LITTLE ROCK, AR. (Jan. 15, 2013 ) – A gastroenterologist at Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS) is guiding an effort to help children in developing countries recover from potentially deadly cases of pneumonia and malnutrition.
George J. Fuchs, III, MD, will head to Bangladesh next week as part of a symposium and workshop at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddrb) to address the 61 million cases of childhood pneumonia that occur in south Asia each year. Fuchs is a practicing gastroenterologist at Arkansas Children's Hospital (ACH), a professor in the College of Public Health at UAMS and a professor of Pediatrics in the UAMS College of Medicine.
A former leader of the clinical sciences program and nutrition program at the icddrb, Fuchs and his colleagues have designed a study to test how successful an outpatient treatment protocol might be for children suffering from severe malnutrition and severe pneumonia. Kids who are malnourished are much more likely to experience infections like pneumonia, which leads to 2 million pediatric deaths per year — it claims one child every seven seconds. As many as 95 percent of these deaths occur in developing nations like Bangladesh.
"For decades in the hospital setting, scores of these children died," Fuchs said. "We think we can reduce that mortality rate."
These children are among the most severely ill and have therefore always been treated in the hospital. However, hospitals in these nations do not have enough resources or beds available to handle the pediatric epidemic, so a day clinic model might be a successful approach for caring for these children, Fuchs believes. His research team has already tested the day clinic model with success in a carefully controlled setting in urban Dhaka, Bangladesh, and their results were published in Journal of Tropical Pediatrics in 2007. Fuchs and his fellow researchers also advocated for the use of a standardized management protocol of children with diarrhoeal disease in a study published in Lancet in 1999.
Family dynamics contribute to the pediatric pneumonia and malnutrition mortality rates, as well. Mothers of sick children also face childcare and household responsibilities that prevent them from staying in the hospital. This may lead to many choosing home care instead of seeking care at the hospital.
"The reason we established this daycare clinic approach is that we knew the vast majority of kids who needed treatment weren't getting it," Fuchs said. "Either they don't have the resources to get to the treatment or they just can't stay in a hospital long enough for it to help. If this proves successful, we believe it could be a global model."
Next week's symposium will gather pneumonia and malnutrition experts from around the world to present current strategies and outcomes. Fuchs will discuss the connection between malnutrition and pneumonia.
The next step – an effectiveness trial of scaling up the daycare model within the Bangladesh urban and rural health systems – could start as soon as the spring, and would likely last a couple of years. It would focus on treatment for children between the ages of 2 and 5.
"We will do some basic training of health care workers in this approach to management," Fuchs said. "Then we will monitor its impact and compare treatment results and health care costs to the traditional approach of hospitalized care."
The effectiveness trial has received $1 million from the UBS Optimus Foundation in the form of a challenge grant. Support of the government of Bangladesh and other agencies such as UNICEF, the Asian Development Bank and the U.S. Agency for International Development are also key. Additional commitments are anticipated to completely fund the study.
Arkansas Children's Hospital is the only pediatric medical center in Arkansas and one of the largest in the United States serving children from birth to age 21. Over the past century, ACH has grown to span 29 city blocks and house 370 beds, a staff of approximately 500 physicians, 80 residents in pediatrics and pediatric specialties and more than 4,000 employees. The private, nonprofit healthcare facility boasts an internationally renowned reputation for medical breakthroughs and intensive treatments, unique surgical procedures and forward-thinking medical research - all dedicated to fulfilling our mission of enhancing, sustaining and restoring children's health and development. For more information, visit www.archildrens.org.
UAMS is the state's only comprehensive academic health center, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; a hospital; a statewide network of regional centers; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute, the Donald W. Reynolds Institute on Aging and the Translational Research Institute. Named best Little Rock metropolitan area hospital by U.S. News & World Report, it is the only adult Level 1 trauma center in the state. UAMS has more than 2,800 students and 790 medical residents. It is the state's largest public employer with more than 10,000 employees, including about 1,000 physicians and other professionals who provide care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. Visit www.uams.edu or www.uamshealth.com.
# # #