Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN)

Olowu, AO; Elusiyan, Jerome Boluwaji Elutayo; Esangbedo, DO; Ekure, Ekanem N.; Esezobor, Christopher Imokhuede; Falade, Adegoke G; Osinusi, K; Mukhtar-Yola, M; Meremikwu, Martin; Ibe, BC; Johnson, Wahab Babatunde Rotimi; Oviawe, O; Bastos, Iasmin Nogueira

doi:10.4314/njp.v42i4.1

Cited by 20 publications

(30 citation statements)

References 26 publications

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“…Secondly, our estimate did not capture alternate treatment cost in case of the rst-line failure. It also failed to capture the treatment approach for human immunode ciency virus (HIV) patients with pneumonia or patients at risk of HIV [1,30]. Thirdly, we did not include the treatment of chest indrawing pneumonia with amoxicillin DT since it is not covered in the iCCM tool.…”

Section: Discussionmentioning

confidence: 99%

“…Following the WHO guideline for the treatment of severe pneumonia and the paediatrician association of Nigeria guideline [30], the cost of hospitalisation for severe pneumonia is $39.35 (25.39 -51.20) per case, which will yield a bene t of $2.31 (95% CI: $1.49 -3.38) million from the cost of severe hospitalisation averted. These translate to a total bene t $6.72 (95% CI: 5.48 -8.18) million and a net bene t of $3.31 (95% CI: $2.08 -4.76) million, which will offset 97% of the cost of promotion.…”

Section: Costs and Bene Tsmentioning

confidence: 99%

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Promoting The Integrated Community Case Management of Under-Five Pneumonia In Nigeria: A Cost-Benefit Analysis

Okafor

Ekwunife

2020

Preprint

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BackgroundWhile evidence-based recommendations for the management of under-five pneumonia at the community level were made by the World Health Organisation, the implementation remains poor in Nigeria. Initiatives to promote the integrated community case management (iCCM) of pneumonia through the proprietary and patent medicine vendors (PPMVs) have been poorly utilized possibly due to low financial support and perceived benefit. This study provides cost and benefit estimates and implications of promoting the iCCM through the PPMVs’ education and support. The outcome of this study will help inform healthcare decisions in Nigeria. MethodsThis study was a cost-benefit analysis using simulation-based decision-analytic Markov model. Two approaches were compared, the current scenario which is the use of amoxicillin dispersible tablet (DT) and amoxicillin DT plus promotion. Health outcomes include disability-adjusted life years averted (converted to monetary benefit) and severe pneumonia hospitalisation cost averted. Both the cost and benefit were expressed in 2018 US dollars. ResultsThe incremental benefit-cost ratio of promoting the iCCM was 1.37, while the total net-benefit was $3.31 (95% CI: $2.08 – 4.76) million from the whole country perspective, which will offset over three-quarter of the promotion cost. Implementing the promotion exercise at a cost above $6.82 million will not be a worthwhile decision. ConclusionPromoting the iCCM for the treatment of pneumonia in children under-five through education and support of the PPMVs holds promises to harness the benefits amoxicillin DT and provide a high return on investment. A nationwide promotion exercise should be considered especially in remote areas of the country.

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Section: Discussionmentioning

confidence: 99%

Section: Costs and Bene Tsmentioning

confidence: 99%

Promoting The Integrated Community Case Management of Under-Five Pneumonia In Nigeria: A Cost-Benefit Analysis

Okafor

Ekwunife

2020

Preprint

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“…Specifically, stepping down to the appropriate oral antibiotic when improvement is sustained is recommended in the guidelines for management of Community Acquired Pneumoniae (CAP) in Nigeria. [28] In addition, the review of choice, dose and route of administration of prescribed antibiotic at certain time points (48-72 hours) as recommended by the Centers for Disease Control and Prevention (CDC) and other reputable global authorities should be encouraged. [29,30] Antibiotic Time out [29] and Start SmartThen Focus [30] approach are examples of such initiatives prompting physicians to perform reviews with the aim of taking certain decisions including the possibility of adjusting the route of administration from IV to PO route.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a paediatric hospital in Nigeria

