Treatment practices and outcomes of chest indrawing pneumonia in children aged 2–59 months in primary health facilities of Kamuli District, Eastern Uganda

Background: The World Health Organization revised its pneumonia guideline for managing children with chest indrawing and/or fast breathing, classifying them as 'pneumonia' and treating them with oral antibiotics at home; the Integrated Management of Childhood Illness (IMCI) protocol was revised accordingly. Evidence is needed on outcomes and treatment practices with the application of revised guidelines in programme settings. Methods: This prospective observational cohort study was conducted in seven selected health centres in Uganda from November 2022 to May 2023. The IMCI-trained health workers identified and enrolled children aged 2-59 months presenting with cough and/or difficult breathing and chest indrawing without any general danger signs. The primary outcome was vital status at day 15 after the initial assessment. Secondary outcomes were prevalence of and adherence to antibiotic use, and hospitalisation. Enrolled children were given age-appropriate treatment. Results: Of the 316 children who were enrolled, 68.4% (n/N = 216/316) were aged 12-59 months, and 93.7% (n/N = 296/316) had comorbidities, primarily malaria and diarrhoea. All were prescribed oral amoxicillin. Two children were lost to follow-up; thus, we followed 314 children on day 15. In children aged 2-11 months, 93.9% (n/N = 93/99) received a correct prescription compared to 20% (n/N = 43/215) among 12-59-month-olds. Adherence to five days of treatment was reported for 64.3% (n/N = 202/314) of children. According to the mothers' self report, no deaths were reported, 95.2% (n/N = 299/314) were cured; 2.2% (n/N = 7/314) were worse with six of seven hospitalised, and 2.5% (n/N = 8/314) were the same as the condition at time of enrolment. Most children were well-nourished; 3.8% had a weight-for-height (WHZ) z-score