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Randomized Controlled Trial
. 2012 Nov;87(5 Suppl):11-20.
doi: 10.4269/ajtmh.2012.12-0078.

Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality: a cluster-randomized controlled trial in Ghana

Margaret A Chinbuah, Piet A Kager, Mercy Abbey, Margaret Gyapong, Elizabeth Awini, Justice Nonvignon, Martin Adjuik, Moses Aikins, Franco Pagnoni, John O Gyapong
Randomized Controlled Trial

Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality: a cluster-randomized controlled trial in Ghana

Margaret A Chinbuah et al. Am J Trop Med Hyg. 2012 Nov.

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.

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Conflict of interest statement

Disclosure: TDR/UNDP Trial registration. A: 20189: The trial protocol can be accessed from the WHO (Ethics Committee).

Figures

Figure 1.
Figure 1.
Overall timeline of the trial with a stepped wedge introduction of the interventions.
Figure 2.
Figure 2.
Cluster and participant flow after first randomization.
Figure 3.
Figure 3.
Cluster and participant flow after second randomization.
See this image and copyright information in PMC

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