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Adherence to amoxicillin among children with non-severe pneumonia treated by community health workers

Pneumonia is an important cause of under-five mortality in northern Uganda, a rural region that has an insufficient health workforce and has been affected by conflict with the Lord’s Resistance Army in recent years. In this context, community health workers (CHWs) have the potential to be a valuable resource for the provision of accessible treatment of pneumonia for children 2 to 59 months of age.

This study aimed to evaluate the rate of adherence to amoxicillin and thereby provide insight into the effectiveness of CHWs in this setting. A secondary aim of the study was to assess for any difference in adherence rates on days 3 and 5 of treatment with amoxicillin. This was a prospective, exhaustive study of 2 to 59 month old children treated for non-severe pneumonia in five sub-counties of Kitgum and Lamwo districts. 97 children and their caregivers were interviewed and adherence was measured through self-report and blister pack review. Interviews were conducted with 62 CHWs to assess their ability to classify and manage pneumonia.

The adherence rate was 70.5%, and no significant difference was seen between days 3 and 5 of treatment. The age of the child (2-11 months), perceived ease of administration of the medication, and marital status of the caregivers were significantly associated with adherence. 87.9% of CHWs correctly counted respiratory rates. Few studies of antibiotic adherence within integrated integrated community case management (iCCM) programs exist.

The CHWs in this study have the knowledge and competence to identify and manage non-severe pneumonia, and adherence rates were comparable to those found in studies of adherence to artemisinin-based combination therapies in stable low-income countries. More studies are needed that evaluate rates of adherence to antibiotics in populations served by iCCM.