***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a cluster r and omized trial , Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective OBJECTIVE . The purpose of this work was to evaluate whether education about zinc supplements and provision of zinc supplements to caregivers is effective in the treatment of  acute diarrhea  and whether this strategy adversely affects the use of oral rehydration salts . PATIENTS AND METHODS . Six clusters of 30 000 people each in Haryana , India , were r and omly assigned to intervention and control sites . Government and private providers and village health workers were trained to prescribe zinc and oral rehydration salts for use in diarrheal episodes in 1-month-old to 5-year-old children in intervention communities ; in the control sites , oral rehydration salts alone was promoted . In 2 cross-sectional surveys commencing 3 months ( survey 2 ) and 6 months ( survey 3 ) after the start of the intervention , care-seeking behavior , drug therapy , and oral rehydration salts use during diarrhea , diarrheal and respiratory morbidity , and hospitalization rates were measured . RESULTS . In the 2 surveys , zinc was used in 36.5 % ( n = 1571 ) and 59.8 % ( n = 1649 ) and oral rehydration salts in 34.8 % ( n = 1571 ) and 59.2 % ( n = 1649 ) of diarrheal episodes occurring in the 4 weeks preceding interviews in the intervention areas . In control areas , oral rehydration salts were used in 7.8 % ( n = 2209 ) and 9.8 % ( n = 2609 ) of episodes . In the intervention communities , care seeking for diarrhea reduced by 34 % ( survey 3 ) , as did the prescription of drugs of unknown identity ( survey 3 ) and antibiotics ( survey 3 ) for diarrhea . The 24-hour prevalences of diarrhea and acute lower respiratory infections were lower in the intervention communities ( survey 3 ) . All-cause , diarrhea , and pneumonia hospitalizations in the preceding 3 months were reduced in the intervention compared with control areas ( survey 3 ) . CONCLUSIONS . Diarrhea is more effectively treated when caregivers receive education on zinc supplementation and have ready access to supplies of oral rehydration salts and zinc , and this approach does not adversely affect the use of oral rehydration salts ; in fact , it greatly increases use of the same A prospect i ve intervention study was conducted in Ballabgarh block of Haryana . The study area has a population of about 30,000 under a state run P.H.C. area . The control area has a population of about 60,000 under Comprehensive Rural Health Services Project of All India Institute of Medical Sciences . ARI control strategies as advocated by WHO was instituted in the study area . Measles and DPT immunization was strengthened . The ARI cases detected or reported to Health Workers were managed as per the st and ard case management procedure . The underfives mortality , infant and 1–4 years mortality rates were initially higher in study area and differences were statistically significant . After 2 years , the reductions in study area were substantial and differences were not statistically significant . The ARI mortality in underfives , and 1–4 years were higher in study area at the beginning compared to control area . Though they were less than in control area after 2 years of intervention the observed differences were not statistically significant in both periods . The reduction of 37 % in underfives mortality and 26 % due ARI mortality is substantial . More benefit was attained with measles immunization than with st and ard case management . ARI control programme is advocated for application on national level vigourously covering with measles immunization and to include the village based private practitioners in the strategy for effective case management Background : A growing body of evidence indicates a relationship between household indoor air pollution from cooking fires and adverse neonatal outcomes , such as  low birth weight ( LBW )  , in re source -poor countries . Objective : We examined the effect of reduced wood smoke exposure in pregnancy on LBW  of Guatemalan infants in RESPIRE ( R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) . Methods : Pregnant women ( n = 266 ) either received a chimney stove ( intervention ) or continued to cook over an open fire ( control ) . Between October 2002 and December 2004 we weighed 174 eligible infants ( 69 to mothers who used a chimney stove and 105 to mothers who used an open fire during pregnancy ) within 48 hr of birth . Multivariate linear regression and adjusted odds ratios ( ORs ) were used to estimate differences in birth weight and LBW ( < 2,500 g ) associated with chimney-stove versus open-fire use during pregnancy . Results : Pregnant women using chimney stoves had a 39 % reduction in mean exposure to carbon monoxide compared with those using open fires . LBW prevalence was high at 22.4 % . On average , infants born to mothers who used a stove weighed 89 g more [ 95 % confidence interval ( CI ) , –27 to 204 g ] than infants whose mothers used open fires after adjusting for maternal height , diastolic blood pressure , gravidity , and season of birth . The adjusted OR for LBW was 0.74 ( 95 % CI , 0.33–1.66 ) among infants of stove users compared with open-fire users . Average birth weight was 296 g higher ( 95 % CI , 109–482 g ) in infants born during the cold season ( after harvest ) than in other infants ; this unanticipated finding may reflect the role of maternal nutrition on birth weight in an impoverished region . Conclusions : A chimney stove reduced wood smoke exposures and was associated with reduced LBW occurrence . Although not statistically significant , the estimated effect was consistent with previous studies We compared use of community medicine distributors ( CMDs ) and drug use under integrated community case management and home-based management strategies in children 6–59 months of age in eastern Ug and a. A cross-sectional study with 1,095 children was nested in a cluster r and omized trial with integrated community case management ( CMDs treating malaria and pneumonia ) as the intervention and home-based management ( CMDs treating only malaria ) as the control . Care-seeking from CMDs  was higher in intervention areas ( 31 % ) than in control areas ( 22 % ; P = 0.01 ) . Prompt and appropriate treatment of malaria was higher in intervention areas ( 18 % ) than in control areas ( 12 % ; P = 0.03 ) and among CMD users ( 37 % ) than other health providers ( 9 % ) . The mean number of drugs among CMD users compared with other health providers was 1.6 versus 2.4 in intervention areas and 1.4 versus 2.3 in control areas . Use of CMDs  was low . However , integrated community case management of childhood illnesses increased use of CMDs and rational drug use In 1990 , the Ministry of Public Health of Thail and started a five-year education program on management of cases with acute respiratory infection ( ARI ) . The objective of this- study was to test whether such a program could reduce the average number of sick days of the target children . 