Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco

Time to recovery from severe community-acquired pneumonia and its predictors among 6 to 59 months of age children admitted to South Wollo zone public hospitals, North East Ethiopia: a prospective follow-up study

INTRODUCTION

Ethiopia is one of those countries with higher burden of community acquired pneumonia among its people, under five children are the members of society that are highly affected by pneumonia particularly Severe Community Acquired Pneumonia. However, there are limited studies on time to recovery and its predictors in under-five children and most of them are retrospective which fails to address important variables that affect the time to recovery. Therefore, the aim of this study was to estimate the median time to recovery and its predictors among under five children admitted to South Wollo zone public hospitals, North East Ethiopia.

METHODS

An institution-based prospective cohort study was conducted from March 10 to May 10, 2021, with 270 study subjects. A systematic random sampling technique was used. Data was collected by interview and chart review. The data were entered and analyzed using Epi Data version 3.1 and STATA version 14.0, respectively. Kaplan-Meier and Cox regression models were used to test the time and predictors of recovery from severe community-acquired pneumonia.

RESULTS

The overall incidence of recovery rate (95% confidence interval) from Severe Community-Acquired Pneumonia was 20.45(17.84-23.46) per 100 person days observation with median (IQR) time to recovery of [3, 5] days. The predictors of time to recovery from Severe Community-Acquired Pneumonia were having comorbidities on admission [AHR = 0.49 (95%CI: 0.32,0.75)], reaching hospitals after 5 days of onset of symptoms [AHR = 0.35 (95%CI: 0.20,0.60)], having Middle Upper Arm Circumference < = 12.5 cm [AHR = 0.21 (95%CI: 0.12,0.37)], the presence of smoker in the house [AHR = 0.21 (95%CI: 0.10,0.42)] and being not fully immunized for age [AHR = 0.35 (95%CI: 0.24,0.53)].

CONCLUSION AND RECOMMENDATIONS

Generally the recovery time of children with Severe Community Acquired Pneumonia in the study area was within the recommended national standards. Due attention should be given to children with the identified predictors while treating them.

Time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga Zone public hospitals, western Ethiopia, 2023; a retrospective cohort study

BACKGROUND

Globally, pneumonia is one of the leading causes of morbidity and mortality as well as hospitalization burden for under-five children. Despite significant initiatives implemented to reduce morbidity and mortality from pneumonia in under-five children, little is known regarding the time to recovery and its predictors among under-five children admitted with severe pneumonia in Ethiopia. Hence, this study intended to estimate the median time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga zone public hospitals, western Ethiopia; 2023.

METHODS

An institution-based retrospective cohort study was conducted among 383 under-five children who were admitted with severe pneumonia in East Wallaga zone public hospitals from January 2017 to December 2022. A systematic sampling method was used to select eligible medical records. EpiData Version 4.6 was used to enter the data and analyzed using STATA Version 17.0. Cox-proportional hazard assumption test and model fitness were checked. Variables with P-value ˂ 0.25 at bivariable Cox regression analysis were selected for the multivariable Cox proportional model. A multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from severe pneumonia at a P-value < 0.05.

RESULTS

At the end of the follow-up, 356 observations were developed an event (recovered) with the median time to recovery of 4 days with IQR of 3-5 days. The overall incidence rate of recovery was 22.26 per 100 (95% CI: 20.07-24.70) person-days observations. Being rural residency (AHR: 0.75, 95% CI: 0.60-0.93), late presenters for seeking care (AHR = 0.70, 95% CI: 0.53-0.93), presence of danger sign at admission (AHR = 1.46, 95% CI: 1.15-1.83), and presence of comorbidity (AHR = 1.63, 95% CI, 1.31-2.04) were found to have a statistically significant association with prolonged recovery time.

CONCLUSION

The median time to recovery from severe pneumonia was long, and factors such as Residence, co-morbidity, presence of danger signs, and duration prior to seeking care were statistically significant predictors of recovery time from severe pneumonia. Hence, due attention has to be given to increasing the community's health-seeking behavior to visit health facility early and especial attention should be given for children with danger signs and comorbidity.

Treatment outcome of pneumonia and its associated factors among pediatric patients admitted to Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia

Background

Pneumonia is the leading cause of morbidity and mortality among children worldwide. Despite its substantial impact, there exists a dearth of evidence regarding treatment outcomes and related factors, particularly within the Ethiopian context. This study endeavors to address these critical gaps by examining the treatment outcome of pneumonia among pediatric patients hospitalized in the Hiwot Fana Comprehensive Specialized University Hospital.

