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Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh.

Ashraf H, Alam NH, Chisti MJ, Salam MA, Ahmed T, Gyr N - BMJ Open (2012)

Bottom Line: 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 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'.

View Article: PubMed Central - PubMed

Affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

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).

No MeSH data available.


Related in: MedlinePlus

Trial profile of children with severe pneumonia. RCT, randomised controlledtrial.
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Related In: Results  -  Collection

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fig1: Trial profile of children with severe pneumonia. RCT, randomised controlledtrial.

Mentions: In total, 360 children living in the Mirpur, Dhaka, Bangladesh, with severe pneumoniawere enrolled into the original randomised controlled trial study15 and were equally (180 in each) assigned randomly to theoutpatient day care or inpatient hospital care (figure1). The children were then followed up for 3 months after dischargefrom their primary treatment sites. The health status of the study children at the timeof discharge from the clinic/hospital is shown in table 1. The mean age (SD) of the children was 8 (7) months, 291 (81%)were infants (2–11 months), 220 (61%) were men and 330 (92%) were breastfed with significantly more infants receiving the hospital care (table 1). Most of the children were well nourished without anywasting, but only with a mild degree of under-nutrition (table 1). About half of the children belonged to poor families(48%) with a monthly income of about US$70, while 72% of the fathers were daylabourers or rickshaw-pullers, and 87% of the mothers were housewives.


Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh.

Ashraf H, Alam NH, Chisti MJ, Salam MA, Ahmed T, Gyr N - BMJ Open (2012)

Trial profile of children with severe pneumonia. RCT, randomised controlledtrial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4400608&req=5

fig1: Trial profile of children with severe pneumonia. RCT, randomised controlledtrial.
Mentions: In total, 360 children living in the Mirpur, Dhaka, Bangladesh, with severe pneumoniawere enrolled into the original randomised controlled trial study15 and were equally (180 in each) assigned randomly to theoutpatient day care or inpatient hospital care (figure1). The children were then followed up for 3 months after dischargefrom their primary treatment sites. The health status of the study children at the timeof discharge from the clinic/hospital is shown in table 1. The mean age (SD) of the children was 8 (7) months, 291 (81%)were infants (2–11 months), 220 (61%) were men and 330 (92%) were breastfed with significantly more infants receiving the hospital care (table 1). Most of the children were well nourished without anywasting, but only with a mild degree of under-nutrition (table 1). About half of the children belonged to poor families(48%) with a monthly income of about US$70, while 72% of the fathers were daylabourers or rickshaw-pullers, and 87% of the mothers were housewives.

Bottom Line: 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 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'.

View Article: PubMed Central - PubMed

Affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

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).

No MeSH data available.


Related in: MedlinePlus