Community-acquired pneumonia in Indonesian children: insights into diagnosis, treatment compliance, and healthcare provider challenges.

BACKGROUND: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality in children worldwide. Inappropriate antibiotic use by healthcare workers contributes significantly to the growing problem of antibiotic resistance. This study assessed the knowledge, attitudes, and practices (KAP) of Indonesian primary healthcare workers in diagnosing and treating paediatric CAP, alongside challenges in guideline adherence. METHODS: Three studies were conducted in Indonesia. The first study reviewed medical records from Riau Islands and Central Java Provinces to assess adherence to CAP guidelines. The second evaluated KAP using pre- and post-tests, and online follow-up. The third used focus group discussions (FGDs) to explore the challenges in diagnosis and management. RESULTS: Out of 921 records, 37.6% of patients were misclassified as having CAP according to the World Health Organization (WHO) guideline, while 53.3% were misclassified based on the Ministry of Health of the Republic of Indonesia (MoH RI) guideline. Antibiotics were prescribed in 89.3% and 87.6% of these cases. Among correctly classified cases, 73.2% were prescribed amoxicillin in line with WHO guideline, but only 11.6% were dosed within the recommended 75-100 mg/kg/day range. Furthermore, 74.6% of patients were prescribed antibiotics more frequently, and only 28.3% received the appropriate treatment duration. The training significantly improved KAP among healthcare workers. Separately, nurses and midwives showed better practical application of the guidelines compared to physicians. Qualitative analysis identified themes highlighting diagnostic accuracy, antibiotic prescribing practices, and tailored training programs. CONCLUSIONS: This study highlights significant inconsistencies in paediatric CAP management among healthcare providers in Indonesia and emphasises the need for targeted training to enhance guideline compliance and improve patient outcomes.