Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi
Introduction Young infants 7–59 days old with fast breathing pneumonia presented to a primary level health facility receive a 7-day course of amoxicillin as per the WHO guideline. However, community-level health workers (CLHW) are not allowed to treat these infants. This trial evaluated the communit...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/8/e006578.full |
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| author | Humphreys Nsona Tadesse Awoke Ayele Sunita Taneja Nita Bhandari Abebaw Gebeyehu Kassahun Alemu Don P Mathanga Lulu M Muhe Samira Aboubaker Gashaw Andargie Zemene Tigabu Salim Sadruddin Gunjan Aggarwal Yasir B Nisar Suresh Dalpath Jasmine Kaur Yasir Bin Nisar Golam Mothabbir Shohel Rana ASM Nawshad Ahmed Alemayehu Teklu Ashenafi Tazebew Sudarshan Mundra Amarnath Mehrotra Amneet P. Kumar Gomezgani Jenda Peter Moschovis Shamim Ahmad Qazi |
| author_facet | Humphreys Nsona Tadesse Awoke Ayele Sunita Taneja Nita Bhandari Abebaw Gebeyehu Kassahun Alemu Don P Mathanga Lulu M Muhe Samira Aboubaker Gashaw Andargie Zemene Tigabu Salim Sadruddin Gunjan Aggarwal Yasir B Nisar Suresh Dalpath Jasmine Kaur Yasir Bin Nisar Golam Mothabbir Shohel Rana ASM Nawshad Ahmed Alemayehu Teklu Ashenafi Tazebew Sudarshan Mundra Amarnath Mehrotra Amneet P. Kumar Gomezgani Jenda Peter Moschovis Shamim Ahmad Qazi |
| author_sort | Humphreys Nsona |
| collection | DOAJ |
| description | Introduction Young infants 7–59 days old with fast breathing pneumonia presented to a primary level health facility receive a 7-day course of amoxicillin as per the WHO guideline. However, community-level health workers (CLHW) are not allowed to treat these infants. This trial evaluated the community level treatment of non-hypoxaemic young infants with fast breathing pneumonia by CLHWs.Methods This cluster-randomised, open-label, non-inferiority trial was conducted in rural areas of Bangladesh, Ethiopia, India and Malawi. We randomly allocated clusters (first-level health facility) 1:1, stratified by the population size, to an intervention group (enhanced community case management) or control group (standard community case management). Infants aged 7–59 days with a respiratory rate of ≥60 breaths/min and oxygen saturation (SpO2) ≥90% were enrolled. In the intervention clusters, these infants were treated with a 7-day course of oral amoxicillin (according to WHO weight bands) and were regularly followed up by CLHWs. In the control clusters, CLHWs continued the standard management (assess and refer after pre-referral antibiotic dose) and followed up according to the national programme guideline. The primary outcome of treatment failure was assessed in both groups by independent outcome assessors on days 6 and 14 after enrolment. Secondary outcomes (accuracy and impact of pulse oximetry) were also assessed.Results Between September 2016 and December 2018, we enrolled 2334 infants (1168 in intervention and 1166 in control clusters) from 208 clusters (104 intervention and 104 control). Of 2334, 22 infants with fast breathing were excluded from analysis, leaving 2312 (1155 in intervention clusters and 1157 in control clusters) for intention-to-treat analysis. The proportion of treatment failure was 5.4% (63/1155) in intervention and 6.3% (73/1157) in the control clusters, including two deaths (0.2%) in each group. The adjusted risk difference for treatment failure between the two groups was −1.0% (95% CI −3.0% to 1.1%). The secondary outcome showed that CLHWs in the intervention clusters performed all recommended steps of pulse oximetry assessment in 94% (1050/1115) of enrolled patients.Conclusions The 7-day amoxicillin treatment for 7–59 days old non-hypoxaemic infants with fast breathing pneumonia by CLHWs was non-inferior to the currently recommended referral strategy.Trial registration numbers CTRI/2017/02/007761 and ACTRN12617000857303. |
| first_indexed | 2024-12-20T18:31:58Z |
| format | Article |
