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. 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 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.

The Airbel Impact Lab at IRC is a team of researchers, strategists and innovators committed to the accelerated design, rigorous evaluation and cost-effective scaling of the most impactful solutions supporting people affected by crisis.