Development and implementation of a national programme for the management of severe and very severe pneumonia in children in Malawi
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The reduction of child mortality by two-thirds from its 1990 level by 2015—the fourth United Nations Millennium Development Goal—is a major challenge. Pneumonia accounts for much (≥20%) of this mortality in poor countries, but standard case management (SCM) of pneumonia  has the potential to reduce overall child mortality. A recent meta-analysis estimated that SCM of pneumonia could reduce overall mortality in neonates, infants under 1 y old, and children aged 0–4 y, respectively, by 27%, 20%, and 24%, and pneumonia-specific mortality by 42%, 36%, and 36% in the same age groups . However, even proven intervention strategies cannot function without an effective ‘‘delivery strategy’’ . For, example, although the World Health Organization (WHO)/United Nations Children’s Fund has developed an Integrated Management of Childhood Illness (IMCI) strategy to reduce child mortality, of the 100+ low- and middle-income countries that introduced IMCI in the 1990s, only 48% had scaled up coverage by the end of 2002. Weak health systems were the main cause of this failure with the poorest countries doing worst . We describe here the development and scaling-up of a country-wide delivery strategy of SCM for pneumonia in children in Malawi, a country where more than 200 children per thousand die before they are 5 y old.