title: The community case management of pneumonia in Africa: a review of the evidence.
abstract: Pneumonia causes around 750 000 child deaths per year in sub-Saharan African (SSA) countries. The lack of accessibility to prompt and effective treatment is an important contributor to this burden. Community case management of pneumonia (CCMp) uses trained community health workers (CHWs) to administer antibiotics to suspected child pneumonia cases in villages. This strategy has been gaining momentum in low- and middle-income countries, and the World Health Organization and United Nations children's fund have recently encouraged countries to broaden community case management to other diseases. Recommendations in favour CCMp are based on three meta-analyses showing its efficacy to reduce childhood mortality and morbidity attributable to pneumonia although most of the studies in the meta-analyses were conducted in Asian countries. This is problematic as community case management strategies have been implemented in very different ways in Asian and SSA countries, partly due to differences in malaria prevalence. Therefore, we conducted a narrative synthesis to systematically review the evidence on CCMp in SSA. Results show that there is a lack of evidence concerning its efficacy and effectiveness in SSA, irrespective of whether case management is integrated with other diseases or not. CHWs encounter difficulties in counting the respiratory rate. Their adherence to the guidelines is poorer when they are required to manage several illnesses or children with severe signs. CCMp thus encompasses issues of over-treatment and missed treatment, with potentially negative consequences such as increased lethality in severe cases and antibiotics resistance. The current lack of evidence concerning its efficacy, effectiveness and the factors leading to successful implementation, coupled with CHWs' poor adherence, demand a thorough examination of the legitimacy of implementing CCMp in SSA countries.
authors.affiliation: Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France thomas.druetz@umontreal.ca.
authors.forename: Thomas
authors.initials: T
authors.lastname: Druetz
authors.affiliation: Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France.
authors.forename: Kendra
authors.initials: K
authors.lastname: Siekmans
authors.affiliation: Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Goossens
authors.affiliation: Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France.
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.affiliation: Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France.
authors.forename: Slim
authors.initials: S
authors.lastname: Haddad
mesh_terms: D017954:Africa South of the Sahara; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D003150:Community Health Workers / Q000458:organization & administration; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000628:therapy*; D015397:Program Evaluation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Case management; acute respiratory infections; community health; systematic reviews