Attachments
Executive summary
Pneumonia and diarrhoea account for 23% of under-five mortality and were responsible for an estimated 1.17 million deaths in children under five globally. Furthermore, pneumonia and diarrhoea were responsible for 18% of mortality in children 5–9 years of age, resulting in an estimated 86 000 preventable deaths globally in 2021. Existing World Health Organization (WHO) guidance on the clinical management of pneumonia and diarrhoea has mainly focused on children less than 5 years of age. WHO had not developed clinical guidance on the management of these conditions in children 5–9 years of age, which is a gap being addressed in response to calls from national policy- and decision-makers.
Given this situation, as well as the changing epidemiologic and demographic profiles of countries, the enhanced clinical understanding of prevention and management of pneumonia and diarrhoea, and the introduction of new interventions, a state-of-the-art review of existing guidance had been overdue.
The goal of the guideline is to develop, update and consolidate recommendations on the management of pneumonia and diarrhoea in order to inform, revise or update the development of clinical protocols for the management of pneumonia and diarrhoea in children up to 10 years of age.
This guideline aims to help WHO Member States and their partners make evidence-informed decisions on the appropriate actions in their efforts to address common childhood illnesses, including pneumonia and diarrhoea.
The process of updating the existing guidance began in 2020 and was followed by the appointment of a Guideline Development Group (GDG), consultations, development of key questions in Population, Intervention, Comparator and Outcome (PICO) format, and the production of systematic reviews to answer those questions. All steps have followed those laid out in the WHO Handbook for guideline development, using the Grading of Recommendations Assessment and Evaluation (GRADE) approach.
Through this process, including extensive discussions continuing into December 2023, the GDG agreed on the recommendations for pneumonia shown in Table 1, and for diarrhoea shown in Table 2.
The main changes from previous recommendations involve giving greater scope for pneumonia treatment at the community level, using a specific set of signs and symptoms to diagnose hypoxaemia when pulse oximetry is not available, and a new dose for zinc supplementation (see significant changes to recommendations in each section).
Antibiotic resistance issues were taken into account in all relevant discussions, given current global concerns about antibiotic stewardship. Some of the antibiotics considered are on WHO’s AWARE watch list.