# Outcomes of children aged 2–59 months with chest indrawing pneumonia managed on an outpatient basis in selected primary health facilities in Zambia

## TL;DR

This study shows that treating young children with chest indrawing pneumonia as outpatients in Zambia using oral amoxicillin is effective and safe, with high cure rates and no deaths.

## Contribution

The study provides evidence that outpatient management of chest indrawing pneumonia using IMCI protocols is feasible and effective in Zambian primary health facilities.

## Key findings

- All 314 followed children survived, with 77.1% cured and 22.9% clinically better by day 15.
- Oral amoxicillin had an 82.2% cure rate, significantly higher than cotrimoxazole and erythromycin.
- Girls and fully vaccinated children had higher cure rates compared to boys and partially/unvaccinated children.

## Abstract

Zambia has a high burden of child pneumonia, with approximately 6000 children under five dying annually from this condition. We aimed to gather evidence about the outcomes two weeks after enrolment for children 2–59 months with chest indrawing pneumonia who were managed in primary health care facilities in Zambia.

This was a prospective cohort study conducted between October 2022 and April 2024 in eight primary health care facilities from Lusaka, Chibombo, and Chongwe districts. Children aged 2–59 months with cough and/or breathing difficulty and lower chest indrawing were enrolled, treated on an outpatient basis according to the Integrated Management of Childhood Illness (IMCI) protocol, and followed up on day 15 after enrolment.

We enrolled 335 children in the study (median age of 17 months, 56.4% female). Among them, 63% were aged 12–59 months, 23.6% had a height-for-age z-score of<−3.0, and 10.5% had a weight-for-age z-score of<−3.0. By day 15, 314 children had follow-up data, all of whom survived. Of these, 77.1% were cured, 22.9% were reported as being ‘clinically better’, and none failed therapy. Most children were treated with oral amoxicillin (84.1%), with a cure rate of 82.2%. Children treated with cotrimoxazole (60% cure rate) and erythromycin (26.7% cure rate) had lower success rates. A higher proportion of girls (81.4%) were cured compared to boys (71.5%), and children who were fully vaccinated (79.6%) had a higher cure rate than those who were partially or not vaccinated (48.0%). Children of educated parents had higher cure rates than those of uneducated parents.

Children with chest indrawing pneumonia were successfully treated with oral amoxicillin in an outpatient setting, improving access to treatment and reducing costs for both health care systems and families. This approach also helps reduce the risk of healthcare-associated infections. It is essential that health care providers in primary health facilities are trained to use IMCI protocols when managing children under five.