Method

A facility-based cross-sectional study was conducted on 204 children (≤14 years of age) diagnosed with pneumonia and admitted to the Hiwot Fana Comprehensive Specialized University Hospital. An interview using a structured questionnaire accompanied by a review of medical records was used to collect data from the parents/guardians. A binary logistic regression model with an adjusted odds ratio (AOR) and a 95% confidence interval (CI) was used to identify the associated factors with the outcome variable. Statistical significance was set at P < 0.05 in the multivariable analysis.

Result

Among the 204 children (≤14 years) included in the study, 119 (93.6%, 95% CI: 90.2-96.9) patients with pneumonia survived whereas 13 (6.4%, 95% CI: 3.1-9.7) died. Multivariable logistic regression analysis, after adjustments for potential confounders, revealed that children who had malnutrition (AOR = 3.5, 95% CI: 2.37-12.44), were unvaccinated (AOR =  3.41, 95% CI: 2.25-11.87), had altered mental states during admission (AOR = 4.49, 95% CI: 2.28-17.85), and had complicated types of pneumonia (AOR = 5.70, 95% CI: 2.98-15.09) were independently associated with mortality.

Conclusion

Poor treatment outcome was 6.4% among pediatric patients admitted with pneumonia in this study setting. Being unvaccinated, malnourished, and admitted with a complicated type of pneumonia as well as having altered consciousness at the time of admission were significantly associated with poor treatment outcomes. These findings underscore the critical need to prioritize preventative measures against malnutrition and unvaccinated status in children. Early identification of such children and proper interventions are imperative to reducing such outcomes, particularly in resource-constrained settings.

Predictors of recovery time from severe community-acquired pneumonia among paediatrics patients in selected hospitals in Addis Ababa, Ethiopia: an institution-based retrospective cohort study

OBJECTIVE

Severe community-acquired pneumonia (SCAP) is a significant cause of morbidity worldwide and a major cause of morbidity and mortality in developing countries. Ethiopia ranks 6th out of 15 countries with the highest mortality rate due to pneumonia in children under 5 years of age. The aim of this study was to determine the recovery time from SCAP and factors in paediatric patients in selected hospitals in Addis Ababa.

DESIGN, PARTICIPANTS AND SETTING

A retrospective cohort study was conducted among 407 randomly selected paediatric patients admitted with SCAP in Addis Ababa public hospitals from 1 January 2018 to 31 December 2020.

PRIMARY AND SECONDARY OUTCOMES

Recovery time and recovery rate from SCAP were estimated using Kaplan-Meier and simple frequency statistics, respectively, and the adjusted HR with a 95% CI was used to identify associated factors for recovery.

RESULTS

91.5% (95% CI: 88.3% to 94.1%) of children recovered from SCAP with an overall recovery rate of 11.5 (95% CI: 10.37 to 12.76) per 100 person-day observation, and the median recovery time was 6 days. In the multivariable analysis, older age and the absence of comorbidities were protective factors for early recovery, while stunting and late utilisation of medical care were risk factors.

CONCLUSION

The median recovery time after SCAP was very long compared with the optimal recovery time of 3 days given in the British Thoracic Society guidelines. Older age and absence of comorbidities were found to shorten recovery time, whereas stunting and late initiation of treatment delayed recovery. Therefore, measures that increase the recovery rate and shorten the recovery time, such as primary prevention to eliminate malnutrition and increase the utilisation of medical care in the community, should be strengthened, and health workers should focus on the early detection and treatment of comorbid diseases.

Clinical features and risk factors analysis for poor outcomes of severe community-acquired pneumonia in children: a nomogram prediction model

Background

Pneumonia remains the leading cause of death among children aged 1-59 months. The early prediction of poor outcomes (PO) is of critical concern. This study aimed to explore the risk factors relating to PO in severe community-acquired pneumonia (SCAP) and build a PO-predictive nomogram model for children with SCAP.

Methods

We retrospectively identified 300 Chinese pediatric patients diagnosed with SCAP who were hospitalized in the Affiliated Hospital of Southwest Medical University from August 1, 2018, to October 31, 2021. Children were divided into the PO and the non-PO groups. The occurrence of PO was designated as the dependent variable. Univariate and multivariate logistic regression analyses were used to identify the risk factors of PO. A nomogram model was constructed from the multivariate logistic regression analysis and internally validated for model discrimination and calibration. The performance of the nomogram was estimated using the concordance index (C-index).

