Abdul Bari|Salim Sadruddin|Arif Raza Khan|Ibad ul Haque Khan|Asia Khan|Iqbal A Lehri|W. Bentley Macleod|Matthew P. Fox|Donald M. Thea|Shamim Qazi
Community case management of severe pneumonia with oral amoxicillin in children aged 2–59 months in Haripur district, Pakistan: a cluster randomised trial
United States Educational Foundation in Pakistan|Save the Children|United States Educational Foundation in Pakistan|United States Educational Foundation in Pakistan|United States Educational Foundation in Pakistan|Boston University|Center for Global Health|Boston University|Center for Global Health|Boston University|Center for Global Health|World Health Organization
background first dose oral cotrimoxazole referral recommended whodefined severe pneumonia difficulties referral compliance reported many lowresource settings resulting low access appropriate treatment objective study assess whether community case management lady health workers lhws oral amoxicillin children severe pneumonia equivalent current standard care methods haripur district pakistan 28 clusters randomly assigned stratification 11 ratio intervention control clusters use computergenerated randomisation sequence children included study aged 259 months whodefined severe pneumonia living study area intervention clusters communitybased lhws provided mothers oral amoxicillin 8090 mgkg per day 375 mg twice day infants aged 211 months 625 mg twice day aged 1259 months specific guidance use control clusters lhws gave first dose oral cotrimoxazole age 211 months sulfamethoxazole 200 mg plus trimethoprim 40 mg age 12 months 5 years sulfamethoxazole 300 mg plus trimethoprim 60 mg referred children health facility standard care participants carers assessors masked treatment assignment primary outcome treatment failure day 6 analysis per protocol adjustment clustering within groups use generalised estimating equations study registered number isrctn10618300 findings assigned 1995 children treatment 14 intervention clusters 1477 14 control clusters analysed 1857 1354 children respectively clusteradjusted treatment failure rates day 6 significantly reduced intervention clusters 165 9 vs 241 18 risk difference 89 95 ci 124 54 adjustment baseline covariates made little difference 73 101 45 two deaths reported control clusters one intervention cluster risk reduction occurrence fever lower chest indrawing day 3 67 100 33 adverse events diarrhoea n4 skin rash n1 intervention clusters diarrhoea n3 control clusters interpretation community case management could result standardised treatment children severe pneumonia reduce delay treatment initiation reduce costs families healthcare systems funding united states agency international development usaid