Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh
Hasan Ashraf, Nur H Alam, Mohammod Jobayer Chisti, Mohammed Abdus Salam, Tahmeed Ahmed, Niklaus Gyr, Hasan Ashraf, Nur H Alam, Mohammod Jobayer Chisti, Mohammed Abdus Salam, Tahmeed Ahmed, Niklaus Gyr
Abstract
Objectives: To compare the features of relapse, morbidity, mortality and re-hospitalisation following successful discharge after severe pneumonia in children between a day care group and a hospital group and to explore the predictors of failures during 3 months of follow-up.
Design: An observational study following two cohorts of children with severe pneumonia for 3 months after discharge from hospital/clinic.
Setting: Day care was provided at the Radda Clinic and hospital care at a hospital in Dhaka, Bangladesh.
Participants: Children aged 2-59 months with severe pneumonia attending the clinic/hospital who survived to discharge.
Intervention: No intervention was done except providing some medications for minor illnesses, if indicated.
Primary outcome measures: The primary outcome measures were the proportion of successes and failures of day care at follow-up visits as determined by estimating the OR with 95% CI in comparison to hospital care.
Results: The authors enrolled 360 children with a mean (SD) age of 8 (7) months, 81% were infants and 61% were men. The follow-up compliance dropped from 95% at first to 85% at sixth visit. The common morbidities during the follow-up period included cough (28%), fever (17%), diarrhoea (9%) and rapid breathing (7%). During the follow-up period, significantly more day care children (n=22 (OR 12.2 (95% CI 8.2-17.8))) required re-hospitalisation after completion of initial day care compared with initial hospital care group (n=11 (OR 6.1 (95% CI 3.4-10.6))). The predictors for failure were associated with tachycardia, tachypnoea and hypoxaemia on admission and prolonged duration of stay.
Conclusions: There are considerable morbidities in children discharged following treatment of severe pneumonia like cough, fever, rapid breathing and diarrhoea during 3-month period. The findings indicate the importance of follow-up for early detection of medical problems and their management to reduce the risk of death. Establishment of an effective community follow-up would be ideal to address the problem of 'non-compliance with follow-up'.
Trial registration: The original randomised control trial comparing day care with hospital care was registered at http://www.clinicaltrials.gov (identifier NCT00455468).
Conflict of interest statement
Competing interests: None.
Figures
References
- Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010;375:1969–87.
- Rudan I, Tomaskovic L, Boschi-Pinto C, et al. ; WHO Child Health Epidemiology Reference Group. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ 2004;82:895–903.
- Rudan R, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008;86:408–16.
- Ashraf H, Chisti MJ, Alam NH. Treatment of childhood pneumonia in developing countries. In: Health Management, eds. Rijeka, Croatia: Sciyo, Krzysztof Smigorski ISBN 978-953-307-120-6 2010:59–88.
- Mulholland K. Magnitude of the problem of childhood pneumonia. Lancet 1999;354:590–2.
- Williams BG, Gouws E, Boschi-Pinto C, et al. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002;2:25–32.
- Baqui AH, Black RE, Arifeen SE, et al. Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study. Bull World Health Organ 1998;76:161–71.
- Chisti MJ, Duke T, Robertson CF, et al. Co-morbidity: exploring the clinical overlap between pneumonia and diarrhoea in a hospital in Dhaka, Bangladesh. Ann Trop Paediatr 2011;31:311–19.
- MASCOT pneumonia study group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet 2002;360:835–41.
- Bari A, Sadruddin S, Khan A, et al. Community case management of severe pneumonia with oral amoxicillin in children aged 2-59 months in Haripur district, Pakistan: a cluster randomised trial. Lancet 2011;378:1796–803.
- Hazir T, Fox LM, Nasir YB, et al. ; For the New Outpatient Short-Course Home Oral Therapy for Severe Pneumonia (NO-SHOTS) Study Group. Ambulatory short-course high-dose amoxicillin for treatment of severe pneumonia in children: a randomised equivalency trial. Lancet 2008;371:49–56.
- World Health Organization. Acute Respiratory Infections in Children: Case Management in Small Hospitals in Developing Countries. A Manual for Doctors and Other Senior Health Workers. WHO/ARI/90.5. Geneva: WHO, 1990.
- Ashraf H, Ahmed T, Hossain MI, et al. Day-care management of children with severe malnutrition in an urban health clinic in Dhaka, Bangladesh. J Trop Pediatr 2007;53:171–8.
- Ashraf H, Jahan SA, Alam NH, et al. 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. Arch Dis Child 2008;93:490–4.
- Ashraf H, Mahmud R, Alam NH, et al. Randomized controlled trial of day care versus hospital care of severe pneumonia in Bangladesh. Pediatrics 2010;126:e807–15.
- Ashraf H, Alam NH, Salam MA, et al. A follow-up experience of 6 months after treatment of children with severe acute malnutrition in Dhaka, Bangladesh. J Trop Pediatr. Published Online First: 11 October 2011.
- Jubran A. Pulse oximetry. Crit Care 1999;3:R11–17.
- Jubran A, Tobin MJ. Reliability of pulse oximetry in titrating supplemental oxygen therapy in ventilator-dependent patients. Chest 1990;97:1420–5.
- Khanum S, Ashworth A, Huttly SRA. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet 1994;344:1728–32.
Source: PubMed