Mortality among Children with Pneumonia at Seven Kenyan Hospitals

Agweyu, Ambrose (2015) Mortality among Children with Pneumonia at Seven Kenyan Hospitals. Masters thesis, University of Nairobi.

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Background: Studies conducted prior to the introduction of the pneumococcal and Haemophilus influenzae type B conjugate vaccines show that mortality related to childhood pneumonia may be higher among children from sub-Saharan Africa than in other regions. Current estimates of pneumonia case fatality in African children will provide useful evidence to support discussions on local adaptation of global guidelines. Objectives: The primary objective of this study was to determine the case fatality rate among children admitted with pneumonia at Kenyan hospitals. Risk factors for mortality within this population were explored as a secondary objective. Methods: A retrospective longitudinal survey of inpatient records of children hospitalized with pneumonia between September 2011 and August 2013 was conducted at seven public hospitals selected to represent the spectrum of common serious childhood illnesses in Kenya. Health workers at all sites were trained and provided with the national case management guidelines. Case records for children aged between 2 and 59 months were retrieved. Children diagnosed with severe malnutrition or meningitis and those with missing outcome data were excluded from the analysis. All eligible records for children hospitalized during the period of the study were sampled. Categorical data were tabulated and summarized as proportions while continuous variables were reported as means, with standard deviations or medians, with inter-quartile ranges (IQR) as appropriate. The primary outcome, cumulative inpatient mortality, was computed as a proportion with a corresponding 95% confidence interval (CI). Univariate associations of potential risk factors with mortality were explored using Chi-squared statistics. Findings from these univariate analyses were then used to fit a logistic regression model to determine independent risk factors for mortality. Results: Of 5820 children aged 2 – 59 months admitted with pneumonia over the period of interest, 243 and 3478 with meningitis and severe malnutrition respectively and 115 with missing data on clinical outcome were excluded. 1984 eligible children were included in the analysis. The median age of the study participants was 14 months (IQR 7 to 24 months). Non-severe, severe and very severe pneumonia cases comprised 447 (23%), 956 (48%) and 481 (29%) of 1984 children respectively. The case fatality of all pneumonia cases was 77/1984 (3.9%). Mortality among non-severe, severe and very severe categories was 5/447 (1.1%), 22/956 (2.3%) and 50/581 (8.6%) respectively. In univariate analyses, younger age group (2-11 months), moderate and severe malnutrition, mild to moderate and severe pallor, some and severe dehydration and admission at a Level V hospital were associated with increased mortality. Risk factors for mortality in multivariate analysis were: very severe pneumonia (versus non-severe pneumonia) (Odds ratio (OR) 6.0; P=0.04), both mild / moderate pallor and severe pallor (versus no pallor) (OR 6.1; P<0.01 and OR 16.4; P<0.01 respectively), both some and severe dehydration / shock (versus absence of dehydration) (OR 3.8 P=0.02 and OR 24.6; P<0.01 respectively), both moderate and severe malnutrition defined by weight for age Z score (OR 3.8; P=0.03 and OR 4.0; P=0.02 respectively) and hospitalization at Level V facilities (OR 3.3; P=0.01). Conclusions: Case fatality for pneumonia was 3.9% and was substantially higher in the very severe category. Very severe pneumonia, pallor, dehydration, moderate and severe malnutrition, and hospitalization at Level V hospitals were associated with increased mortality in this population. Age and respiratory rate were not associated with mortality. Recommendations: The findings of this study should be disseminated for use in policy meetings to update the current pneumonia guidelines. Prospective studies are required to determine the aetiology and optimize the management of pneumonia, particularly among children with very severe presentations, pallor and dehydration.

Item Type: Thesis (Masters)
Subjects: R Medicine > RB Pathology
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions: Africana
Depositing User: Mr Nahum Osman
Date Deposited: 16 Jun 2016 10:17
Last Modified: 16 Jun 2016 10:17

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