Day-care management of severe and very severe pneumonia, without associated co-morbidities such as severe malnutrition, in an urban health clinic in Dhaka, Bangladesh.

Full Abstract

BACKGROUND:
Management of severe and very severe pneumonia in children relies on hospital-based treatment, but practical barriers often prevent children in areas with the highest rates from receiving hospital care.

OBJECTIVE:
To develop and prospectively evaluate a day-care clinic approach, which provided antibiotics, feeding and supportive care during the day with continued care provided by parents at home, as an effective alternative to hospitalisation.

METHODS:
Children aged 2-59 months with severe or very severe pneumonia without associated co-morbidities, denied admission to hospital because of lack of beds, were enrolled at Radda Clinic, Dhaka and received antibiotics, feeding and supportive care from 08:00 to 17:00 every day, while mothers were educated on continuation of care at home during the night.

RESULTS:
From June 2003 to May 2005, 251 children were enrolled. Severe and very severe pneumonia was present in 189 (75%) and 62 (25%) children, respectively, and 143 (57%) were hypoxaemic with a mean (SD) oxygen saturation of 93 (4)%, which increased to 98 (3)% on oxygen therapy. The mean (SD) day-care period was 7 (2) days. Successful management was possible in 234 children (93% (95% CI 89% to 96%)), but 11 (4.4% (95% CI 2.5% to 7.7%)) had to be referred to hospital, and six (2.4% (95% CI 1.1% to 5.1%)) discontinued treatment. There were no deaths during the day-care study period; however, four children (1.6% (95% CI 0.6% to 4.0%)) died during the 3-month follow-up period, and 11 (4.4% (95% CI 2.5% to 7.7%)) required hospital admission.

CONCLUSION:
Severe and very severe pneumonia in children without associated co-morbidities such as severe malnutrition can be successfully managed at day-care clinics.

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Author information

Author/s: Ashraf, H (H); Jahan, S A (SA); Alam, N H (NH); Mahmud, R (R); Kamal, S M (SM); Salam, M A (MA); Gyr, N (N);

Affiliation: Clinical Sciences Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. ashrafh@icddrb.org

Journal and publication information

Publication Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't

Journal: Archives of disease in childhood (Arch Dis Child), published in England. (Language: eng)

Reference: 2008-Jun; vol 93 (issue 6) : pp 490-4

Dates: Created 2008/05/22; Completed 2008/06/20;

PMID: 17804591, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Anti-Bacterial Agents - therapeutic use
Bangladesh - epidemiology
Child, Preschool
Day Care - methods; standards
Early Diagnosis
Female
Follow-Up Studies
Health Services Accessibility

Health Services Accessibility
Humans
Infant
Male
Parents - education
Pneumonia - diagnosis; epidemiology; therapy
Prospective Studies
Urban Health - standards

Associated Chemicals: Anti-Bacterial Agents (0)

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