Get home safe synonym9/27/2023 ![]() ![]() While this change was carried through in revised primary care and hospital guidelines, the community case management guidelines (iCCM) for community health workers (CHWs) still recommend that CHWs refer children with chest-indrawing pneumonia to a hospital. The 2013 revision described “pneumonia” and “severe pneumonia” classifications and included children with chest indrawing and no other danger signs (chest-indrawing pneumonia) in the pneumonia group that could be safely managed outside of a hospital. Pneumonia with chest indrawing in children aged 2-59 months was considered at least “severe” with parenteral antibiotics being recommended. The previous WHO pneumonia classification separated pneumonia into non-severe, severe, and very severe categories. The guidelines for pneumonia were updated in 2013 and changes in severity classification and treatment recommendations for children 2-59 months of age were made. World Health Organization (WHO) clinical guidelines for children are intended to provide evidence-based guidance to health workers in diverse clinical settings, with a focus on low-resource and smaller health facilities. Additional safeguards include caregiver understanding and ability to return for review. Pulse oximetry is a critical risk-assessment tool that is currently not widely available and can identify severely ill patients with hypoxaemia otherwise possibly missed by clinical assessment alone. Risk assessment includes clinical danger signs, oxygen saturation, and the presence of comorbidities such as undernutrition, anaemia, or HIV. Evidence from trials (n = 3) and observational (n = 6) studies in these and other countries confirms the acceptability and feasibility of home management of chest-indrawing pneumonia in low-risk cases, so long as safeguards are in place. Two community-based and two hospital-based trials in Pakistan and India found that home treatment of chest-indrawing pneumonia was associated with similar or superior treatment outcomes to hospital admission. We included 14 studies, including seven randomised trials, from a variety of urban and rural contexts in 11 countries.
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