Randomized controlled trial of day care versus hospital care of severe pneumonia in Bangladesh.
OBJECTIVE
A randomized controlled trial compared day care versus hospital care management of pneumonia.


METHODS
Children 2 to 59 months of age with severe pneumonia received either day care, with antibiotic treatment, feeding, and supportive care from 8:00 am to 5:00 pm, or hospital care, with similar 24-hour treatment.


RESULTS
In 2006-2008, 360 children were assigned randomly to receive either day care or hospital care; 189 (53%) had hypoxemia, with a mean±SD oxygen saturation of 93±4%, which increased to 99±1% after oxygen therapy. The mean±SD durations of day care and hospital care were 7.1±2.3 and 6.5±2.8 days, respectively. Successful management was possible for 156 (87.7% [95% confidence interval [CI]: 80.9%-90.9%]) of 180 children in the day care group and 173 (96.1% [95% CI: 92.2%-98.1%]) of 180 children in the hospital care group (P=.001). Twenty-three children in the day care group (12.8% [95% CI: 8.7%-18.4%] and 4 children in the hospital care group (2.2% [95% CI: 0.9%-5.6%] required referral to hospitals (P<.001). During the follow-up period, 22 children in the day care group (14.1% [95% CI: 9.5%-20.4%]) and 11 children in the hospital care group (6.4% [95% CI: 3.6%-11%]) required readmission to hospitals (P=.01). The estimated costs per child treated successfully at the clinic and the hospital were US$114 and US$178, respectively.


CONCLUSIONS
Severe childhood pneumonia without severe malnutrition can be successfully managed at day care clinics, except for children with hypoxemia who require prolonged oxygen therapy.
Ashraf
Hasan
H
International Centre for Diarrhoeal Disease Research, Bangladesh, Clinical Sciences Division, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. ashrafh@icddrb.org
Mahmud
Rokhsana
R
Alam
Nur H
NH
Jahan
Selina A
SA
Kamal
Syed M
SM
Haque
Fazlul
F
Salam
Mohammed A
MA
Gyr
Niklaus
N
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001459:Bangladesh; D002443:Ceftriaxone / Q000008:administration & dosage; D002675:Child, Preschool; D003631:Day Care, Medical; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000097:blood / Q000150:complications / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D010100:Oxygen