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

Nightingale, R; Colbourn, T; Mukanga, D; Mankhambo, L; Lufesi, N; McCollum, ED; 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 , 8 (21) pp. 1-8. 10.1186/s41479-016-0024-8. Green open access

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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.

Type: Article
Title: Non-adherence to community oral-antibiotic treatment in children with fast-breathing pneumonia in Malawi– secondary analysis of a prospective cohort study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s41479-016-0024-8
Publisher version: http://doi.org/10.1186/s41479-016-0024-8
Language: English
Additional information: Copyright © 2017 The Author(s). All rights reserved. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Pneumonia, Non-adherence, Oral antibiotics, iCCM, Child, Sub-Saharan Africa, Treatment, failure
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/1535288
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