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Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

Original publication

DOI

10.2471/blt.07.048512

Type

Journal article

Journal

Bull World Health Organ

Publication Date

05/2008

Volume

86

Pages

349 - 355

Keywords

AIDS-Related Opportunistic Infections, Anti-Bacterial Agents, Case Management, Child, Child Nutrition Disorders, Child, Preschool, Comorbidity, Global Health, Health Care Rationing, Health Facilities, Health Facility Administration, Humans, Hypoxia, Infant, Infant, Newborn, Oxygen Inhalation Therapy, Pneumonia, Treatment Outcome, Vitamin A, Vitamins