Randomized Controlled Trial of Day Care Versus Hospital Care of Severe Pneumonia in Bangladesh

Abstract

OBJECTIVE: A randomized controlled trial compared day care versus hospital care management of pneumonia. METHODS: Children 2 to 59 months of age with severe pneumonia received either day care, with antibiotic treatment, feeding, and supportive care from 8:00 am to 5:00 pm, or hospital care, with similar 24-hour treatment. RESULTS: In 2006–2008, 360 children were assigned randomly to receive either day care or hospital care; 189 (53%) had hypoxemia, with a mean ± SD oxygen saturation of 93 ± 4%, which increased to 99 ± 1% after oxygen therapy. The mean ± SD durations of day care and hospital care were 7.1 ± 2.3 and 6.5 ± 2.8 days, respectively. Successful management was possible for 156 (87.7% [95% confidence interval [CI]: 80.9%–90.9%]) of 180 children in the day care group and 173 (96.1% [95% CI: 92.2%–98.1%]) of 180 children in the hospital care group (P = .001). Twenty-three children in the day care group (12.8% [95% CI: 8.7%–18.4%] and 4 children in the hospital care group (2.2% [95% CI: 0.9%–5.6%] required referral to hospitals (P < .001). During the follow-up period, 22 children in the day care group (14.1% [95% CI: 9.5%–20.4%]) and 11 children in the hospital care group (6.4% [95% CI: 3.6%–11%]) required readmission to hospitals (P = .01). The estimated costs per child treated successfully at the clinic and the hospital were US$114 and US$178, respectively. CONCLUSION: Severe childhood pneumonia without severe malnutrition can be successfully managed at day care clinics, except for children with hypoxemia who require prolonged oxygen therapy.