Results

According to the efficacy evaluation criteria, 56 of 300 children demonstrated PO. The multivariate logistic regression analysis resulted in the following independent risk factors for PO: co-morbidity (OR: 8.032, 95% CI: 3.556-18.140, P < 0.0001), requiring invasive mechanical ventilation (IMV) (OR: 7.081, 95% CI: 2.250-22.282, P = 0.001), and ALB < 35 g/L (OR: 3.203, 95% CI: 1.151-8.912, P = 0.026). Results of the internal validation confirmed that the model provided good discrimination (concordance index [C-index], 0.876 [95% CI: 0.828-0.925]). The calibration plots in the nomogram model were of high quality.

Conclusion

The nomogram facilitated accurate prediction of PO in children diagnosed with SCAP and could be helpful for clinical decision-making.

Predictors of prolonged hospitalization among children aged 2-59 months with severe community-acquired pneumonia in public hospitals of Benishangul-Gumuz Region, Ethiopia: a multicenter retrospective follow-up study

Background

Pneumonia is a leading cause of morbidity and mortality among children aged under 5 years in Ethiopia. Prolonged hospitalization of severe community-acquired pneumonia is a significant problem in resource-limited countries. This study seeks to provide insights that can help improve the management and outcomes of severe community-acquired pneumonia, which is particularly important in the context of the Benishangul-Gumuz Region, Ethiopia, where access to quality healthcare services is limited, and childhood pneumonia is a significant health challenge.

Objective

The aim of the study was to determine the predictors of prolonged hospitalization among children aged 2-59 months admitted with severe community-acquired pneumonia between 1 January 2016 and 30 December 2020 in the public hospitals in Benishangul-Gumuz Region, Ethiopia.

Method

A retrospective follow-up study design was conducted among randomly selected samples of 526 children. Data were entered into EPI data version 4.6 and analyzed using STATA version 14.0. The Cox proportional hazard regression model was fitted to identify the independent predictors of prolonged hospitalization, and variables with a p-value <0.05 in the multivariable model were considered statistically significant.

Results

The median hospital stay was 5 days (interquartile range 2-8 = 6). Approximately 149 (28.93%) children had prolonged hospitalization (>5 days) and the recovery rate from severe community-acquired pneumonia was 19.69 per 100 person-day observations. The significant predictors of prolonged hospitalization were as follows: having facility referral sources [0.79, 95% confidence interval (CI), 0.63-0.98]; a nutritional status of wasting (0.64, 95% CI, 0.44-0.94); anemia (0.65, 95% CI, 0.46-0.90); no identified hemoglobin level (0.53, 95% CI, 0.41-0.70); no identified blood film (0.65, 95% CI, 0.53-0.80); no chest x-ray investigation (0.81, 95% CI, 0.65-0.99); pulmonary effusion (0.31, 95% CI, 0.15-0.66); and late presenters to hospital (0.67, 95% CI, 0.53-0.84) at admission.

Conclusions

The median length of stay in hospital was delayed compared to other studies. Wasting, late presenting to hospital, pulmonary effusion, anemia, absence of investigations of hemoglobin level, chest x-ray, and blood film at admission time were factors that significantly prolonged the hospitalization time. Hence, attention should be given to the prevention of malnutrition and anemia in children, increasing early health-seeking behavior in the community. Attention should be given to complications such as pleural effusion, and investigations, such as chest x-ray, hemoglobin levels, and blood films, should be performed when the child is admitted.

What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review

Background

Knowledge of the risk factors for and causes of treatment failure and mortality in childhood pneumonia is important for prevention, diagnosis, and treatment at an individual and population level. This review aimed to identify the most important risk factors for mortality among children aged under ten years with pneumonia.

Methods

We systematically searched MEDLINE, EMBASE, and PubMed for observational and interventional studies reporting risk factors for mortality in children (aged two months to nine years) in low- and middle-income countries (LMICs). We screened articles according to specified inclusion and exclusion criteria, assessed risk of bias using the EPHPP framework, and extracted data on demographic, clinical, and laboratory risk factors for death. We synthesized data descriptively and using Forest plots and did not attempt meta-analysis due to the heterogeneity in study design, definitions, and populations.

