Objectives: To evaluate the clinical outcomes and costs of managing pneumonia and severe malnutrition in a day clinic (DC) management model (outpatient) vs. hospital care (inpatient). Methods: Randomised clinical trial where children aged 2 months to 5 years with pneumonia and severe malnutrition were randomly allocated to DC or inpatient hospital care. We used block randomisation of variable length from 8 to 20 and produced computer-generated random numbers that were assigned to one of the two interventions. Successful management was defined as resolution of clinical signs of pneumonia and being discharged from the model of care (DC or hospital) without need for referral to a hospital (DC), or referral to another hospital. All the children in both DC and hospital received intramuscular ceftriaxone, daily nutrition support and micronutrients. Results: Four hundred and seventy children were randomly assigned to either DC or hospital care. Successful management was achieved for 184 of 235 (78.3%) by DC alone, vs. 201 of 235 (85.5%) by hospital inpatient care [RR (95% CI) = 0.79 (0.65–0.97), P = 0.02]. During 6 months of follow-up, 30/235 (12.8%) in the DC group and 36/235 (15.3%) required readmission to hospital in the hospital care group [RR (95% CI) = 0.89 (0.67–1.18), P = 0.21]. The average overall healthcare and societal cost was 34% lower in DC (US$ 188 ± 11.7) than in hospital (US$ 285 ± 13.6) (P < 0.001), and costs for households were 33% lower. Conclusions: There was a 7% greater probability of successful management of pneumonia and severe malnutrition when inpatient hospital care rather than the outpatient day clinic care was the initial method of care. However, where timely referral mechanisms were in place, 94% of children with pneumonia and severe malnutrition were successfully managed initially in a day clinic, and costs were substantially lower than with hospital admission.
|Number of pages||10|
|Journal||Tropical Medicine and International Health|
|State||Published - Jul 2019|
Bibliographical noteFunding Information:
We are grateful to the physicians, nurses, research assistants and health workers for their contribution during patient enrolment and data collection, and to the parents of the children involved in this study for their generous participation. Dr Hasan Ashraf tragically died in 2015 after drafting the original manuscript. Publication of this study pays tribute to Dr Ashraf’s tireless work over two decades to research and improve child health and nutrition in Bangladesh. This research was funded by the UBS Optimus Foundation, Zu€rich, Switzerland. The grant provider (UBS Optimus Foundation) had no role in study design, data collection, data analysis, data interpretation or writing the manuscript.
© 2019 John Wiley & Sons Ltd
- cost evaluation
- inpatient care
- outpatient care
- randomised clinical trial
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Infectious Diseases