title: 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.
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.
  
  
  CONCLUSIONS
  Severe and very severe pneumonia in children without associated co-morbidities such as severe malnutrition can be successfully managed at day-care clinics.
authors.affiliation: Clinical Sciences Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. ashrafh@icddrb.org
authors.forename: H
authors.initials: H
authors.lastname: Ashraf
authors.forename: S A
authors.initials: SA
authors.lastname: Jahan
authors.forename: N H
authors.initials: NH
authors.lastname: Alam
authors.forename: R
authors.initials: R
authors.lastname: Mahmud
authors.forename: S M
authors.initials: SM
authors.lastname: Kamal
authors.forename: M A
authors.initials: MA
authors.lastname: Salam
authors.forename: N
authors.initials: N
authors.lastname: Gyr
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D003631:Day Care, Medical / Q000379:methods / Q000592:standards*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000193:education*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D014504:Urban Health / Q000592:standards*