Findings

We included 143 studies in this review. Hypoxaemia (low blood oxygen level), decreased conscious state, severe acute malnutrition, and the presence of an underlying chronic condition were the risk factors most strongly and consistently associated with increased mortality in children with pneumonia. Additional important clinical factors that were associated with mortality in the majority of studies included particular clinical signs (cyanosis, pallor, tachypnoea, chest indrawing, convulsions, diarrhoea), chronic comorbidities (anaemia, HIV infection, congenital heart disease, heart failure), as well as other non-severe forms of malnutrition. Important demographic factors associated with mortality in the majority of studies included age <12 months and inadequate immunisation. Important laboratory and investigation findings associated with mortality in the majority of studies included: confirmed Pneumocystis jirovecii pneumonia (PJP), consolidation on chest x-ray, pleural effusion on chest x-ray, and leukopenia. Several other demographic, clinical and laboratory findings were associated with mortality less consistently or in a small numbers of studies.

Conclusions

Risk assessment for children with pneumonia should include routine evaluation for hypoxaemia (pulse oximetry), decreased conscious state (e.g. AVPU), malnutrition (severe, moderate, and stunting), and the presence of an underlying chronic condition as these are strongly and consistently associated with increased mortality. Other potentially useful risk factors include the presence of pallor or anaemia, chest indrawing, young age (<12 months), inadequate immunisation, and leukopenia.

Epidemiology and mortality predictors for severe childhood community-acquired pneumonia in ICUs: A retrospective observational study

Background

To identify the epidemiology and mortality predictors of severe childhood community-acquired pneumonia (CAP) and evaluate the influence of medications on clinical outcomes in the real world.

Methods

We conducted a multicenter retrospective observational study among children aged ≤5 years with severe CAP, separately comparing the detailed information between those who experienced in-hospital death and those who survived in three different age groups. A multivariate logistic regression model was used to determine mortality predictors.

Results

A total of 945 children were recruited: 341 young children aged 2-59 months, 47 infants aged 29 days to 2 months, and 557 neonates aged less than 28 days. A total of 88 deaths occurred (9.3%). There was low adherence to antimicrobial guidelines in the group aged 2-59 months, and carbapenems widely served as initial empirical regimens. However, analysis of all three age groups showed that the efficacy of antibacterial drugs with initial empirical selection grades higher than those recommended by the guidelines was not better than that of antibacterial drugs with grades recommended by the guidelines. In multivariate analyses, very severe pneumonia (odds ratio (OR): 3.48; 95% confidence interval (CI): 1.36-8.93), lower birth weight (OR: 4.64; 95% CI: 1.78-12.20), severe underweight (OR: 6.06; 95% CI: 2.34-15.63), mechanical ventilation (OR: 2.58; 95% CI: 1.00-6.62; OR: 15.63; 95% CI 3.25-76.92), a higher number of comorbidities (OR: 8.40; 95% CI: 1.89-37.04), comorbidities including anemia (OR: 5.24; 95% CI: 2.33-11.76) and gastrointestinal hemorrhage (OR: 3.79; 95% CI: 1.36-10.53), and the use of sedative-hypnotics (OR: 2.60; 95% CI: 1.14-5.95) were independent risk factors for death; infants treated with probiotics had a lower mortality rate (OR: 0.14; 95% CI: 0.06-0.33).

Conclusions

Severe CAP remains a primary cause of death in children under 5 years of age. Clinical characteristics, comorbidities and medications are evidently associated with death. Importantly, we should pay particular attention to the identification of mortality predictors and establish prophylactic measures to reduce mortality.

Study to evaluate the socio-demographic and environmental factors affecting morbidity and mortality of community acquired pneumonia in children <5years

Aim: To evaluate the socio demographic and environmental factors affecting morbidity and mortality of community acquired pneumonia in children <5years. Materials and methods: The present Observational longitudinal study was carried in the Department of Paediatrics, Dr. D.Y. Patil Medical College, Pune, among 70 children less than 5 years of age admitted in the In-patient department , Neonatal Intensive Care Unit and Paediatric Intensive Care Unit diagnosed as community acquired pneumonia of either sex in the hospital. The study was carried out from may 2019-september 2021. The children who fulfilled the WHO criteria of Community Acquired Pneumonia were in addition to the Chest x-ray and investigations findings suggestive of CAP were enrolled. The details of the patient's personal and demographic profile, clinical presentation, underlying condition, laboratory investigations, therapy and course in the hospital, and the final outcome were all recorded on a pre-designed proforma. Results: Mean age of children presenting with pneumonia (31.92 months) was approximately similar with those presenting with severe pneumonia (30.37 months).

