Understanding the current childhood pneumonia management practices in Nepal

Funders :
World Health Organization

Investigators:
Prof.Dr Sudha Basnet (PI)
Dr Suchita Shrestha (CO-PI)
Dr Sajal Twanabasu
Saraswati Budhathoki(CO-PI)
Amritraj Pokhrel (Site Coordinator)
Seema K. Chaudhary (Site Coordinator))
Sushmita Shrestha (Research Monitor)
Divesh Shrestha (Data Management Officer)

Pneumonia remains a leading cause of morbidity and mortality in children aged 1-59 months. In Nepal, pneumonia cases among children under five increased from 45 per 1,000 in 2020/2021 to 55.1 per 1,000 in 2021/2022, with 13.3% of acute respiratory infection (ARI) cases classified as pneumonia. The WHO revised its childhood pneumonia classification in 2012, simplifying it into two categories: “pneumonia”, managed with oral amoxicillin on an outpatient basis, and “severe pneumonia”, requiring hospital referral and injectable antibiotics. Following this revision, many countries, including Nepal, adopted the guideline, while others continued to recommend hospitalization for chest indrawing pneumonia. Despite this shift, concerns persist regarding the outpatient management of chest indrawing pneumonia. Studies, including a retrospective analysis in Kenya, suggest that children with additional risk factors—such as malnutrition or mild to moderate anemia—may face increased mortality, raising questions about treatment adequacy. In response, WHO convened an expert panel in 2018 to evaluate these concerns, identifying key areas requiring further research, including the potential need to reconsider chest indrawing as a referral criteria on pneumonia management.

Primary objective

To evaluate the outcome (survival status) of 2-59 months old children with chest indrawing pneumonia by day 15 who present at the primary health care facility in a programme setting.

Secondary objective

  • To examine the management (including oral treatment, which one, for how many days, or hospitalisation, with injectable antibiotics, how many days, and treatment adherence) of children 2-59 months of age with chest indrawing pneumonia presenting at the primary health care facility in a programme setting

Study Participants

Children aged 2-59 months with chest indrawing pneumonia.

This is a prospective observational cohort study which is being e conducted in Dhading district, Nepal. Dhading is one of the 75 districts of Nepal that lies in Bagmati province and covers an area of 1926 square kms. According to the National Population and Housing Census 2021, the population of Dhading was 3,25,710 out of which 24,023 were children from newborn to under 5-year age group. There are 2 municipalities and 11 rural municipals in Dhading district; and a total of 124 public health facilities which include 5 hospitals, 2 Primary Health Care Centres (PHCCs), 49 Health Posts (HPs), two Urban Health Centre (UHC)s, 21 Community Health Centres (CHCs), 40 basic health service centre and five additional health facilities.

Trial Sites: Dhading (Nepal)

  1. Baireni Health post
  2. Mahadevbesi Health post
  3. Jogimara Health Post
  4. Gajuri Primary Health Care Centre
  5. Benighat Health Post
  6. Mahadevisthan Health post
  7. Naubise Health Post
  8. Sunaulobazar Health post
  9. Khalte Health post
  10. Salyantar Primary Health Care Centre
  11. Maidi Health Post
  12. Salang Health Post

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