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BU study touts home treatment for pneumonia

Says children in poorer nations would benefit

Email|Print| Text size + By John Donnelly
Globe Staff / January 4, 2008

WASHINGTON - In a finding that could save thousands of children's lives every year, a study published today says that children suffering from pneumonia in developing countries could be treated as effectively at home as in hospitals.

Published in The Lancet medical journal, the study led by Boston University School of Public Health researchers found that children diagnosed with severe pneumonia from bacterial causes fared as well with high doses of oral antibiotics taken at home as with injectible medication administered in hospitals.

Pneumonia is the leading killer of children under age 5 around the world, causing the deaths of an estimated 2 million every year - more than die from AIDS, malaria, measles, or diarrhea. While Western countries have been able to effectively treat the vast majority of children with the illness, in which lungs often fill with fluid causing a shortness of breath, many developing countries have done poorly in treating the disease because of inadequate health systems.

Researchers studied 2,037 children under age 5 who were diagnosed with pneumonia in Pakistan. The children were randomly assigned to two groups, with about half sent home with antibiotics and the others hospitalized. By day six of treatment, researchers found that 87 children failed to improve in the hospital, compared with 77 in the home-based group. Overall, five children died, four of them in the hospital and one at home. When it became clear that treatment was failing in these cases, other therapies were tried before the child died.

Donald M. Thea, a BU professor of international health and lead researcher on the project, said yesterday that he hopes the findings will lead the World Health Organization to change its guidelines for handling cases of severe pneumonia in developing countries. Now, the organization recommends hospitalization of all children diagnosed with severe pneumonia.

Those guidelines, though, are problematic on several fronts. Many children never make it to hospitals, or arrive too late, because of great distances to travel, transportation costs, or other impediments. And many poor countries don't have enough health workers; the pneumonia cases further strain children's wards in hospitals.

Dr. Shamim Qazi, medical officer with WHO's Department of Child and Adolescent Health and Development and a co-author of the study, said in an interview from Geneva that the organization will convene a group of specalists in the coming months to consider revising its guidelines for treatment of pneumonia.

With a change in WHO guidelines, a health facility could diagnose severe pneumonia and then give parents the oral antibiotics for treatment at home. In the future, pending the results of another study in Pakistan involving community health workers, the WHO also is expected to consider recommending that village health workers diagnose and manage cases of severe pneumonia.

Health ministries around the world closely watch any change in WHO guidelines for treatment of diseases, meaning that a changed treatment recommendation for severe pneumonia would likely be followed widely.

"With cases of severe pneumonia, people have been very reluctant not to recommend hospitalization for kids," Thea said in an interview. "But in the back country of Pakistan, or other countries, that is simply not a possibility. But it is OK to give a bottle of amoxicillin, instead of throwing up your hands and doing nothing, which is essentially what is happening now."

The outcome of the WHO's deliberations will not change treatment of pneumonia in the United States or other wealthy countries.

The study's findings suggest that pneumonia, like many diseases, can be managed by local health workers in poor settings, Thea said. That will mean starting programs to train health workers and provide better access to life-saving medication.

"There's a recognition that the health systems are going to be inadequate for a long period of time, and so the best way to address these conditions is to bring the diagnosis and management into the community," he said.

John Donnelly can be reached at donnelly@globe.com.

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