A systematic review of the clinical features of pneumonia in children aged 5-9 years: Implications for guidelines and research

Background

Childhood pneumonia presents a large global burden, though most data and guidelines focus on children less than 5 years old. Less information is available about the clinical presentation of pneumonia in children 5-9 years of age. Appropriate diagnostic and treatment algorithms may differ from those applied to younger children. This systematic literature review aimed to identify clinical features of pneumonia in children aged 5-9 years, with a focus on delineation from other age groups and comparison with existing WHO guidance for pneumonia in children less than 5 years old.

Methods

We searched MEDLINE, EMBASE and PubMed databases for publications that described clinical features of pneumonia in children 5-9 years old, from any country with no date restriction in English. The quality of included studies was evaluated using a modified Effective Public Health Project Practice (EPHPP) tool. Data relating to research context, study type, clinical features of pneumonia and comparisons with children less than 5 years old were extracted. For each clinical feature of pneumonia, we described mean percentage (95% confidence interval) of participants with this finding in terms of aetiology (all cause vs Mycoplasma pneumoniae), and method of diagnosis (radiological vs clinical).

Results

We included 15 publications, eight addressing all-cause pneumonia and seven addressing Mycoplasma pneumoniae. Cough and fever were common in children aged 5-9 years with pneumonia. Tachypnoea was documented in around half of patients. Dyspnoea/difficulty breathing and chest indrawing were present in approximately half of all-cause pneumonia cases, with no data on indrawing in the outpatient setting. Chest and abdominal pain were documented in around one third of cases of all-cause pneumonia, based on limited numbers. In addition to markers of pneumonia severity used in children <5 years, pallor has been identified as being associated with poorer outcomes alongside comorbidities and nutritional status.

Conclusions

Quality research exploring clinical features of pneumonia, treatment and outcomes in children aged 5-9 years using consistent inclusion criteria, definitions of features and age ranges are urgently needed to better inform practice and guidelines. Based on limited data fever and cough are common in this age group, but tachypnoea cannot be relied on for diagnosis. While waiting for better evidence, broader attention to features such as chest and abdominal pain, the role of chest radiographs for diagnosis in the absence of symptoms such as tachypnoea, and risk factors which may influence patient disposition (chest indrawing, pallor, nutritional status) warrant consideration by clinicians.

Protocol registration

PROSPERO: CRD42020213837.

Severe pneumonia: Treatment outcome and its determinant factors among under-five patients, Jimma, Ethiopia

Introduction:

Over 2 million children die from pneumonia each year accounting for almost one in five children’s deaths worldwide which is estimated to be 18% of mortality cases. Therefore, this study is aimed to assess treatment outcome and its determinant factors among under-five patients, Jimma, Ethiopia.

Methods:

Study design was conducted on 522 under-five children with severe pneumonia from 1 January 2017 to 30 December 2020. Pretested chart review format was used to collect data. Data were entered into EpiData, version 3.1, and exported to Statistical Package for the Social Sciences, version 23, for analysis. Logistic regression analysis with 95% confidence interval was used to declare statistical significance at p value <0.05.

Results:

Among 522 under-five children with severe pneumonia, majority (83.91%) of them were improved, whereas 1 over 6 (16.09%) of them were died. This finding showed that children who have malnutrition (adjusted odds ratio = 7.23 (3.17–14.51), p = 0.000), positive serostatus for HIV (adjusted odds ratio = 5.01 (1.91–12.13), p = 0.001), history of upper respiratory tract infections (adjusted odds ratio = 3.27 (1.55–6.91), p = 0.002), unvaccinated (adjusted odds ratio = 4.35 (1.60–11.79), p = 0.004), having complicated types of pneumonia (adjusted odds ratio = 8.48 (4.22–16.65), p < 0.001), and comorbidity disease (adjusted odds ratio = 5.21 (2.03–13.3), p < 0.001) were statistically significant with mortality.

Conclusion:

This study showed that mortality secondary to severe pneumonia was high. Being malnourished, positive serostatus for HIV infection, history of upper respiratory tract infections, unvaccinated, having complicated type of pneumonia, and other comorbidity disease were identified as determinant factors of mortality. Committed, harmonized, and integrated intervention needs to be taken to reduce mortality from severe pneumonia by enhancing child’s nutrition status, early detection and treatment, effectively vaccinating children, and preventing other comorbidity diseases.

