Improving Quality of Care for the Treatment of Childhood Pneumonia

描述（由申请人提供）：隶属于Lata医学研究基金会的塔夫茨大学医学院和印度那格普尔英迪拉甘地政府医学院提议扩大其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。这种参与的目标是改善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200万5岁以下儿童死于肺炎——比死于艾滋病、疟疾和麻疹的儿童总数还要多。低氧血症或感染艾滋病毒的儿童死亡率最高，其死亡率高达80%。低氧血症一直被认为是儿童肺炎死亡率和预后不良的重要预测因素。世界卫生组织（World Health Organization）的病例管理策略使用了严重不足的临床症状来检测低氧血症，导致约30%的低氧血症儿童漏诊。这些儿童没有得到足够的氧气治疗，承受了不良后果的冲击。在世界各地的农村和地区医院，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，以确定获得脉搏血氧仪是否能够挽救生命或具有成本效益。我们建议全球网络站点进行一项聚类随机试验，以评估使用脉搏血氧仪和培训提供者使用脉搏血氧仪来指导氧疗是否能降低肺炎儿童的治疗失败和死亡率。这项研究将在目前没有脉搏血氧仪的农村医院进行。我们将评估这种方法是否具有成本效益。我们还将确定艾滋病毒感染和抗菌素耐药性增加时期治疗失败和死亡率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的肺炎病因学尚未进行研究。脉搏血氧仪是一种简单、易于使用、价格低廉且高度相关的技术，有可能以可持续的方式改善儿童肺炎这一最紧迫的全球卫生问题之一的结果。

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.