TY - JOUR
T1 - Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality
T2 - A cluster-randomized controlled trial in Ghana
AU - Chinbuah, Margaret A.
AU - Kager, Piet A.
AU - Abbey, Mercy
AU - Gyapong, Margaret
AU - Awini, Elizabeth
AU - Nonvignon, Justice
AU - Adjuik, Martin
AU - Aikins, Moses
AU - Pagnoni, Franco
AU - Gyapong, John O.
PY - 2012/11
Y1 - 2012/11
N2 - Malaria and pneumonia are leading causes of childhood mortality. Home Management of fever as Malaria (HMM) enables presumptive treatment with antimalarial drugs but excludes pneumonia.We aimed to evaluate the impact of adding an antibiotic, amoxicillin (AMX) to an antimalarial, artesunate amodiaquine (AAQ+AMX) for treating fever among children 2-59 months of age within the HMM strategy on all-cause mortality. In a stepped-wedge clusterrandomized, open trial, children 2-59 months of age with fever treated with AAQ or AAQ+AMX within HMM were compared with standard care. Mortality reduced significantly by 30% (rate ratio [RR] = 0.70, 95% confidence interval [CI] = 0.53-0.92, P = 0.011) in AAQ clusters and by 44% (RR = 0.56, 95% CI = 0.41-0.76, P = 0.011) in AAQ+AMX clusters compared with control clusters. The 21% mortality reduction between AAQ and AAQ+AMX (RR = 0.79, 95% CI = 0.56-1.12, P = 0.195) was however not statistically significant. Community fever management with antimalarials significantly reduces under-five mortality. Given the lower mortality trend, adding an antibiotic is more beneficial.
AB - Malaria and pneumonia are leading causes of childhood mortality. Home Management of fever as Malaria (HMM) enables presumptive treatment with antimalarial drugs but excludes pneumonia.We aimed to evaluate the impact of adding an antibiotic, amoxicillin (AMX) to an antimalarial, artesunate amodiaquine (AAQ+AMX) for treating fever among children 2-59 months of age within the HMM strategy on all-cause mortality. In a stepped-wedge clusterrandomized, open trial, children 2-59 months of age with fever treated with AAQ or AAQ+AMX within HMM were compared with standard care. Mortality reduced significantly by 30% (rate ratio [RR] = 0.70, 95% confidence interval [CI] = 0.53-0.92, P = 0.011) in AAQ clusters and by 44% (RR = 0.56, 95% CI = 0.41-0.76, P = 0.011) in AAQ+AMX clusters compared with control clusters. The 21% mortality reduction between AAQ and AAQ+AMX (RR = 0.79, 95% CI = 0.56-1.12, P = 0.195) was however not statistically significant. Community fever management with antimalarials significantly reduces under-five mortality. Given the lower mortality trend, adding an antibiotic is more beneficial.
UR - http://www.scopus.com/inward/record.url?scp=84875501765&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.2012.12-0078
DO - 10.4269/ajtmh.2012.12-0078
M3 - Article
C2 - 23136273
AN - SCOPUS:84875501765
SN - 0002-9637
VL - 87
SP - 11
EP - 20
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - SUPPL.5
ER -