title: Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  An observational study following two cohorts of children with severe pneumonia for 3 months after discharge from hospital/clinic.
  
  
  METHODS
  Day care was provided at the Radda Clinic and hospital care at a hospital in Dhaka, Bangladesh.
  
  
  METHODS
  Children aged 2-59 months with severe pneumonia attending the clinic/hospital who survived to discharge.
  
  
  METHODS
  No intervention was done except providing some medications for minor illnesses, if indicated.
  
  
  METHODS
  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'.
  
  
  BACKGROUND
  The original randomised control trial comparing day care with hospital care was registered at http://www.clinicaltrials.gov (identifier NCT00455468).
authors: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
authors: Hasan
authors: H
authors: Ashraf
authors: Nur H
authors: NH
authors: Alam
authors: Mohammod Jobayer
authors: MJ
authors: Chisti
authors: Mohammed Abdus
authors: MA
authors: Salam
authors: Tahmeed
authors: T
authors: Ahmed
authors: Niklaus
authors: N
authors: Gyr