title: A clinical guidance tool to improve the care of children hospitalized with severe pneumonia in Lusaka, Zambia.
abstract: Pneumonia is the leading infectious cause of death among children, with approximately half of deaths attributable to pneumonia occurring in limited health resource settings of sub-Saharan Africa. Clinical guidance tools and checklists have been used to improve health outcomes and standardize care. This study was conducted to evaluate the impact of a clinical guidance tool designed to improve outcomes for children hospitalized with severe pneumonia in Zambia.
  
  
  
  This study was conducted at University Teaching Hospital in Lusaka, Zambia from October 10, 2011 to March 21, 2014 among children 1 month to 5 years of age with severe pneumonia. In March 2013, a clinical guidance tool was implemented to standardize and improve care. In-hospital mortality pre-and post-implementation was compared.
  
  
  
  Four hundred forty-three children were enrolled in the pre-intervention period and 250 in the post-intervention period. Overall, 18.2 % of children died during hospitalization, with 44 % of deaths occurring within the first 24 h after admission. Mortality was associated with HIV infection status, pneumonia severity, and weight-for-height z-score. Despite improving and standardizing the care received, the clinical guidance tool did not significantly reduce mortality (relative risk: 0.89; 95 % CI: 0.65, 1.23). The tool appeared to be more effective among HIV-exposed but uninfected children and children younger than 6 months of age.
  
  
  
  Simple tools are needed to ensure that children hospitalized with pneumonia receive the best possible care in accordance with recommended guidelines. The clinical guidance tool was well-accepted and easy to use and succeeded in standardizing and improving care. Further research is needed to determine if similar interventions can improve treatment outcomes and should be implemented on a larger scale.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA. csutcli1@jhu.edu.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Sutcliffe
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston University, Boston, MA, USA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.affiliation: Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Seidenberg
authors.affiliation: Department of Paediatrics, University of Zambia, School of Medicine, Lusaka, Zambia.
authors.forename: James
authors.initials: J
authors.lastname: Chipeta
authors.affiliation: Zambia Center for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mwananyanda
authors.affiliation: Department of Paediatrics, University of Zambia, School of Medicine, Lusaka, Zambia.
authors.forename: Somwe Wa
authors.initials: SW
authors.lastname: Somwe
authors.affiliation: University of Missouri School of Medicine, Columbia Missouri, MO, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Duncan
authors.affiliation: Zambia Center for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Magdalene
authors.initials: M
authors.lastname: Mwale
authors.affiliation: Department of Paediatrics, University of Zambia, School of Medicine, Lusaka, Zambia.
authors.forename: Justin
authors.initials: J
authors.lastname: Mulindwa
authors.affiliation: Department of Paediatrics, University of Zambia, School of Medicine, Lusaka, Zambia.
authors.forename: Musaku
authors.initials: M
authors.lastname: Mwenechenya
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, WA, USA.
authors.forename: Rasa
authors.initials: R
authors.lastname: Izadnegahdar
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
mesh_terms: D057189:Checklist / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000150:complications; D017052:Hospital Mortality; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D015024:Zambia
keywords: Global health; HIV; Pneumonia; Sub-Saharan Africa