Daycare approach an effective alternative to hospitalisation

Management of severe childhood pneumonia by daycare approach is an alternative to hospitalisation, and can reduce the treatment cost by half, scientists of icddr,b at a seminar said yesterday.

Based on a clinical trial, they also said that some 80 to 90 percent children with severe pneumonia -- malnourished or not -- can be treated under this approach in the existing healthcare system in the country, and is as effective as the World Health Organization (WHO) prescribed mechanism.

Moderated by Prof George Fuchs of University of Kentucky in USA, experts from home and abroad and policymakers attended the seminar at the Sasakawa Auditorium of icddr,b in Dhaka.

According to WHO, pneumonia is the single largest infectious cause of death in children worldwide -- killing some 8,08,694 children under the age of five in 2017.

This disease, a result of acute respiratory infection caused by a number of agents -- including viruses, bacteria and fungi -- can be prevented with simple interventions and treated with low-cost, low-tech medication and care.

However, lack of timely access to treatment intensifies the risk and causes death of “one child every 39 seconds globally”, Unicef estimates.

Dr Nur Haque Alam, senior scientist (nutrition and clinical services division) at icddr,b presented the result of the effectiveness trial of daycare approach.

“A smaller investment in upgrading day care facilities through development of trained human resources and procurement of supporting equipment [pulse oximeter for oxygen therapy and so on] could provide an effective alternative to hospital facilities,” Dr Nur said in his presentation.

In her presentation on economic evaluation of the approach, Dr Marufa Sultana, assistant scientist at icddr,b, showed that average cost per patient is USD186.33 in hospital management of severe pneumonia while it is only USD 94.96, almost half, in daycare approach.

In another presentation, Dr Halida Hanum Akhter, professor at Johns Hopkins University in USA, highlighted that the daycare approach is feasible in the existing healthcare system with some changes.

In the question-answer session, speakers discussed the readiness of the healthcare facilities, especially of the union healthcare centres or community clinics, to adopt daycare services.

“Result of the study is convincing. Without government initiative, it would be tough to scale it up for the national level. There are challenges in readiness also,” said Dr Daniel Frey, member of Unicef foundation board of Sweden, said in his speech.

Speaking as special guest, Prof Abul Kalam Azad, director general of the Directorate General of Health Services, said, “The problem with the union health centres is whether they are ready or not. Here, upazila health complexes, district and the tertiary-level hospitals could be good options to implement the daycare approach.”

Presided over by Syed Monjurul Islam, acting executive director of icddr,b; Prof Marcel Tanner of Swiss Academy of Sciences; Prof Tahmeed Ahmed, senior director (nutrition and clinical services division) at icddr,b; and Dr Khaleda Islam, former director (primary health care) at DGHS, spoke at the event, among others.