EVERY WOMEN EVERY CHILD UN COMMISSION ON LIFE-‐SAVING

3.4.2 Amoxicillin tablets for treatment of pneumonia in children Problem statement Childhood pneumonia, often of bacterial origin, can easily be fatal when occurring in rural areas without access to immediate diagnosis and treatment. Newly developed child-­‐friendly antibiotic treatment is now available in the form of amoxicillin dispersible tablets (tablets that easily dissolve in water, replacing bulky antibiotic syrup in glass bottles). Specific issues identified Provider issues: -­‐ Pneumonia diagnosis is subject to barriers stemming from (i) the limited availability of respiratory rate counters, (ii) a lack of training to effectively use respiratory rate counters, resulting in user error, and (iii) design deficiencies of respiratory rate counters. Amongst children treated for respiratory illness (including pneumonia), only 33% were assessed for fast breathing (96% of private providers did not ask if the child has difficult or rapid breathing). Misdiagnosis can be fatal; one study showed that approximately 37% of fatal pneumonia cases were misdiagnosed as malaria. -­‐ Inadequate private providers' knowledge and behavior: Private sector providers, who provide the majority of care for pneumonia in Uganda, have little incentive to perform differential diagnoses and often prescribe more expensive medicines, sometimes in partial doses. Public provider knowledge is also often poor. Formulation/ market shaping: There is a lack of availability of dispersible Amoxicillin in the private and public sectors. In the public sector, in the 45 districts covered by SURE, Amoxicillin caps was only available in 75% of HC2 and 78% of HC3 during the last quarter of 2012. For facilities that have been out of stock at least one day, the average stock out over the last 3 months lasted 25 days at HC2 and HC38. No data is available dispersible Amoxicillin specifically. Quality: Lack of an active coordination mechanism between the partners: A significant number of stakeholders have an interest in the pneumonia diagnosis and treatment: public, private for-­profit and private not-­‐for profit organizations. There is a risk of overlaps, inefficiencies and loss of opportunity if these efforts are not well harmonized and coordinated Evidence/ regulatory issues: Lack of a conducive regulatory framework for Amoxicillin: Amoxicillin is not the recommended 1st line treatment for pneumonia in the current clinical guidelines. Amoxicillin dosing in children does not tally with WHO recommendations. Despite the fact that Amoxicillin is included in the Essential Medicines List and as such included in the kit pushed to HC II and VHT, Amoxicillin is only recommended at HC II in EMHSLU 2012.