Authors' reply

摘要

Eric Simoes makes a valid point and we agree that all efforts should be made to improve the referral of children who are sick and in need of referral care. Children who are most at risk of death will need to be promptly identified and referred to either the nearest health facility or hospital. WHO has already modified referral guidelines for severe pneumonia.However, despite efforts to improve links between community and referral facilities in developing countries, many children with pneumonia never reach a health facility.2 Community case management of pneumonia has shown to be effective in reducing pneumonia mortality3 and WHO and UNICEF recommend it where access to care for illness is low.4 Many countries have begun or are considering employing and training community health workers to diagnose and treat pneumonia.5 If done well through trained community health workers, community case management has the ability to bring care to substantially more children in need and reduce mortality.