Peer-reviewed article

Implementation of an intervention to scale up coverage of pneumonia management in children younger than 5 years in a north Indian district: protocol for a quasi-experimental, mixed-methods, pre-post implementation study.

Gadapani Pathak B, Nisar YB, Madhur T, Garg N, Qazi S et al. · 7 Jul 2025

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This is a study protocol for a quasi-experimental implementation project in Palwal district, India, designed to improve pneumonia treatment coverage in children under 5 years old. The study will use a three-phase approach combining formative research, model testing, and scaled-up delivery through Health and Wellness Centres. About 4,167 households will be surveyed to identify approximately 120 pneumonia cases among 2,400 children under 5. The research will collect both quantitative data on treatment coverage and qualitative data on implementation processes through focus groups and interviews.

Key points

Pneumonia is a leading cause of under-five mortality in India, with high mortality rates persisting despite national programmes
The study aims to achieve high population-based coverage of pneumonia treatment following the Government of India's revised 2019 Childhood Pneumonia Management Guidelines
The implementation uses a three-phase approach: formative research, iterative model testing in a learning block, and scale-up with concurrent evaluation
Approximately 120 pneumonia cases among 2,400 children under 5 will be analysed from ~4,167 surveyed households
The study employs mixed methods combining quantitative analysis (descriptive statistics and generalised linear models) with qualitative analysis (thematic analysis of interviews and focus groups)

Limitations

This is a protocol document rather than results, so it cannot report what the intervention achieved or any actual outcomes. The estimated sample of only 120 pneumonia cases is relatively small for statistical analysis, and the study's quasi-experimental pre-post design without a separate control group limits causal inference compared to randomised designs.

Abstract

Introduction The National Family Health Survey-5 has reported an under-five mortality rate of 41.9 per 1000 live births in India. Pneumonia, one of the leading causes of under-five mortality, contributes substantially to this figure. The Indian government has made efforts through multiple national programmes, but pneumonia-specific mortality remains high. The Government of India revised their Childhood Pneumonia Management Guidelines in 2019 to improve under-five pneumonia prevention and management. This implementation study aims to achieve a high population-based coverage of pneumonia treatment for under 5 yearold children in the Palwal district of India. Method and analysis This implementation study uses a quasi-experimental pre-post design and a mixed-methods approach, conducted in three phases: (i) formative research, (ii) model optimisation through iterative testing in a learning block and (iii) scale-up and concurrent evaluation. The study is set in Palwal district, Haryana, and the primary catchment/study area will be the Health and Wellness Centres, the most accessible public health facilities for the community. Approximately 4167 households will be surveyed to capture ~2400 under-five children, among whom about 120 pneumonia cases (based on an estimated 5% prevalence) will be included in the analysis of treatment coverage and outcomes. Quantitative data will be analysed using descriptive statistics and generalised linear models, while qualitative data from focus group discussions and in-depth interviews will be thematically analysed using NVivo software. Ethics and dissemination Ethical approval was granted by the ethical committees of the Society for Applied Studies (ERC/IR Pneumonia/2021), the Regional Ethics Committee of Western Norway (2022/531608) and the WHO(ERC.0003652). Additionally, this study has obtained the Government of Haryana state (Memo no. HSHRC/2022/505) and Health Ministry steering committee (approval date: 19 Dec 2022, proposal id 2022-17596) approvals. Informed consent will be obtained from all participants, including caregivers and healthcare workers, prior to data collection. Dissemination meetings in the study country will share results with stakeholders, including Ministry of Health officials, health managers, families of under-five children, community leaders and academia, to discuss national health programme implications. Results will also be shared regionally and globally, with publications and presentations encouraged in national and international forums. Study registration Clinical Trials Registry - India, CTRI/2021/03/031622.

Findings the Hub has extracted

Each claim below is labelled by its type of design and links back to this report.

Survival

Problem

High under-five mortality from pneumonia in India despite national programmes, with inadequate coverage of evidence-based pneumonia management

Intervention: Implementation of revised Government of India Childhood Pneumonia Management Guidelines through Health and Wellness Centres using a three-phase approach: formative research, iterative model testing, and scaled delivery with concurrent evaluation
Population: Children under 5 years old in Palwal district, Haryana, India; approximately 2,400 children will be surveyed with ~120 pneumonia cases included in treatment coverage analysis

Key finding

This is a protocol document; no results are yet available

Pre/post