Abstract

Objective: Management of severe and very severe pneumonia in children relies on hospital-based treatment but practical barriers prevent these children in areas with highest rates from receiving hospital care. We developed and prospectively evaluated a day-care clinic approach that provided antibiotics, feeding and supportive care during day with continued care provided by parents at home as an effective alternative to hospitalization.

Methods: Children aged 2-59 months with severe and very severe pneumonia without any associated co-morbidities, denied admission to hospital because of lack of beds were enrolled at Radda Clinic, Dhaka and received antibiotics, feeding and supportive cares from 8:00 am-5:00 pm every day, while mothers were educated on continuation of care at home during night hours.

Results: From June 2003-May 2005, 251 children were enrolled. Severe and very severe pneumonia was present in 189/251 (75%) and 62/251 (25%) children, respectively while 143/251 (57%) were hypoxemic with mean (SD) oxygen saturation of 93 (4)% that increased to 98 (3)% upon oxygen therapy. The mean (SD) duration of day-care period was 7 (2) days. Successful management was possible in 234/251 [93% (95% CI, 89-96%)] children, 4.4% (95% CI, 2.5-7.7%) referred to hospitals, and 2.4% (95% CI, 1.1-5.1%) discontinued treatment. None died during day-care study period; however, during 3-months' follow-up period, 4/251 [1.6% (95% CI, 0.6-4%)] children died, and 11/251 [4.4% (95% CI, 2.5-7.7%)] required hospital admission.

Conclusion: Severe and very severe pneumonia in children without any associated co-morbidities like severe malnutrition can be successfully managed at existing day-care clinics.