Childhood pneumonia can be managed thru day-care

Scientists in Dhaka on Sunday announced that day-care management of severe childhood pneumonia is effective, reduces the need for hospitalisation, and at half the cost. The internationally renowned healthcare research centre in Bangladesh popularly known as the iddr,b in collaboration with the University of Basel, Switzerland and the University of Kentucky, USA carried out the four-year research in Bangladesh.

Their findings and recommendations were disclosed on Sunday at a dissemination seminar organised icddr,b at it Sasakawa auditorium in the capital. The seminar highlighted findings of an innovative treatment method of severe childhood pneumonia through a day-care management approach within the health system of Bangladesh.

The scientists also reported that the model is equally effective, safe and much less expensive compared to the World Health Organisation (WHO) recommended standard management of severe childhood pneumonia, which involves hospitalisation of children for supportive treatment including oxygen therapy, fluid and nutritional management, and antibiotics. The day-care pneumonia management has great potential for scale-up within the existing health system of Bangladesh and other developing countries, the researchers said.

Globally, 120 million episodes of pneumonia per year affect children under 5 years of age, over 10% of which (14 million) progress to severe episodes and require hospitalisation. In developing countries, acute lower respiratory tract infection (ALRI) particularly pneumonia is the leading cause of death among children under 5 years of age accounting for one in every five of the 5 million deaths per year.

In Bangladesh, more than one child died due to pneumonia every hour in 2018, which accounts more than 12,000 children in that year alone. Additionally, childhood malnutrition remains a significant health problem and a major contributing factor to poor outcomes of childhood pneumonia treatment.

While hospitalisation is the recommended care for severe pneumonia, most low- and middle-income countries often do not have enough paediatric beds and hospitals to meet the demand of all children with severe pneumonia or malnutrition. Additionally, mothers of ill children have other childcare and household responsibilities that prevent their ability to attend the child during hospitalization, which is often mandatory for the entire hospital stay.

Further, transportation cost for long-distance travel to the hospital, lack of adequate childcare at home, among others represent significant additional limitations to hospitalization. Globally, alternative treatment modalities such as "day-care model" are therefore being sought for children who cannot be hospitalised but are too sick to be managed at home.

Dr Tahmeed Ahmed, Senior Director, Nutrition and Clinical Services Division, icddr,b welcomed the participants while Dr Nur Haque Alam, Emeritus Scientist at icddr,b and principal investigator of the study presented an overview of the study which took place during 2015 to 2019.

Dr Marufa Sultana, health economics PhD Candidate at Deakin University, Australia presented on the cost effectiveness prospects of the model. Dr Halida Akter, Former Country Representative of Pathfinder Bangladesh and Adjunct Professor at Johns Hopkins University, USA presented the findings of a series of clinical trials which showed 90% of children with severe pneumonia with or without malnutrition can safely be treated in the day-care clinics.

Dr Khaleda Islam, Former Director of Primary Health Care, Directorate General Health Services (DGHS), Bangladesh shared her insights on how the model can be incorporated in the Government health system.

Day-care management of severe pneumonia involves arranging/modifying an outdoor facility with pediatric beds along with provision of measurement of vital signs, suction of nasopharyngeal aspirates, blood oxygen saturation measurement, oxygen cylinder, availability of antibiotics, food for patient and twice-a-day follow-up by nurse / health care provider. Careful monitoring of patients should also be in place.

The findings of the effectiveness trial of day-care compared to usual care management (hospitalisation) of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh shows promise for wider scale up involving government health system and non-government organisation-based primary health care and costs approximately half that of hospitalized treatment.

About the prospects of the day-care model for treatment of severe pneumonia Professor George Fuchs, University of Kentucky, USA said, “The day-care approach represents a significant advance for the children with pneumonia and their families as well as for the healthcare system.”

Professor Dr Manzoor Hussain, President, Bangladesh Paediatric Association (BPA) and Dr Daniel Frey, Board Member of UNICEF Foundation, Switzerland also spoke on the occasion. Syed Monjurul Islam, Deputy Executive Director, at icddr,b and Chair of the session concluded the seminar with thanks to the participants. The study was supported by UNICEF, UBS Optimus Foundation, Botnar Foundation, Eagle Foundation, icddr,b and Government of Bangladesh.