Uptake of the New National Outpatient Pneumonia Guidelines for the Management of Children Aged 2 to 59 Months at the Kenyatta National Hospital, Outpatient Department.

Abstract

Background Pneumonia is the second highest infectious cause of death among children aged below five years accounting for 15% deaths annually. Case management is the corner stone of pneumonia control strategies. It consists of assessing and classifying severity of illness using simple clinical signs and symptoms then treating appropriately(2). In 2014, the World Health Organization revised the original IMCI guidelines prompted by new evidence, to re-classify childhood pneumonia from the former four severity categories to the current three severity categories. In addition, use of oral high dose amoxicillin was recommended to manage non-severe pneumonia(3). The MoH updated the National Integrated Management of Newborn and Childhood Illnesses pneumonia guidelines and introduced oral high-dose amoxicillin for outpatient management of pneumonia in 2018 following a local study (1). Primary Objective: To determine the proportion of patients that presented with cough and or difficulty in breathing who received documented complete assessment, documented correct classification and given the appropriate treatment consistent with the current IMNCI national guidelines. The Secondary Objective: To determine factors associated with poor uptake of the new national pneumonia case management guidelines. Methodology This was a quantitative hospital based Cross sectional survey conducted on patients aged between 2 to 59 months with cough and or difficulty in breathing presenting in the Paediatrics Emergency Unit of Kenyatta National Hospital, between 1st of February and 10th of April 2022. Adherence to guidelines was assessed based on performance and documentation of three main areas of care; assessment to allow for correct classification and treatment prescribed in tandem with the new Kenyan pneumonia guidelines. Results We reviewed records of 377 eligible patients visiting the outpatient department during the study period. The median age was 20 months IQR (8-36) and a male to female ratio of 1.33:1. The overall guideline adherence during assessment was less than 1%, documented correct classification 48.0% and none of the patients correctly classified as pneumonia got the guideline recommended high dose of dispersible amoxicillin tablets. Ninety six percent of the patients correctly classified as no pneumonia received an antibiotic. Age greater than one year was significantly associated with non-adherence to correct classification OR 1.29 95% CI (1.03-2.19), p=0.03. Conclusion Overall guidelines adherence was low at all levels. None of the patients diagnosed as non-severe pneumonia received the MoH IMNCI guideline recommended high dose amoxicillin dispersible tablets.