title: Randomized controlled trial of day care versus hospital care of severe pneumonia in Bangladesh.
abstract: 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.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh, Clinical Sciences Division, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. ashrafh@icddrb.org
authors.forename: Hasan
authors.initials: H
authors.lastname: Ashraf
authors.forename: Rokhsana
authors.initials: R
authors.lastname: Mahmud
authors.forename: Nur H
authors.initials: NH
authors.lastname: Alam
authors.forename: Selina A
authors.initials: SA
authors.lastname: Jahan
authors.forename: Syed M
authors.initials: SM
authors.lastname: Kamal
authors.forename: Fazlul
authors.initials: F
authors.lastname: Haque
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Salam
authors.forename: Niklaus
authors.initials: N
authors.lastname: Gyr
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D010100:Oxygen