Development and implementation of a national programme for the management of severe and very severe pneumonia in children in Malawi
Date
2009-11
Authors
Enarson, Penelope Marjorie
Gie, Robert
Enarson, Donald A.
Mwansambo, Charles
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science -- PLOS
Abstract
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 [1] 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 [2].
However, even proven intervention strategies cannot function without an effective ‘‘delivery strategy’’ [3]. 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 [3].
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.
Description
The original publication is available at http://www.plosmedicine.org
Keywords
Integrated Management of Childhood Illness, Severe and very severe pneumonia in children, Standard case management (SCM)
Citation
Enarson, P.M., Gie, R., Enarson, D.A. & Mwansambo, C. 2009. Development and Implementation of a National Programme for the Management of Severe and Very Severe Pneumonia in Children in Malawi. PLoS Medicine, 6 (11): e1000137. doi:10.1371/journal.pmed.1000137