126 Randomized Controlled Trial of Day-Care and Hospitalized Management of Severe Pneumonia with Severe Acute Malnutrition in Children in Bangladesh

Abstract

Background and aims Severe childhood pneumonia and severe acute malnutrition (SAM) require hospitalized management but inadequate pediatric beds limits hospital-care in Bangladesh. As two prospective observational studies showed that day-care facility-based management of severe pneumonia and SAM were successful as alternatives to hospitalization, a RCT was conducted. Methods A randomized hospital (ICHSH) versus day-care (The Radda Clinic equipped with oxygen, suction, pulse oximeter, nebulizer, glucometer) comparative study was carried out to evaluate the safety and effectiveness of day-care model. Children aged 2-59 months having severe pneumonia with SAM were randomized to day-care or hospital-care. Parents brought children at 08:00 at daycare clinic and back home at 17:00 daily after receiving antibiotics, diet, micronutrients and oxygen. For hospital-care, children received similar 24-hour treatment with antibiotics, diet, micronutrients and oxygen daily. Both day-care and hospital management continued daily until improvement and discharged. Results In total, 340 children were randomized to either day-care or hospital-care management. Successful management was possible in 136/170 [80% (95% CI 73.4-85.3%)] day-care children and 144/170 [84.7% (95% CI 78.5-89.3%)] hospital-care children. Of remaining 34 day-care children, 29 [17.1% (95% CI 12.1-23.4%)] were referred to hospital and 5 [2.9% (95% CI 1.3-6.7%)] discontinued treatment. Of remaining 26 hospital-care children, 18 [10.6% (95% CI 6.8-16.1%)] were referred to specialized hospitals and 6 [3.5% (95% CI 1.6-7.5%)] discontinued treatment. Conclusion Children with severe pneumonia with SAM could be treated safely and effectively on a day-care basis at established daycare clinics, similar to hospital management, if required logistic support is available.