Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Ashraf, Hasan, Alam, Nur H, Chisti, Mohammod Jobayer, Salam, Mohammed Abdus, Ahmed, Tahmeed, Gyr, Niklaus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Group 2012
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
_version_ 1782367056222486528
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
work_keys_str_mv AT ashrafhasan observationalfollowupstudyfollowingtwocohortsofchildrenwithseverepneumoniaafterdischargefromdaycareclinichospitalindhakabangladesh
AT alamnurh observationalfollowupstudyfollowingtwocohortsofchildrenwithseverepneumoniaafterdischargefromdaycareclinichospitalindhakabangladesh
AT chistimohammodjobayer observationalfollowupstudyfollowingtwocohortsofchildrenwithseverepneumoniaafterdischargefromdaycareclinichospitalindhakabangladesh
AT salammohammedabdus observationalfollowupstudyfollowingtwocohortsofchildrenwithseverepneumoniaafterdischargefromdaycareclinichospitalindhakabangladesh
AT ahmedtahmeed observationalfollowupstudyfollowingtwocohortsofchildrenwithseverepneumoniaafterdischargefromdaycareclinichospitalindhakabangladesh
AT gyrniklaus observationalfollowupstudyfollowingtwocohortsofchildrenwithseverepneumoniaafterdischargefromdaycareclinichospitalindhakabangladesh