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Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh
  1. Hasan Ashraf1,
  2. Nur H Alam1,
  3. Mohammod Jobayer Chisti1,
  4. Mohammed Abdus Salam1,
  5. Tahmeed Ahmed1,
  6. Niklaus Gyr2
  1. 1Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
  2. 2Department of Internal Medicine, University of Basel, Basel, Switzerland
  1. Correspondence to Dr Hasan Ashraf; ashrafh{at}


Objectives To compare the features of relapse, morbidity, mortality and re-hospitalisation following successful discharge after severe pneumonia in children between a day care group and a hospital group and to explore the predictors of failures during 3 months of follow-up.

Design An observational study following two cohorts of children with severe pneumonia for 3 months after discharge from hospital/clinic.

Setting Day care was provided at the Radda Clinic and hospital care at a hospital in Dhaka, Bangladesh.

Participants Children aged 2–59 months with severe pneumonia attending the clinic/hospital who survived to discharge.

Intervention No intervention was done except providing some medications for minor illnesses, if indicated.

Primary outcome measures The primary outcome measures were the proportion of successes and failures of day care at follow-up visits as determined by estimating the OR with 95% CI in comparison to hospital care.

Results The authors enrolled 360 children with a mean (SD) age of 8 (7) months, 81% were infants and 61% were men. The follow-up compliance dropped from 95% at first to 85% at sixth visit. The common morbidities during the follow-up period included cough (28%), fever (17%), diarrhoea (9%) and rapid breathing (7%). During the follow-up period, significantly more day care children (n=22 (OR 12.2 (95% CI 8.2–17.8))) required re-hospitalisation after completion of initial day care compared with initial hospital care group (n=11 (OR 6.1 (95% CI 3.4–10.6))). The predictors for failure were associated with tachycardia, tachypnoea and hypoxaemia on admission and prolonged duration of stay.

Conclusions There are considerable morbidities in children discharged following treatment of severe pneumonia like cough, fever, rapid breathing and diarrhoea during 3-month period. The findings indicate the importance of follow-up for early detection of medical problems and their management to reduce the risk of death. Establishment of an effective community follow-up would be ideal to address the problem of ‘non-compliance with follow-up’.

Trial registration The original randomised control trial comparing day care with hospital care was registered at (identifier NCT00455468).

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Ashraf H, Alam NH, Chisti MJ, et al. Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh. BMJ Open 2012;2:e000961. doi:10.1136/bmjopen-2012-000961

  • Contributors HA, NHA and NG conceived the idea; HA, NHA and MAS contributed to study data interpretation; HA, MAS and NG wrote the paper. HA, NHA, MJC, MAS, TA and NG critically analysed and approved the manuscript.

  • Funding This work was supported by the Eagle Foundation (Geneva, Switzerland) (grant GR-00485).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Research and Ethical Review Committees of International Centre for Diarrhoeal Disease Research, Bangladesh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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