30 villages in the study district were r and omly allocated into 15 study and 15 control villages . A 2-day training workshop for village health volunteers from the study villages was conducted . The cohort of children age below 5 years in the two areas were followed-up for 19 week in the peak season of the disease . Among the 664 and 649 target children with 67,083 and 67,984 child-days observed in the study and the control villages , 71 and 41 children , respectively , were free from any episode . The preventive odds ratio of treatment adjusted for age and village effects = 0.88 , 95 % ( CI 0.4 - 1.95 ) . The median of the average sick periods in the individuals were 27 and 34 days , respectively . After adjusting for age , episodes/month and locality , the ratio of average sick days between children in the study and control villages was 0.89 ( 95 % CI 0.76 - 1.05 ) or 11 % shorter duration without statistical significance . The adjusted odds ratios of visiting the health center , private clinics , the community hospital and provincial hospital were 0.95 ( 95 % CI 0.69 - 1.25 ) , 1.43 ( 95 % CI 0.98 - 2.11 ) , 2.01 ( 95 % CI 1.06 - 3.82 ) and 4.71 ( 95 % CI 1.50 - 14.8 ) , respectively . The training program thus had rather little impact on morbidity of the disease but tended to promote utilization of higher level of health services by the affected children BACKGROUND Pneumonia is a leading global cause of morbidity and mortality in children younger than 5 years . In Pakistan , the proportion of deaths due to pneumonia is higher in rural areas than it is in urban areas , with a substantial proportion of individuals dying at home because referral for care is problematic in such areas . We aim ed to establish whether community case identification and management of severe pneumonia by oral antibiotics delivered through community health workers has the potential to reduce the number of infants dying at home . METHODS We did a cluster-r and omised controlled trial in Matiari district of rural Sindh , Pakistan . Public-sector lady health workers ( LHWs ) undertook community case management of WHO-defined severe pneumonia . The children in intervention clusters with suspected pneumonia were screened by LHWs and those diagnosed with severe pneumonia were prescribed oral amoxicillin syrup ( 90 mg/kg per day in two doses ) for 5 days at home . Children in control clusters were given one dose of oral co-trimoxazole and were referred to their nearest health facility for admission and intravenous antibiotics , as per government policy . In both groups , follow-up visits at home were done at days 2 , 3 , 6 , and 14 by LHW . The primary outcome was treatment failure by day 6 after enrolment . We matched and r and omly allocated 18 clusters ( union councils , the smallest administrative unit of the district ) to either intervention and control using a computer-generated r and omisation scheme . Analyses were done per- protocol . This trial is registered with Clinical Trials.gov , number NCT01192789 . FINDINGS 2341 children in intervention clusters and 2069 children in control clusters participated in the study , enrolled between Feb 13 , 2008 , and March 15 , 2010 . We recorded 187 ( 8 % ) treatment failures by day 6 in the intervention group and 273 ( 13 % ) in the control group . After adjusting for clustering , the risk difference for treatment failure was -5·2 % ( 95 % CI -13·7 % to 3·3 % ) . We recorded three deaths , two by day 6 and one between days 7 and 14 . We recorded no serious adverse events . INTERPRETATION Public sector LHWs in Pakistan were able to satisfactorily diagnose and treat severe pneumonia at home in rural Pakistan . This strategy might effectively reach children with pneumonia in setting s where referral is difficult , and it could be a key component of community detection and management strategies for childhood pneumonia . FUNDING US Agency for International Development through grants to John Snow Incorporation and Boston University , USA BACKGROUND WHO and UNICEF launched the Integrated Management of Childhood Illness ( IMCI ) strategy in the mid-1990s to reduce deaths from diarrhoea , pneumonia , malaria , measles , and malnutrition in children younger than 5 years . We assessed the effect of IMCI on health and nutrition of children younger than 5 years in Bangladesh . METHODS In this cluster r and omised trial , 20 first-level government health facilities in the Matlab subdistrict of Bangladesh and their catchment areas ( total population about 350 000 ) were paired and r and omly assigned to either IMCI ( intervention ; ten clusters ) or usual services ( comparison ; ten clusters ) . All three components of IMCI-health-worker training , health-systems improvements , and family and community activities-were implemented beginning in February , 2002 . Assessment included household and health facility surveys tracking intermediate outputs and outcomes , and nutrition and mortality changes in intervention and comparison areas . Primary endpoint was mortality in children aged between 7 days and 59 months .  Analysis was by intention to treat . This study is registered , number IS RCT N52793850 . FINDINGS The yearly rate of mortality reduction in children younger than 5 years ( excluding deaths in first week of life ) was similar in IMCI and comparison areas ( 8.6%vs 7.8 % ) . In the last 2 years of the study , the mortality rate was 13.4 % lower in IMCI than in comparison areas ( 95 % CI -14.2 to 34.3 ) , corresponding to 4.2 fewer deaths per 1000 livebirths ( 95 % CI -4.1 to 12.4 ; p=0.30 ) . Implementation of IMCI led to improved health-worker skills , health-system support , and family and community practice s , translating into increased care-seeking for illnesses . In IMCI areas , more children younger than 6 months were exclusively breastfed ( 76%vs 65 % , difference of differences  
    Output:
    
Community case management for diarrhea and pneumonia is associated with a 32 % reduction in pneumonia specific mortality , while the evidence on diarrhea related mortality is weak .
Conclusion Community based interventions have the potential to scale up care seeking and the use of essential commodities and significantly decrease morbidity and mortality burden due to diarrhea and pneumonia in children under the age of five years