Low uptake of follow-up care for children with pneumonia compounded by suboptimal drug regimen adherence in Northwest Ethiopia: Longitudinal follow-up study

<h2>Abstract</h2><h3>Problem considered</h3> The integrated management of newborn and childhood illnesses guideline recommends follow-up care for children with pneumonia on the second day after initial treatment. However, evidence on follow-up care utilization and its determinants is limited. Therefore, this study aimed to investigate follow-up care utilization, associated factors, and adherence to the treatment regimen. <h3>Methods</h3> A prospective follow-up study was conducted in northwest Ethiopia from March to July 2023 among 818 under-five children with pneumonia who were treated as outpatients. Two-stage sampling was employed. Data were collected using validated questionnaires. Descriptive and multilevel binary logistic regression analyses were performed. <h3>Results</h3> Only one-third, 259 (31.7 %, 95 % CI: 28.6, 34.9), of caregivers of children with pneumonia sought follow-up care. Of these, 213 (82.2 %) children received the correct treatment regimen. Factors associated with follow-up care utilization included receiving treatment from healthcare providers who counseled caregivers on when to return immediately (AOR: 1.9, 95 % CI: 1.2, 3.0), from facilities with internal quality assessment (AOR: 2.8, 95 % CI: 1.3, 6.1), those located nearest to the community (AOR: 2.9, 95 % CI: 1.8, 4.9), and those providing better quality of service (AOR: 4.1, 95 % CI: 1.4, 11.8). <h3>Conclusion</h3> Low utilization of follow-up care for children with pneumonia represents a critical gap in the continuum of care. This issue is further compounded by suboptimal adherence to medication regimens. Follow-up care utilization for childhood pneumonia is influenced by the interplay of individual and facility-specific factors. The study findings imply that improving process quality can increase follow-up care utilization.