone ChiromboLilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi.
Ajib PhiriDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Lilongwe Campus, Lilongwe, Malawi.
Amy Sarah GinsburgUniversity of Washington Clinical Trial Center, Seattle, Washington, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes.

methodsWhen clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes.

resultsBetween March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was "other infiltrates only" in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was "primary endpoint pneumonia"(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58).

conclusionsIn this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with "primary endpoint pneumonia" was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs.

trial registrationITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov ( NCT02760420 , NCT02678195 , and NCT02960919 , respectively).

Indexed as

PneumoniaRadiography, ThoracicChild, PreschoolHumansInfantMalawiChest radiographyChildhood pneumonia

Identifiers

PMID35012490
PMCPMC8744340

What OpenQuestion holds

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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.