title: Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality: a cluster-randomized controlled trial in Ghana.
abstract: 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 cluster-randomized, 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.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Chinbuah
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Mercy
authors.initials: M
authors.lastname: Abbey
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Awini
authors.forename: Justice
authors.initials: J
authors.lastname: Nonvignon
authors.forename: Martin
authors.initials: M
authors.lastname: Adjuik
authors.forename: Moses
authors.initials: M
authors.lastname: Aikins
authors.forename: Franco
authors.initials: F
authors.lastname: Pagnoni
authors.forename: John O
authors.initials: JO
authors.lastname: Gyapong
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D019090:Case Management; D046688:Child Mortality; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D019468:Disease Management; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000401:mortality*; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; D000658:Amoxicillin