Table 1

WHO under 5, IMAI and operational study definitions of pneumonia

Clinical signs
Adapted from WHO Pocket Book of Hospital Care for Children for children under 5 years5
Clinical signs
Adapted from the IMAI District Clinician manual for adolescents and adults*6
Clinical signs
Operational study definitions
Severe pneumonia
Recommended treatment:intravenouspenicillin withgentamicin
History of cough or difficulty breathing and any one of:
  • Oxygen saturations <90%, or central cyanosis

  • Severe respiratory distress

  • General danger sign (inability to breast feed or drink, lethargy or reduced level of consciousness, convulsions)

Any one of:
  • Appears obstructed

  • Central cyanosis

  • Severe respiratory distress


AND any one of:
  • Oxygen saturations <90%

  • Respiratory rate >30/min

  • Fever or suspected infection

  • Signs of severe respiratory distress

Pneumonia diagnosis and any one of:
  • Central cyanosis

  • Severe respiratory distress (grunting, stridor)

  • General danger sign (inability to feed or drink, reduced level of consciousness)

Non-severe pneumoniaRecommended treatment: intravenous penicillin or oral amoxicillin†History of cough or difficulty breathing and
  • Fast breathing (for age) or

  • Chest indrawing

  • Without any of the criteria for severe pneumonia

  • Signs and symptoms of pneumonia without meeting the criteria for severe pneumonia

  • Pneumonia diagnosis without meeting the criteria for severe pneumonia

  • *The assessment for severe pneumonia comes after an initial ‘quick check’ using the airway, breathing, circulation approach to identify patients presenting with emergency signs and is not intended for those with features of shock.

  • †These are the recommendations as per the WHO Pocket Book of Hospital Care for Children.5

  • IMAI, Integrated Management of Adolescent and Adult Illness.