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 Baqui, Jennifer Bryce, Robert E Black

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)822-830
Number of pages9
JournalThe Lancet
Volume372
Issue number9641
DOIs
StatePublished - 2008

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Bangladesh
Pneumonia
Cohort Studies
Guidelines
Referral and Consultation
Hospital Records
Health Facilities
Health Status
Observational Studies
Safety
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chowdhury, E. K., El Arifeen, S., Rahman, M., Hoque, DM. E., Hossain, M. A., Begum, K., ... Black, R. E. (2008). Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study. The Lancet, 372(9641), 822-830. https://doi.org/10.1016/S0140-6736(08)61166-6

Care at first-level facilities for children with severe pneumonia in Bangladesh : a cohort study. / Chowdhury, Enayet K.; El Arifeen, Shams; Rahman, Muntasirur; Hoque, DM Emdadul; Hossain, M. Altaf; Begum, Khadija; Siddik, Ashraf; Begum, Nazma; Rahman, Qazi Sadeq ur; Akter, Tasnima; Haque, Twaha M.; Al-Helal, ZA Motin; Baqui, Abdullah; Bryce, Jennifer; Black, Robert E.

In: The Lancet, Vol. 372, No. 9641, 2008, p. 822-830.

Research output: Contribution to journalArticle

Chowdhury, EK, El Arifeen, S, Rahman, M, Hoque, DME, Hossain, MA, Begum, K, Siddik, A, Begum, N, Rahman, QSU, Akter, T, Haque, TM, Al-Helal, ZAM, Baqui, A, Bryce, J & Black, RE 2008, 'Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study', The Lancet, vol. 372, no. 9641, pp. 822-830. https://doi.org/10.1016/S0140-6736(08)61166-6
Chowdhury EK, El Arifeen S, Rahman M, Hoque DME, Hossain MA, Begum K et al. Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study. The Lancet. 2008;372(9641):822-830. https://doi.org/10.1016/S0140-6736(08)61166-6
Chowdhury, Enayet K. ; El Arifeen, Shams ; Rahman, Muntasirur ; Hoque, DM Emdadul ; Hossain, M. Altaf ; Begum, Khadija ; Siddik, Ashraf ; Begum, Nazma ; Rahman, Qazi Sadeq ur ; Akter, Tasnima ; Haque, Twaha M. ; Al-Helal, ZA Motin ; Baqui, Abdullah ; Bryce, Jennifer ; Black, Robert E. / Care at first-level facilities for children with severe pneumonia in Bangladesh : a cohort study. In: The Lancet. 2008 ; Vol. 372, No. 9641. pp. 822-830.
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AU - Chowdhury, Enayet K.

AU - El Arifeen, Shams

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

AU - Bryce, Jennifer

AU - Black, Robert E

PY - 2008

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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

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