Table 1.
Outcome case definitions used for the survey
| Outcome | Definition |
|---|---|
| Diagnosis | |
| Pneumonia | Cough or difficult breathing along with fast breathing, according to the survey team–measured respiratory rate, in children 2–59 months of age without general danger signs*. |
| Severe pneumonia | Cough or difficult breathing in a child who also had any general danger signs*, chest indrawing, or stridor. Presence of indrawing or stridor was assessed by the survey team. Children < 2 months of age were not included in the pneumonia definitions, which only pertain to children 2–59 months of age in IMCI. |
| Uncomplicated diarrhea | Acute diarrhea with some or no dehydration per local IMCI guidelines in children < 5 years of age without danger signs.*† Presence of dehydration was assessed by the survey team. |
| Severe diarrhea | Acute diarrhea with danger signs*† or severe dehydration per local IMCI guidelines in children < 5 years of age. Presence of severe dehydration was assessed by the survey team. |
| Recommended treatment | |
| Pneumonia | HCW followed local IMCI guidance to administer, dispense, or prescribe: cotrimoxazole,‡ amoxicillin, or erythromycin for children with pneumonia, regardless of dose. |
| Uncomplicated diarrhea | HCW administered, dispensed, or prescribed ORS and zinc for children 2–59 months of age with diarrhea; and ORS only for children with uncomplicated diarrhea < 2 months of age, regardless of dose. |
HCW = health-care worker; IMCI = integrated management of childhood illness; ORS = oral rehydration salts.
Unable to drink or breastfeed, vomiting everything, lethargic or unconscious, or history of convulsions in children 2–59 months of age.
For children < 2 months of age: not feeding well, convulsions, fast breathing (≥ 60 breaths per minute), severe chest indrawing, grunting, fever (≥ 37.5°C), low body temperature (< 35.5°C), or movement only when stimulated or no movement at all.
Cotrimoxazole is no longer recommended in the latest local IMCI material issued in 2013, but as Malawi had limited training on the latest IMCI, cotrimoxazole was considered as one of the recommended antibiotic selections for pneumonia.