{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T07:54:51Z","timestamp":1793346891095,"version":"4.5.0"},"reference-count":20,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-008068"],"award-info":[{"award-number":["INV-008068"]}],"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":[[2025,7,28]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pneumonia remains a leading cause of under-5 mortality in sub-Saharan Africa, accounting for approximately 14% of deaths in this age group. In Malawi, pneumonia accounts for 12% of under-5 deaths, with recent data revealing a concerning trend of over 110\u2009000 new cases reported in 6\u2009months. The Malawi government has made significant strides in reducing childhood mortality through the Integrated Community Case Management (iCCM) strategy, resulting in an 11% reduction in under-5 mortality over a 5-year period. However, the current iCCM strategy does not include the management of chest indrawing pneumonia in children aged 2\u201359 months and fast-breathing pneumonia in infants aged up to 2 months. This implementation research aims to increase pneumonia treatment coverage for under-5\u2009year-old children in Kasungu District, Malawi, by expanding the community-based management of pneumonia by the iCCM-trained Health Surveillance Assistants (HSAs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The current implementation research using both qualitative and quantitative data collection methods will assess the feasibility and acceptability of iCCM-trained HSAs managing chest indrawing pneumonia and fast-breathing pneumonia in children under 5 with oral amoxicillin at the community level in district Kasungu using the existing district health system. The study will employ a district health system model, leveraging existing trained iCCM HSAs to enrol and manage infants aged 7\u201359\u2009days with fast-breathing pneumonia and 2\u201359-month-old children with chest indrawing pneumonia in the community with 7-day and 5-day oral amoxicillin, respectively. HSAs will also use pulse oximetry to identify hypoxaemic children for prompt referral to a hospital for further care. Sociodemographic features of enrolled children will be documented. Enrolled children will be followed up on treatment compliance using follow-up forms. The pneumonia treatment coverage will be assessed using baseline, midline and end-line surveys using both qualitative and quantitative data collection methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was obtained from the National Health Research Sciences Committee and the WHO Ethics Committee. The implementation research findings will be disseminated to national-level stakeholders and specifically targeted at District Health Offices, which are responsible for implementing the interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101346","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:25:26Z","timestamp":1765369526000},"page":"e101346","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Increasing the pneumonia treatment coverage among children under 5 years old through \u2018Enhanced Management of Pneumonia in the Community\u2019: implementation research protocol"],"prefix":"10.1136","volume":"15","author":[{"given":"Humphreys","family":"Nsona","sequence":"first","affiliation":[{"name":"IMCI Unit, Government of Malawi Ministry of Health, Lilongwe, Central Region, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Golombe","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulemu","family":"Zulu","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy","family":"Magombo","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haxson","family":"Twaibu","sequence":"additional","affiliation":[{"name":"IMCI Unit, Government of Malawi Ministry of Health, Lilongwe, Central Region, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prosper","family":"Mbemba","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chigomezgo","family":"Msowoya","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esau","family":"Chagoma","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aljanat","family":"Sadala","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Dedza","sequence":"additional","affiliation":[{"name":"IMCI Unit, Government of Malawi Ministry of Health, Lilongwe, Central Region, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anusa","family":"Mangwilisa","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf","family":"Banda","sequence":"additional","affiliation":[{"name":"Kasungu District Hospital, Kasungu, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyson","family":"Chizani","sequence":"additional","affiliation":[{"name":"H and K Data Management Centre, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whyte","family":"Mpezeni","sequence":"additional","affiliation":[{"name":"Kamuzu Central Hospital, Lilongwe, Central Region, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim Ahmad","family":"Qazi","sequence":"additional","affiliation":[{"name":"Independent Consultant Paediatrician, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9720-5699","authenticated-orcid":false,"given":"Yasir Bin","family":"Nisar","sequence":"additional","affiliation":[{"name":"Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"2026010703462758000_15.12.e101346.1","unstructured":"United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) . 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