Correct diagnostic classification and treatment of pneumonia symptoms in under-five children, northwest Ethiopia: a cross-sectional study

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INTRODUCTION: Despite Ethiopia's adoption of the Integrated Management of Newborn and Childhood Illnesses (IMNCI) strategy, pneumonia continues to be the leading infectious cause of death among under-five children. Therefore, this study aimed to determine the proportion of under-five children who had received the accurate diagnostic classification and appropriate treatment for symptoms of pneumonia using the IMNCI guideline and to identify factors associated with guideline adherence. METHODS: A cross-sectional study was conducted between March and July 2023 among sick under-five children who visited health centres in the South Gondar zone, northwest Ethiopia. We employed two-stage random sampling. Observation of healthcare providers' clinical assessment, diagnosis and treatment; re-assessing children; interviewing caregivers and healthcare providers; and facility audit were applied to collect the data. Both descriptive and multilevel binary logistic regression analyses were done. RESULTS: Only 35.6% (95% CI: 33.2, 38.0) of sick children with pneumonia symptoms received the correct classification and treatment. Factors associated with accurate diagnostic classification and appropriate treatment included being a young infant (adjusted OR (AOR): 2.8, 95% CI: 1.4, 5.4), absence of fever (AOR: 1.5, 95% CI: 1.1, 2.0), longer consultation times (AOR: 1.4, 95% CI: 1.1, 1.9), receiving care from healthcare providers who referred to the chart booklet during diagnosis and treatment (AOR: 3.9, 95% CI: 2.8, 5.4), taking the IMNCI training (AOR: 2.4, 95% CI: 1.5, 3.7), lower patient caseloads (AOR: 1.7, 95% CI: 1.1, 2.6) and having regular review meetings on health services quality (AOR: 1.8, 95% CI: 1.3, 2.5). CONCLUSIONS: The proportion of correct classification and treatment of sick children with pneumonia symptoms was low, leading to poor treatment outcomes, irrational use of antibiotics and antimicrobial resistance. Almost all cluster-level associated factors are modifiable. Strengthening accountability, mentoring and implementing tailored strategies are crucial to enhancing healthcare providers' adherence to the IMNCI guidelines.