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New inquiry published in The Lancet finds that
much higher proportions of children with severe pneumonia are treated
correctly if they are allowed to be treated at local, first-level
facilities instead of hospitals.
Since the mid-1990s and the issuing of The Intergrated Management of
Childhood Illness (IMCI) guidelines, it has been suggested that
children with hard pneumonia are treated at hospitals. In poorer and
more rural areas, however, children ar often referred to hospital care
simply do non attend; many fail to receive passable care. An alternative
to hospitals is treatment in local, first-level facilities, and it is
the refuge and effectiveness of these facilities that Drs. Enayet Karim
Chowdhury and Shams El Arifeen (International Center for Diarrheal
Disease Research, Bangladesh [ICDDR,B]) and colleagues study in their
recent research. These modified guidelines also recommend that children
with the most severe cases of pneumonia ar referred to the hospital.
The study sample consisted of two cohorts of children from 10
first-level health facilities in rural Matlab, Bangladesh - all
facilities that had been exploitation the former IMCI guidelines. One cohort
included 261 children world Health Organization attended the facilities betwixt May 2003 and
April 2004, before the researchers implemented the limited guidelines.
In this group, 94% were referred to hospital, 36%
received appropriate care, and 1.1% (3 children) died. In the
second cohort, 1,271 children were treated at the facilities after the
modified guidelines were implemented. In this group, 8% were referred
to hospital, 90% standard appropriate care, and 0.6% (7
children) died.
"Local adaptation of the IMCI guidelines, with appropriate training and
supervision, could allow dependable and in effect management of severe
pneumonia, especially if compliance with referral is difficult because
of geographic, financial, or cultural barriers," conclude the authors.
An concomitant comment written by Dr Igor Rudan (Croatian Centre for
Global Health, University of Split Medical School, Croatia) and Dr
Harry Campbell (University of Edinburgh Medical School, UK) notes that:
"We welcome a strong increase in investment in controlled trials
in developing countries to address essential gaps in information - such as
correct case management of severe pneumonia in children with HIV
infection - and in health-policy and systems research to identify
effective ways to improve and scale up implementation of interventions
against pneumonia."
Care at first-level facilities for children with severe pneumonia in
Bangladesh: a cohort study
Enayet K Chowdhury, Shams El Arifeen, Muntasirur Rahman, DM
Emdadul Hoque, M Altaf Hossain, Khadija Begum, Ashraf Siddik, Nazma
Begum, Qazi Sadeq-ur Rahman, Tasnima Akter, Twaha M Haque, ZA Motin
Al-Helal, Abdullah H Baqui, Jennifer Bryce, Robert E Black
The Lancet (2008).
DOI:10.1016/S0140-6736(08)61166-6
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Written by: Peter M Crosta
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Saturday 6 September 2008
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