Egbuchulam

Anyika

Soremekun

2018

JHA

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Background: The burden of infectious diseases among Nigerian children is high. These children are often prescribed antibiotics during periods of hospitalisation. Unfortunately antibiotic resistance (ABR) threatens the availability and efficacy of antibiotics for use by vulnerable children and the future generations. Monitoring prescribing trends in our hospital as a means of identifying targets for improving prescribing is inevitable. Objective: The aim of the study was to evaluate antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a Paediatric hospital in Nigeria. Methods: A retrospective survey was carried out using case notes of previously hospitalised patients admitted between January and June 2016. Data from 150 case notes of patients admitted for suspected bacterial infections were collected using a predesigned data collection form. Patients' demographics, infection type, details of prescribed antibiotics, length of hospital stay and microbiological assessments were noted. Data were analysed using statistical package for social sciences (SPSS) version 22. Frequencies and percentages were calculated for categorical variables. Means and standard deviations were calculated for continuous (numerical) variables. Correlation was also employed in the analysis. Results: Of the 150 patients, 53.3% were males and 86% were children under 5 years of age. The mean duration of hospital stay was 7.59 (± 5.4) days. The most common infections were respiratory tract infection (32%) and sepsis (31.3%). The most common empirically prescribed antibiotics at the onset of admission were Gentamicin and a fixed dose combination of Ampicillin/Cloxacillin which were prescribed for 64.7% and 52.7% of the patients respectively. Cultures were ordered for only 7 (4.7%) of patients at the onset of hospitalisation. All antibiotics administered on admission were parenteral formulations and only 4% of the patients had their antibiotic switched to oral route on or before the third day of patients' admission. Another 71.3% were converted to oral formulations on the day of discharge from the hospital. A total of 87.3% were discharged on antibiotics and the most commonly prescribed antibiotic at discharge was Cefixime (37.2% of antibiotics prescribed as take home medication). Conclusions: Antibiotics were started empirically in all cases and cultures were ordered for few patients at the start of antibiotic therapy. Cultures should be more frequently ordered in the hospital to guide antibiotic prescribing for patients admitted for suspected bacterial infections. In addition, timely intravenous (IV) to oral (PO) antibiotic switch should be practised whenever appropriate. Educating physicians on the benefits of early switch from IV to PO formulations when appropriate is also recommended. Initiatives such as the "Antibiotic Time out" or Start Smart-then Focus approach will be appropriate in the hospital. Introduction of an empiric antibiotic policy in the hospital is highly recommended.

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“…We used data extracted from the case notes to classify diagnoses according to the presence of syndrome defining clinical signs, using standard WHO case definitions, ( S1 Table ) and generate disease specific QOC scores ( S2 Table ). The QOC scores evaluated assessment, diagnosis, treatment, and monitoring against WHO and Nigerian standard guidelines for each illness [ 27 , 33 ]. The content and weighting of each domain reflected the key steps in management: assessment of primary and secondary signs/symptoms; diagnostic classification; treatment with primary and supportive therapies; and monitoring of vital signs.…”

Section: Methodsmentioning

confidence: 99%

Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria

et al. 2021

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Objectives To evaluate the effect of improved hospital oxygen systems on quality of care (QOC) for children with severe pneumonia, severe malaria, and diarrhoea with severe dehydration. Design Stepped-wedge cluster randomised trial (unblinded), randomised at hospital-level. Setting 12 hospitals in south-west Nigeria. Participants 7,141 children (aged 28 days to 14 years) admitted with severe pneumonia, severe malaria or diarrhoea with severe dehydration between January 2014 and October 2017. Interventions Phase 1 (pulse oximetry) introduced pulse oximetry for all admitted children. Phase 2 (full oxygen system) (i) standardised oxygen equipment package, (ii) clinical education and support, (iii) technical training and support, and (iv) infrastructure and systems support. Outcome measures We used quantitative QOC scores evaluating assessment, diagnosis, treatment, and monitoring practices against World Health Organization and Nigerian standards. We evaluated mean differences in QOC scores between study periods (baseline, oximetry, full oxygen system), using mixed-effects linear regression. Results 7,141 eligible participants; 6,893 (96.5%) had adequate data for analysis. Mean paediatric QOC score (maximum 6) increased from 1.64 to 3.00 (adjusted mean difference 1.39; 95% CI 1.08–1.69, p<0.001) for severe pneumonia and 2.81 to 4.04 (aMD 1.53; 95% CI 1.23–1.83, p<0.001) for severe malaria, comparing the full intervention to baseline, but did not change for diarrhoea with severe dehydration (aMD -0.12; 95% CI -0.46–0.23, p = 0.501). After excluding practices directly related to pulse oximetry and oxygen, we found aMD 0.23 for severe pneumonia (95% CI -0.02–0.48, p = 0.072) and 0.65 for severe malaria (95% CI 0.41–0.89, p<0.001) comparing full intervention to baseline. Sub-analysis showed some improvements (and no deterioration) in care processes not directly related to oxygen or pulse oximetry. Conclusion Improvements in hospital oxygen systems were associated with higher QOC scores, attributable to better use of pulse oximetry and oxygen as well as broader improvements in clinical care, with no negative distortions in care practices. Trial registration ACTRN12617000341325

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Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN)

Cited by 20 publications

References 26 publications

Promoting The Integrated Community Case Management of Under-Five Pneumonia In Nigeria: A Cost-Benefit Analysis

Promoting The Integrated Community Case Management of Under-Five Pneumonia In Nigeria: A Cost-Benefit Analysis

Antibiotic prescribing practices for hospitalised children with suspected bacterial infections in a paediatric hospital in Nigeria

Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria

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