Evidence map›Paper›PMID 41521822›Full record

Observational studyJournal of global health2026

Outcome and management of 2-59-month-old Nigerian children with chest indrawing pneumonia at primary-level healthcare facilities: a prospective cohort study.

Adegoke G Falade, Obioma C Uchendu, Ayobami A Bakare, Tim Colbourn, Omotayo E Olojede, Joseph K Abuo, Olabisi Olasupo, Hamish R Graham, Rochelle A Burgess, Julius Salako and 7 more

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. 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

17 authors.

Adegoke G FaladeDepartment of Paediatrics, University of Ibadan, Ibadan, Oyo State, Nigeria.
Obioma C UchenduDepartment of Community Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
Ayobami A BakareDepartment of Community Medicine, University College Hospital, Ibadan Nigeria.
Tim ColbournInstitute for Global Health, University College London, London, UK.
Omotayo E OlojedeDepartment of Health Promotion and Education, University of Ibadan, Ibadan, Oyo State, Nigeria.
Joseph K AbuoDepartment of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo State, Nigeria.
Olabisi OlasupoDepartment of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria.
Hamish R GrahamCentre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.
Rochelle A BurgessInstitute for Global Health, University College London, London, UK.
Julius SalakoDepartment of Paediatrics, University of Ibadan, Ibadan, Oyo State, Nigeria.
Ayodamola A BakareDepartment of Paediatrics, University of Ibadan, Ibadan, Oyo State, Nigeria.
Funmilayo ShittuDepartment of Paediatrics, University of Ibadan, Ibadan, Oyo State, Nigeria.
Agnese IulianoInstitute for Global Health, University College London, London, UK.
Eric D McCollumSchool of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Yasir Bin NisarDepartment of Sexual, Reproductive, Maternal, Child and Adolescent Heath and Ageing, Geneva, Switzerland.
Shamim A QaziIndependent Consultant, Geneva, Switzerland.
Carina KingDepartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden.

Funding

Gates Foundation INV-007927
6 · The paper itself

Abstract

Background: In 2012, World Health Organization (WHO) recommended outpatient oral amoxicillin for children aged 2-59 months with chest indrawing pneumonia without general danger signs, based on randomised trials. We assessed mortality and case management for such children routinely managed at primary healthcare centres (PHCs) in Lagos, Nigeria. Methods: This prospective observational cohort study (September 2021-September 2023) was conducted in Ikorodu Local Government Area (LGA), nested within the Integrated Sustainable childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) Lagos study across 16 PHCs. PHC healthcare workers (HCWs) trained in Integrated Management of Childhood Illness (IMCI) provided routine care, while INSPIRING staff independently assessed eligibility using IMCI criteria. The primary outcome was the 14-day case fatality rate (CFR) among children with chest indrawing pneumonia without general danger signs; secondary outcomes included antibiotic use, treatment adherence, and referral practices. Results: PHC HCW identified 24 chest indrawing cases, while INSPIRING staff diagnosed 247 cases, including 19 of the 24 identified by PHC HCWs. Among those followed up (n = 16), the CFR was 6.3% (n/N = 1/16; 95% confidence interval (CI) = 0.2-30.2) for PHC HCW identified cases; with the same death identified by INSPIRING staff (n/N = 1/197; CFR = 0.5%). The single event in each cohort, and high loss to follow-up, imply that these CFR estimates are statistically fragile and should be interpreted as indicative only. Only 4% (n/N = 1/24) of children received routine care aligned with IMCI protocols. Of those prescribed antibiotics, 50% (n/N = 4/8) completed the full course, and just 1 of the 6 of referred children was admitted to hospital. Conclusions: PHC HCWs rarely diagnosed chest indrawing pneumonia, and one-third of the patients were lost to follow up leading to a smaller than expected sample and therefore an imprecise CFR. Improving HCW capacity to identify and manage pneumonia, alongside strengthening IMCI implementation, is critical to reducing preventable child deaths in this setting.

Indexed as

PneumoniaPrimary Health CareAmoxicillinAnti-Bacterial AgentsChild, PreschoolFemaleHumansInfantMaleNigeriaProspective StudiesAmoxicillinAnti-Bacterial Agents

Identifiers

PMID41521822
PMCPMC12793930

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.