Paediatric pneumonia in Zimbabwe: management and pharmaceutical costs of inpatient care.

Acute respiratory infection exacts a heavy toll on the children of Zimbabwe. During 1986-7 significant resources were committed to manage this condition that accounted for 35 per cent of outpatient visits. Moreover, pneumonia or acute lower respiratory infection (ALRI) represented the greatest proportion of paediatric hospital inpatient discharge diagnoses (32 per cent) and was responsible for 33 per cent of under 5 deaths in Harare. Case management and pharmaceutical cost patterns for paediatric ALRI inpatients are compared for representative rural district and provincial hospitals and an urban central hospital in Harare. The case-mix of patients was similar at all three hospital levels. Significantly, mildly ill patients between the ages of 7 months and 5 years were uniformly over-treated based on management protocols recommended both in the Essential Drug List for Zimbabwe and by the World Health Organization (WHO). The resulting excessive expenditure was Z$26000 (1Z$ = 0.59U$$ in 1986) for this category of patient in 1986. Reasons for the lack of compliance with WHO management protocols are explored.