TY - JOUR
T1 - Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study
AU - Chowdhury, Enayet Karim
AU - Arifeen, Shams E
AU - Rahman, Muntasirur
AU - Hoque, DM Emdadul
AU - Hossain, M Altaf
AU - Begum, Khadija
AU - Siddik, Ashraf
AU - Begum, Nazma
AU - Rahman, Qazi Sadeq-ur
AU - Akter, Tasnima
AU - Haque, Twaha M
AU - Al-Helal, ZA Motin
AU - Baqui, Abdullah H
AU - Bryce, Jennifer
AU - Black, Robert E
PY - 2008
Y1 - 2008
N2 - Background: Guidelines on integrated management of childhood illness (IMCI) for severe pneumonia recommend referral to hospitals. However, in many settings, children who are referred do not actually attend hospital, which severely limits appropriate care. We aimed to assess the safety and effectiveness of modified guidelines that allowed most children with severe pneumonia to be treated locally in first-level facilities, with referral only for those with danger signs or other severe classifications. Methods: We did an observational cohort study in ten first-level health facilities in Matlab, rural Bangladesh that had implemented IMCI guidelines. We assessed children with severe pneumonia who were aged between 2 and 59 months, and for whom we could obtain complete information, in two cohorts: 261 children who presented to these facilities between May, 2003, and April, 2004 (before implementation of the modified guidelines) and 1271 children between September, 2004, and August, 2005 (after full implementation). We obtained information about the characteristics and management of their illness, including referrals and admissions to hospital, from facility records. Staff visited households to obtain details of treatment, socioeconomic information, and final outcome, including mortality data. Findings: 245 (94 ) of 261 children who had severe pneumonia were referred to hospital before the guidelines were modified, compared with 107 (8 ) of 1271 after implementation (p
AB - Background: Guidelines on integrated management of childhood illness (IMCI) for severe pneumonia recommend referral to hospitals. However, in many settings, children who are referred do not actually attend hospital, which severely limits appropriate care. We aimed to assess the safety and effectiveness of modified guidelines that allowed most children with severe pneumonia to be treated locally in first-level facilities, with referral only for those with danger signs or other severe classifications. Methods: We did an observational cohort study in ten first-level health facilities in Matlab, rural Bangladesh that had implemented IMCI guidelines. We assessed children with severe pneumonia who were aged between 2 and 59 months, and for whom we could obtain complete information, in two cohorts: 261 children who presented to these facilities between May, 2003, and April, 2004 (before implementation of the modified guidelines) and 1271 children between September, 2004, and August, 2005 (after full implementation). We obtained information about the characteristics and management of their illness, including referrals and admissions to hospital, from facility records. Staff visited households to obtain details of treatment, socioeconomic information, and final outcome, including mortality data. Findings: 245 (94 ) of 261 children who had severe pneumonia were referred to hospital before the guidelines were modified, compared with 107 (8 ) of 1271 after implementation (p
UR - http://www.sciencedirect.com.ezproxy.lib.monash.edu.au/science/article/pii/S0140673608611666
U2 - 10.1016/S0140-6736(08)61166-6
DO - 10.1016/S0140-6736(08)61166-6
M3 - Article
VL - 372
SP - 822
EP - 830
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9641
ER -