Improving Quality of Care for the Treatment of Childhood Pneumonia

描述(由申请人提供)：塔夫茨大学医学院和印度那格浦尔的英迪拉·甘地政府医学院，隶属于拉塔医学研究基金会，正在提议扩大他们在儿童肺炎研究方面的长期多学科合作和伙伴关系，并正在申请参加全球妇女和儿童健康研究网络。这次参与的目的是提高新生儿和幼儿的科学知识和成果，并扩大印度那格浦尔研究单位的能力和基础设施。他们对全球网络应用程序的建议侧重于儿童肺炎。每年至少有200万名5岁以下儿童死于肺炎--比死于艾滋病、疟疾和麻疹的儿童人数总和还要多。感染艾滋病毒的儿童死亡率最高，死亡率高达80%。长期以来，低氧血症一直被认为是儿童肺炎死亡率和不良预后的重要预测因子。世界卫生组织的病例管理策略使用严重不足的临床体征来检测低氧血症，大约30%的低氧血症儿童被遗漏。这些儿童没有接受急需的氧气治疗，并首当其冲地承受着不良后果。在世界各地的农村和地区医院，还没有对脉搏血氧仪进行投资，以检测低氧血症，部分原因是没有进行临床试验，以确定使用脉搏血氧仪是挽救生命还是具有成本效益。我们建议Global Network Sites进行一项整群随机试验，以评估使用脉搏血氧仪和培训提供者指导氧疗是否能减少肺炎儿童的治疗失败和死亡率。这项研究将在目前无法获得脉搏血氧仪的乡村医院进行。我们会评估这种做法是否符合成本效益。我们还将确定在艾滋病毒感染和抗菌素耐药性增加的时代治疗失败和死亡的微生物学预测因素，因为自20世纪80年代以来，发展中国家社区环境中肺炎的病原学一直没有得到研究。引入脉搏血氧仪是一种简单、易用、廉价和高度相关的技术，有可能以可持续的方式改善儿童肺炎这一最紧迫的全球健康问题的结果。

DESCRIPTION (provided by applicant): Tufts University School of Medicine and the Indira Gandhi Government Medical College Nagpur, India, affiliated with Lata Medical Research Foundation, are proposing to expand their longstanding multidisciplinary collaboration and partnership in the study of childhood pneumonia and are applying to participate in the Global Network for Women's and Children's Health Research. The goal of this participation is to improve scientific knowledge and outcomes in neonates and young children and to expand capacity and infrastructure in the research unit at Nagpur, India. Their proposal for the Global Network application focuses on childhood pneumonia. Every year, at least 2 million children under age 5 die of pneumonia - more than the number of children who die of AIDS, malaria and measles combined. Mortality is highest in children who are hypoxemicor infected with HIV, where mortality rates are as high as 80%. Hypoxemia has long been recognized as an important predictor of mortality and poor outcome in childhood pneumonia. The World Health Organization's case-management strategy uses woefully inadequate clinical signs to detect hypoxemia, missing about 30% of children who are hypoxemic. These children do not receive much needed oxygen therapy and bear the brunt of adverse outcomes. Investment in pulse oximetry to detect hypoxemia in rural and district hospitals worldwide has not occurred, partly because no clinical trial has been conducted to determine whether access to pulse oximetry is either life-saving or cost-effective. We propose that Global Network sites conduct a cluster randomized trial to evaluate whether access to pulse oximetry and training providers in its use to guide oxygen therapy decreases treatment failure and mortality in children with pneumonia. The study will be conducted in rural hospitals that currently have no access to pulse oximetry. We will assess whether this approach is cost effective. We will also determine the microbiologic predictors of treatment failure and mortality in the eras of HIV infection and increasing antimicrobial resistance, as the etiology of pneumonia in the community setting in developing countries has not been studied since the 1980s. Introduction of pulse oximetry is a simple, easy to use, inexpensive and highly relevant technology that has the potential to improve outcomes, in a sustainable way, for one of the most pressing global health problems - childhood pneumonia.