Abstract
Background: Pneumonia is a major cause of child mortality among children under 5 years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by the World Health Organization(WHO) in September (2013), pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia.Methods: Disease management of severe childhood pneumonia requires early identification,prompt referral and the availability of intensive quality care. Under 5 years old children with severe pneumonia should receive day care, with antibiotic treatment, feeding, and supportive care with similar 24-hour hospital treatment.Results: Considering that difficulties, International Centre for Diarrheal Disease Research,Bangladesh (ICDDR, B) initiated Day Care Approach (DCA) model, as an innovative, safe,effective and less expensive alternative to hospital management of severe childhood pneumonia.A 24 months old girl came to the health care center with severe breathing difficulty, cough,history of fever and head nodding. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall in drawing, no danger signs, no rales on auscultation, and no hypoxemia. Conclusion: Considering the WHO case management protocol for severe pneumonia, DCA recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at daycare clinics including for children with hypoxemia who is required prolong (4-6 hours) oxygen therapy.
Highlights
Pneumonia sustains as the leading cause of death among under 5 years old children.[1]
The recent World Health Organization (WHO) global report (2013) deemed that pneumonia accounts for approximately 120 million cases every year,[2] among which 14 million (12%) progress to severe pneumonia[3]; and developing countries belong into the most vulnerable vicinity (95%).[1]
She was admitted in a Health and Family Welfare Centre under the Day Care Approach (DCA) basis and treated as a severe pneumonia patient immediately, an out-patient facility providing space, trained staff members, beds, and the necessary equipment’s like antibiotics, oxygen therapy, nebulization, nasopharyngeal suction etc. as indicated
Summary
Pneumonia sustains as the leading cause of death among under 5 years old children.[1]. On Auscultation, crepitation was present in both lung fields and rhonchi was present on upper and middle side of left lung field She was admitted in a Health and Family Welfare Centre under the DCA basis and treated as a severe pneumonia patient immediately, an out-patient facility providing space, trained staff members (doctors, nurses), beds, and the necessary equipment’s like antibiotics, oxygen therapy, nebulization, nasopharyngeal suction etc. Actual outcome On day 0 (admission day): The patient was diagnosed with following physical conditions: age specific fast breathing, severe lower chest wall indrawing, grunting and hypoxemia, temperature (37.4◦C, not fever), respiratory rate (73 breaths/min), SPO2 (84%; without O2) and pulse rate (174 beats/min). On day 3: Patient started improving clinically but there was age specific fast breathing but no chest indrawing, no fever, no tachycardia and no hypoxemia. No hypoxemia, no fast breathing and no tachycardia, she was discharged from Health and Family Welfare Centre
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