{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:15:48Z","timestamp":1792512948762,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1139557"],"award-info":[{"award-number":["OPP1139557"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,13]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To determine the aetiology of community acquired pneumonia in children presenting to primary care in Northern Malawi, and to ascertain predictors for identification of children requiring hospitalisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>The BIOmarkers TO diagnose PnEumonia study was a prospective cohort study conducted from March to June 2016.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Primary care in Northern Malawi.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>494 children aged 2 \u201359 months with WHO defined pneumonia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome(s) and measure(s)<\/jats:title>\n                  <jats:p>Number of children with bacterial infection identified and the sensitivity\/specificity of WHO markers of severity for need for hospitalisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>13 (2.6%) children had a bacterium consistent with pneumonia identified. A virus consistent with pneumonia was identified in in 448 (90.7%) of children. 56 children were admitted to hospital and two children died within 30 days. 442 (89.5%) received antibiotic therapy. Eleven children (2.6%) had HIV. WHO severity markers at baseline demonstrated poor sensitivity for the need for hospitalisation with a sensitivity of 0.303 (95% CI 0.188 to 0.441) and a specificity 0.9 (95% CI 0.868 to 0.926). A prediction rule to indicate the need for hospitalisation was developed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions and relevance<\/jats:title>\n                  <jats:p>The low rate of bacterial infection and high use of antibiotics in the setting of high immunisation rates highlights the changing profile of childhood pneumonia. Similarly, the markers of need for hospitalisation may have changed in the setting of extended immunisation. Further studies are required to examine this.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-046633","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T14:05:45Z","timestamp":1627567545000},"page":"e046633","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Aetiology and severity of childhood pneumonia in primary care in Malawi: a cohort study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5564-2890","authenticated-orcid":false,"given":"Joe","family":"Gallagher","sequence":"first","affiliation":[{"name":"gHealth Research Group, University College Dublin College of Health Sciences, Dublin, Ireland"},{"name":"School of Medicine, University of Limerick, Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8301-6184","authenticated-orcid":false,"given":"Master","family":"Chisale","sequence":"additional","affiliation":[{"name":"Biological Science Department, Faculty of Science Technology and Innovations, Mzuzu University, Mzuzu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudipto","family":"Das","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J","family":"Drew","sequence":"additional","affiliation":[{"name":"Irish Meningitis and Sepsis Reference Laboratory, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadezhda","family":"Glezeva","sequence":"additional","affiliation":[{"name":"gHealth Research Group, University College Dublin College of Health Sciences, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6281-5713","authenticated-orcid":false,"given":"Dermot Michael","family":"Wildes","sequence":"additional","affiliation":[{"name":"gHealth Research Group, University College Dublin College of Health Sciences, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cillian","family":"De Gascun","sequence":"additional","affiliation":[{"name":"National Virus Reference Laboratory, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6155-9340","authenticated-orcid":false,"given":"Tsung-Shu Joseph","family":"Wu","sequence":"additional","affiliation":[{"name":"Luke International Norway, Mzuzu, Malawi"},{"name":"Overseas Mission Department, Pingtung Christian Hospital, Pingtung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T","family":"Ledwidge","sequence":"additional","affiliation":[{"name":"gHealth Research Group, University College Dublin College of Health Sciences, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Watson","sequence":"additional","affiliation":[{"name":"Queen\u2019s University Belfast Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"key":"2025101811245568000_11.7.e046633.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61698-6"},{"key":"2025101811245568000_11.7.e046633.2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku356"},{"key":"2025101811245568000_11.7.e046633.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmm.2013.02.001"},{"key":"2025101811245568000_11.7.e046633.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(15)00002-X"},{"key":"2025101811245568000_11.7.e046633.5","unstructured":"Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries. Geneva: World Health Organization, 2014. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK264162\/"},{"key":"2025101811245568000_11.7.e046633.6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir1071"},{"key":"2025101811245568000_11.7.e046633.7","doi-asserted-by":"publisher","DOI":"10.2471\/blt.16.173401"},{"key":"2025101811245568000_11.7.e046633.8","unstructured":"Organisation WH . Who and UNICEF estimates of national immunization coverage, 2020. 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Placebo vs amoxicillin for nonsevere Fast-Breathing pneumonia in Malawian children aged 2 to 59 months: a double-blind, randomized clinical Noninferiority trial. 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