IMPACT OF A CASE-MANAGEMENT PROTOCOL FOR CHILDHOOD PNEUMONIA IN A RURAL ZAMBIAN HOSPITAL

This study aimed to assess the impact of adopting the WHO case managem ent protocol for childhood pneumonia in a district hospital in rural Z ambia. The subjects were children under 5 years of age with a diagnosi s of pneumonia, admitted in the 9-month period following introduction of the WHO protocol. Management and outcome were compared with a histo rical control group admitted during the same period in the previous ye ar. There were 158 children in the intervention group and 135 controls with similar age and sex distribution. Both groups were malnourished (mean weight-for-age Z score in subjects = -1.91, in controls = -1.83) . There was no significant difference in the numbers receiving parente ral antibiotics or supplementary fluids in each group. However, childr en in the intervention group were significantly more likely to receive oxygen (odds ratio 4.7, 95% confidence interval 2.8-8.1, p < 0.0001). Mortality was significantly greater in the control group (case fatali ty rate, 25%) compared with the intervention group (case fatality rate , 15%; chi(2) = 4.6; p = 0.032). The introduction of the WHO protocol for management of childhood pneumonia and training of staff in its use was accompanied by a fall in mortality from this condition in a rural hospital. The improved survival rate may be related to the more frequ ent use of oxygen.