Risk factors for death among children aged 5-14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

ABSTRACT

BMJ Glob Health

Introduction: There were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5-14 years hospitalised with pneumonia in district-level health facilities in Kenya. Methods: We did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5-14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death. Results: 1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62). Conclusion: Children >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population.

Macpherson, L., Ogero, M., Akech, S., Aluvaala, J., Gathara, D., Irimu, G., English, M., Agweyu, A.

Pages:e001715, Volume:4, Edition:9/24/2019, Date,

Link: https://www.ncbi.nlm.nih.gov/pubmed/31544003

Notes:Macpherson, Liana|Ogero, Morris|Akech, Samuel|Aluvaala, Jalemba|Gathara, David|Irimu, Grace|English, Mike|Agweyu, Ambrose|eng|107769/WT_/Wellcome Trust/United Kingdom|097170/WT_/Wellcome Trust/United Kingdom|MR/R006083/1/MRC_/Medical Research Council/United Kingdom|203077/WT_/Wellcome Trust/United Kingdom|092654/WT_/Wellcome Trust/United Kingdom|EP-C-15-003/EPA/EPA/|WT_/Wellcome Trust/United Kingdom|England|2019/09/24 06:00|BMJ Glob Health. 2019 Sep 3;4(5):e001715. doi: 10.1136/bmjgh-2019-001715. eCollection 2019.

ISBN: 2059-7908 (Print)|2059-7908 (Linking) Permanent ID: PMC6730574 Accession Number: 31544003

Author Address: Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.|Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.|University of Nairobi College of Health Sciences, Nairobi, Kenya.|Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK.

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