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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
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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Group
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400608/ https://www.ncbi.nlm.nih.gov/pubmed/22842561 http://dx.doi.org/10.1136/bmjopen-2012-000961 |
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author | Ashraf, Hasan Alam, Nur H Chisti, Mohammod Jobayer Salam, Mohammed Abdus Ahmed, Tahmeed Gyr, Niklaus |
author_facet | Ashraf, Hasan Alam, Nur H Chisti, Mohammod Jobayer Salam, Mohammed Abdus Ahmed, Tahmeed Gyr, Niklaus |
author_sort | Ashraf, Hasan |
collection | PubMed |
description | 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). |
format | Online Article Text |
id | pubmed-4400608 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BMJ Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-44006082015-04-22 Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh Ashraf, Hasan Alam, Nur H Chisti, Mohammod Jobayer Salam, Mohammed Abdus Ahmed, Tahmeed Gyr, Niklaus BMJ Open Paediatrics 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). BMJ Group 2012-07-27 /pmc/articles/PMC4400608/ /pubmed/22842561 http://dx.doi.org/10.1136/bmjopen-2012-000961 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. |
spellingShingle | Paediatrics Ashraf, Hasan Alam, Nur H Chisti, Mohammod Jobayer Salam, Mohammed Abdus Ahmed, Tahmeed Gyr, Niklaus Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh |
title | Observational follow-up study following two cohorts of children with
severe pneumonia after discharge from day care clinic/hospital in Dhaka,
Bangladesh |
title_full | Observational follow-up study following two cohorts of children with
severe pneumonia after discharge from day care clinic/hospital in Dhaka,
Bangladesh |
title_fullStr | Observational follow-up study following two cohorts of children with
severe pneumonia after discharge from day care clinic/hospital in Dhaka,
Bangladesh |
title_full_unstemmed | Observational follow-up study following two cohorts of children with
severe pneumonia after discharge from day care clinic/hospital in Dhaka,
Bangladesh |
title_short | Observational follow-up study following two cohorts of children with
severe pneumonia after discharge from day care clinic/hospital in Dhaka,
Bangladesh |
title_sort | observational follow-up study following two cohorts of children with
severe pneumonia after discharge from day care clinic/hospital in dhaka,
bangladesh |
topic | Paediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400608/ https://www.ncbi.nlm.nih.gov/pubmed/22842561 http://dx.doi.org/10.1136/bmjopen-2012-000961 |
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