Icddr,b finds low-cost childhood pneumonia treatment

The scientists of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) have found that day-care pneumonia management has great potential for scale-up within the existing healthcare facility in Bangladesh and other developing countries.

To this end, the icddr,b in collaboration with the University of Basel, Switzerland, the University of Kentucky, USA, organised a seminar at its Sasakawa auditorium in the capital's Mohakhali on Sunday. 

The seminar highlighted findings of an innovative treatment method of severe childhood pneumonia through a day-care management approach within the country's health system. 

The scientists said the model is equally effective, safe and much less expensive compared to the World Health Organisation recommended standard management of severe childhood pneumonia.

The treatment model involves hospitalisation of children for supportive treatment, including oxygen therapy, fluid and nutritional management and antibiotics.

Director General of the Directorate General of Health Services Professor Dr Abul Kalam Azad said, "Day-care management of severe pneumonia is a good idea, and we will indeed explore how we can pilot this model in both rural and urban areas for future scale-up."

Dr Nur Haque Alam, Emeritus Scientist at the icddr,b and principal investigator of the study, presented an overview of the study which took place from 2015 to 2019.

Globally, 120 million episodes of pneumonia per year affect children under 5 years, over 10 percent of which – 14 million – progress to severe episodes and require hospitalisation. 

In Bangladesh, more than one child died due to pneumonia every hour in 2018, which accounts for more than 12,000 children in that year alone.

Also, childhood malnutrition remains a significant health problem and a major contributing factor to poor outcomes of childhood pneumonia treatment.

While hospitalisation is the recommended care for severe pneumonia, most low- and middle-income countries often do not have enough paediatric beds and hospitals to meet the demand of all children with severe pneumonia or malnutrition. 

Also, mothers of ill children have other childcare and household responsibilities that prevent their ability to attend the child during hospitalisation, which is often mandatory for the entire hospital stay.

Further, transportation cost for long-distance travel to the hospital, lack of adequate childcare at home, among others, represent significant limitations to hospitalisation. 

Globally, alternative treatment modalities such as "day-care model" are therefore being sought for children who cannot be hospitalised but are too sick to be managed at home. 

Day-care management of severe pneumonia involves arranging or modifying an outdoor facility with pediatric beds along with the provision of measurement of vital signs, the suction of nasopharyngeal aspirates, blood oxygen saturation measurement, oxygen cylinder, availability of antibiotics, food for patient and twice-a-day follow-up by a nurse or health care provider. 

Careful monitoring of patients should also be in place. 

The findings of the effectiveness trial of day-care compared to usual care management (hospitalisation) of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh shows promise for wider scale-up involving government health system and non-government organisation-based primary health care and costs approximately half that of hospitalised treatment. 

Professor Dr Manzoor Hussain, president of Bangladesh Paediatric Association and Dr Daniel Frey, Board Member of UNICEF Foundation, Switzerland also spoke on the occasion.

Syed Monjurul Islam, Deputy Executive Director, at the icddr,b and chair of the session concluded the seminar with thanks to the participants.

The study was supported by UNICEF, UBS Optimus Foundation, Botnar Foundation, Eagle Foundation, icddr,b and the Government of Bangladesh.