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Can We Predict Oral Antibiotic Treatment Failure in Children with Fast-Breathing Pneumonia Managed at the Community Level? A Prospective Cohort Study in Malawi.

King C, McCollum ED, Mankhambo L, Colbourn T, Beard J, Hay Burgess DC, Costello A, Izadnegahdar R, Izadnegahdar R, Lufesi N, Masache G, Mwansambo C, Nambiar B, Johnson E, Platt R, Mukanga D - PLoS ONE (2015)

Bottom Line: Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure.The model demonstrated poor calibration and discrimination (c-statistic: 0.56).Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

View Article: PubMed Central - PubMed

Affiliation: Institute for Global Health, University College London, London, United Kingdom.

ABSTRACT

Background: Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa.

Method: We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping.

Results: We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56).

Conclusion: This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

No MeSH data available.


Related in: MedlinePlus

Observed and predicted treatment failure.The dotted line plots the observed vs. predicted probability of treatment failure the solid line is a bias-corrected version (40 bootstrap repetitions). The rug plot along the top of the graph indicates the distribution of the predicted probabilities.
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pone.0136839.g004: Observed and predicted treatment failure.The dotted line plots the observed vs. predicted probability of treatment failure the solid line is a bias-corrected version (40 bootstrap repetitions). The rug plot along the top of the graph indicates the distribution of the predicted probabilities.

Mentions: Based on the internal (statistical) validation, we found some evidence of over-fitting the logistic model to the data because the slope-shrinkage statistic was 0.6. Fig 4 demonstrates the discrepancy between the apparent and bootstrap-corrected curves. For the sensitivity analysis of outlying CHW measurements, we found no CHWs with suspicious data.


Can We Predict Oral Antibiotic Treatment Failure in Children with Fast-Breathing Pneumonia Managed at the Community Level? A Prospective Cohort Study in Malawi.

King C, McCollum ED, Mankhambo L, Colbourn T, Beard J, Hay Burgess DC, Costello A, Izadnegahdar R, Izadnegahdar R, Lufesi N, Masache G, Mwansambo C, Nambiar B, Johnson E, Platt R, Mukanga D - PLoS ONE (2015)

Observed and predicted treatment failure.The dotted line plots the observed vs. predicted probability of treatment failure the solid line is a bias-corrected version (40 bootstrap repetitions). The rug plot along the top of the graph indicates the distribution of the predicted probabilities.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4551481&req=5

pone.0136839.g004: Observed and predicted treatment failure.The dotted line plots the observed vs. predicted probability of treatment failure the solid line is a bias-corrected version (40 bootstrap repetitions). The rug plot along the top of the graph indicates the distribution of the predicted probabilities.
Mentions: Based on the internal (statistical) validation, we found some evidence of over-fitting the logistic model to the data because the slope-shrinkage statistic was 0.6. Fig 4 demonstrates the discrepancy between the apparent and bootstrap-corrected curves. For the sensitivity analysis of outlying CHW measurements, we found no CHWs with suspicious data.

Bottom Line: Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure.The model demonstrated poor calibration and discrimination (c-statistic: 0.56).Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

View Article: PubMed Central - PubMed

Affiliation: Institute for Global Health, University College London, London, United Kingdom.

ABSTRACT

Background: Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa.

Method: We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping.

Results: We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56).

Conclusion: This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

No MeSH data available.


Related in: MedlinePlus