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Nightingale R, Colbourn T, Mukanga D, et al. Non-adherence to community oral-antibiotic treatment in children with fast-breathing pneumonia in Malawi- secondary analysis of a prospective cohort study. Pneumonia (Nathan). 2016;8:21doi: 10.1186/s41479-016-0024-8.
Nightingale, R., Colbourn, T., Mukanga, D., Mankhambo, L., Lufesi, N., McCollum, E. D., & King, C. (2016). Non-adherence to community oral-antibiotic treatment in children with fast-breathing pneumonia in Malawi- secondary analysis of a prospective cohort study. Pneumonia (Nathan Qld.), 821. https://doi.org/10.1186/s41479-016-0024-8
Nightingale, Rebecca, et al. "Non-adherence to community oral-antibiotic treatment in children with fast-breathing pneumonia in Malawi- secondary analysis of a prospective cohort study." Pneumonia (Nathan Qld.) vol. 8 (2016): 21. doi: https://doi.org/10.1186/s41479-016-0024-8
Nightingale R, Colbourn T, Mukanga D, Mankhambo L, Lufesi N, McCollum ED, King C. Non-adherence to community oral-antibiotic treatment in children with fast-breathing pneumonia in Malawi- secondary analysis of a prospective cohort study. Pneumonia (Nathan). 2016 Nov 24;8:21. doi: 10.1186/s41479-016-0024-8. eCollection 2016. PMID: 28702300; PMCID: PMC5471995.
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Pneumonia (Nathan). 2016 Nov 24;8:21. doi: 10.1186/s41479-016-0024-8. eCollection 2016.

Non-adherence to community oral-antibiotic treatment in children with fast-breathing pneumonia in Malawi- secondary analysis of a prospective cohort study.

Pneumonia (Nathan Qld.)

Rebecca Nightingale, Tim Colbourn, David Mukanga, Limangeni Mankhambo, Norman Lufesi, Eric D McCollum, Carina King

Affiliations

  1. Institute for Global Health, University College London, London, UK.
  2. Science and Health Impact Group (SHI), Kampala, Uganda.
  3. Parent and Child Health Initiative, Lilongwe, Malawi.
  4. Acute Respiratory Infection Unit, Ministry of Health, Lilongwe, Malawi.
  5. Department of Pediatrics, Division of Pulmonology, Johns Hopkins School of Medicine, Baltimore, USA.

PMID: 28702300 PMCID: PMC5471995 DOI: 10.1186/s41479-016-0024-8

Abstract

BACKGROUND: Despite significant progress, pneumonia is still the leading cause of infectious deaths in children under five years of age. Poor adherence to antibiotics has been associated with treatment failure in World Health Organisation (WHO) defined clinical pneumonia; therefore, improving adherence could improve outcomes in children with fast-breathing pneumonia. We examined clinical factors that may affect adherence to oral antibiotics in children in the community setting in Malawi.

METHODS: We conducted a sub-analysis of a prospective cohort of children aged 2-59 months diagnosed by community health workers (CHW) in rural Malawi with WHO fast-breathing pneumonia. Clinical factors identified during CHW diagnosis were investigated using multivariate logistic regression for association with non-adherence, including concurrent diagnoses and treatments. Adherence was measured at both 80% and 100% completion of prescribed oral antibiotics.

RESULTS: Eight hundred thirty-four children were included in our analysis, of which 9.5% and 20.0% were non-adherent at 80% and 100% of treatment completion, respectively. A concurrent infectious diagnosis (OR: 1.76, 95% CI: 0.84-2.96/OR: 1.81, 95% CI: 1.21-2.71) and an illness duration of >24 h prior to diagnosis (OR: 2.14, 95% CI: 1.27-3.60/OR: 1.88, 95% CI: 1.29-2.73) had higher odds of non-adherence when measured at both 80% and 100%. Older age was associated with lower odds of non-adherence when measured at 80% (OR: 0.41, 95% CI: 0.21-0.78).

CONCLUSION: Non-adherence to oral antibiotics was not uncommon in this rural sub-Saharan African setting. As multiple diagnoses by the CHW and longer illness were important factors, this provides an opportunity for further investigation into targeted interventions and refinement of referral guidelines at the community level. Further research into the behavioural drivers of non-adherence within this setting is needed.

Keywords: Child; Non-adherence; Oral antibiotics; Pneumonia; Sub-Saharan Africa; Treatment failure; iCCM

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