| id | doaj.art-e945103524774fe68c9237181bd35b1e |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-12-20T18:31:58Z |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-e945103524774fe68c9237181bd35b1e2022-12-21T19:30:01ZengBMJ Publishing GroupBMJ Global Health2059-79082021-08-016810.1136/bmjgh-2021-006578Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and MalawiHumphreys NsonaTadesse Awoke AyeleSunita TanejaNita Bhandari0Abebaw GebeyehuKassahun AlemuDon P MathangaLulu M MuheSamira AboubakerGashaw AndargieZemene TigabuSalim SadruddinGunjan AggarwalYasir B Nisar1Suresh DalpathJasmine KaurYasir Bin NisarGolam MothabbirShohel RanaASM Nawshad AhmedAlemayehu TekluAshenafi TazebewSudarshan MundraAmarnath MehrotraAmneet P. KumarGomezgani JendaPeter MoschovisShamim Ahmad QaziCenter for Health Research and Development, Society for Applied Studies, New Delhi, IndiaDepartment of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneve, SwitzerlandIntroduction Young infants 7–59 days old with fast breathing pneumonia presented to a primary level health facility receive a 7-day course of amoxicillin as per the WHO guideline. However, community-level health workers (CLHW) are not allowed to treat these infants. This trial evaluated the community level treatment of non-hypoxaemic young infants with fast breathing pneumonia by CLHWs.Methods This cluster-randomised, open-label, non-inferiority trial was conducted in rural areas of Bangladesh, Ethiopia, India and Malawi. We randomly allocated clusters (first-level health facility) 1:1, stratified by the population size, to an intervention group (enhanced community case management) or control group (standard community case management). Infants aged 7–59 days with a respiratory rate of ≥60 breaths/min and oxygen saturation (SpO2) ≥90% were enrolled. In the intervention clusters, these infants were treated with a 7-day course of oral amoxicillin (according to WHO weight bands) and were regularly followed up by CLHWs. In the control clusters, CLHWs continued the standard management (assess and refer after pre-referral antibiotic dose) and followed up according to the national programme guideline. The primary outcome of treatment failure was assessed in both groups by independent outcome assessors on days 6 and 14 after enrolment. Secondary outcomes (accuracy and impact of pulse oximetry) were also assessed.Results Between September 2016 and December 2018, we enrolled 2334 infants (1168 in intervention and 1166 in control clusters) from 208 clusters (104 intervention and 104 control). Of 2334, 22 infants with fast breathing were excluded from analysis, leaving 2312 (1155 in intervention clusters and 1157 in control clusters) for intention-to-treat analysis. The proportion of treatment failure was 5.4% (63/1155) in intervention and 6.3% (73/1157) in the control clusters, including two deaths (0.2%) in each group. The adjusted risk difference for treatment failure between the two groups was −1.0% (95% CI −3.0% to 1.1%). The secondary outcome showed that CLHWs in the intervention clusters performed all recommended steps of pulse oximetry assessment in 94% (1050/1115) of enrolled patients.Conclusions The 7-day amoxicillin treatment for 7–59 days old non-hypoxaemic infants with fast breathing pneumonia by CLHWs was non-inferior to the currently recommended referral strategy.Trial registration numbers CTRI/2017/02/007761 and ACTRN12617000857303.https://gh.bmj.com/content/6/8/e006578.full |
| spellingShingle | Humphreys Nsona Tadesse Awoke Ayele Sunita Taneja Nita Bhandari Abebaw Gebeyehu Kassahun Alemu Don P Mathanga Lulu M Muhe Samira Aboubaker Gashaw Andargie Zemene Tigabu Salim Sadruddin Gunjan Aggarwal Yasir B Nisar Suresh Dalpath Jasmine Kaur Yasir Bin Nisar Golam Mothabbir Shohel Rana ASM Nawshad Ahmed Alemayehu Teklu Ashenafi Tazebew Sudarshan Mundra Amarnath Mehrotra Amneet P. Kumar Gomezgani Jenda Peter Moschovis Shamim Ahmad Qazi Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi BMJ Global Health |
| title | Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi |
| title_full | Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi |
| title_fullStr | Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi |
| title_full_unstemmed | Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi |
| title_short | Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7–59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi |
| title_sort | community based amoxicillin treatment for fast breathing pneumonia in young infants 7 59 days old a cluster randomised trial in rural bangladesh ethiopia india and malawi |
| url | https://gh.bmj.com/content/6/8/e006578.full |
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