ArticleBMJ paediatrics open2025
Correct diagnostic classification and treatment of pneumonia symptoms in under-five children, northwest Ethiopia: a cross-sectional study.
Article in BMJ paediatrics open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDespite 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.
methodsA 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.
resultsOnly 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).
conclusionsThe 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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