Effectiveness Trial of Day-care Versus Usual Care Management of Severe Pneumonia With or Without Malnutrition in Children Using the Existing Health System of Bangladesh

Specific Objectives:

1. To assess whether or not the Day care Approach for the management of severe childhood pneumonia with or without moderate acute malnutrition and/or severe underweight incorporated into the existing urban and rural Health Systems of Bangladesh is safe and effective.
2. To implement the Day care Approach for the management of severe childhood pneumonia with or without moderate acute malnutrition and/or underweight within the Health Systems of Bangladesh as a cost effective alternative to the Existing Treatment of care for both the Health Systems and the families.
3. To examine and compare the cost effectiveness of the Day care Approach versus Existing Treatment of care for the management of severe childhood pneumonia with or without moderate acute malnutrition and/or severe underweight.
4. To identify and assess potential barriers and challenges during the whole implementation process.

Background of the Project including Preliminary Observations:

At present and depending on clinical presentation, pneumonia is classified as severe pneumonia, pneumonia, or no pneumonia, according to the recent guidelines by the World Health Organization in 2013. Since pneumonia is the leading cause of death in <5-year-old children, interventions to promote the prevention and treatment of pneumonia are an essential part of child survival efforts to achieve Millennium Development Goal 4. World Health Organization standard management of severe pneumonia requires hospitalization for supportive treatment including oxygen therapy for hypoxaemia, airway suctioning, fluid and nutritional management, antibiotics, and careful monitoring.

Most, if not all, developing countries including Bangladesh do not have enough hospitals, or pediatric hospital beds to accommodate the demand for admission of all children with severe pneumonia with or without malnutrition and other co-morbidity. In addition, mothers of ill children have other childcare and household responsibilities that constrain their ability to attend the child during hospitalization, which is often mandatory. Furthermore, transportation, cost, long distance from the hospital, lack of adequate child-care at home, or cultural perceptions represent additional huge limitations to hospitalization. Hospitalization also may not be feasible due to inability of parents to stay in hospital for the entire duration of illness. The sum total of all these common potential constraints lead to failure of hospitalization of children with severe pneumonia and severe malnutrition with or without additional co-morbidity. This inadequate availability and use of hospital beds leading to failure of hospitalization of children with severe pneumonia and/or malnutrition assuredly results in excess and unwanted deaths of children, who, with proper care, would otherwise survive. Although Investigators do not have direct evidence (no data available) that the bottleneck to pneumonia deaths in Bangladesh is lack of hospital beds mainly. But Investigators know from experience that many children with severe pneumonia requiring hospitalization are not hospitalized due to the lack of free pediatric beds, as observed during the observational day care studies.