Acute respiratory infections (ARIs) and factors associated with their poor clinical outcome among children under-five years attending pediatric wards of public hospital in Southwest district of Ethiopia: A prospective observational cohort study

This study was designed to assess the prevalence and factors associated with poor clinical outcome of acute respiratory infections (ARIs) among children less than five years of age at Mizan-Tepi university teaching public hospital in southwest district of Ethiopia. A prospective observational cohort study design was conducted from 01 June to August 30, 2020. Data related to socio-demographics, child nutritional status, clinical and environmental characteristics of patients were collected with structured questionnaire. Follow-up data were gathered from patient’s medical records using standard data collection tool. The data were analyzed using SPSS versions 25.0. In this study, 305 children of age less than five years were included. Of these, 124 (40.7%) of children were diagnosed with ARIs, of which 66 (53.2%) were female and 69 (55.6%) were age of 24–59 months. Of children diagnosed with ARIs, 21 (16.9%) were ended with poor clinical outcomes after completion of their treatment. In the multivariate analysis, age of children and presence of any other disease conditions (OR = 0.331; 95% CI: 0.123– 0.880; p= 0.024), exposure to indoor air pollution (OR = 0.344; 95% CI: 0.128– 0.925; p= 0.030),  malnutrition (OR = 0.175; 95% CI: 0.058– 0.523; p= 0.002) and end point pneumonia (OR = 0.305; 95% CI: 0.113–0.821; p= 0.015) were found to be independent factors for poor outcome of under-five children with ARIs. Our findings highlight that timely detection, proper management and treatments as well as addressing other contributing factors are essentials in order to reduce prevalence and poor clinical outcomes of under five children with ARIs.

Critical illness related to community acquired pneumonia, its epidemiology and outcomes in a pediatric intensive care unit of Pakistan

BACKGROUND

To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) METHODS: Retrospective review of medical records of all children (age 1 month to 18 years) admitted to PICU with CAP from January 2013 to March 2018 was done. Patients admitted in last 2 weeks before current illness and those with bronchiolitis (based on clinical diagnosis) were excluded. Data were collected on a structured proforma and included demographic, clinical data, comorbidities, therapeutic information, laboratory data, and outcome data. Results were presented as mean with SD and frequency with percentages. Factors associated with mortality were analyzed, using logistic regression for both univariate and multivariate analyses.

RESULTS

A total of 187 children with severe CAP were identified, 53.5% (n = 100) were <1 year of age and 65.2% (n = 122) were male, 32.6% (n = 61) were underweight, and 24.6% (n = 46) were stunted. A total of 94% (175) required mechanical ventilation. Mortality among the cohort was 20.3% (n = 38) with median length of mechanical ventilation 4 (2-8) days, and median length of PICU stay was 6 (4-12) days. PRISM score >10 on admission, presence of systemic illness, empyema, and length of PICU stay 14 (±2) days were associated with increased mortality among critically ill children admitted with CAP (p < .05).

CONCLUSIONS

Severe illness on presentation, presence of systemic illness and empyema are associated with increased mortality in children admitted to the PICU with severe CAP.

Clinical outcome and risk factors of patients with suspected pneumonia in Southwest district of Ethiopia, 2020: A retrospective study

Acute respiratory infections (ARIs), especially pneumonia, remain the leading cause of childhood mortality and the most common reason for adult hospitalization in low- and middle-income countries, despite advances in preventative and management strategies. This study was conducted to assess factors associated with poor clinical outcome of suspected pneumonia cases among hospitalized patients at the three public health hospitals in Southwest district of Ethiopia. A cross-sectional study was conducted from May to July, 2020. Those patients admitted with suspected pneumonia were followed up during their hospital stay, and data on outcomes were captured by study nurses. Socio-demographics, clinical features, and follow-up data were gathered, and analyzed using SPSS versions 20.0. The differences in patients’ outcome in relation to their clinical features and epidemiologically linked exposures were described and compared using chi-square tests at 95% confident intervals. In this study, 742 patients with suspected pneumonia were analyzed. Of these, 473 (62.8%) of them were male, and 264 (35.6%) were of age 1–4 years. About 533 (71.8%) patients with suspected pneumonia were presented with irregular respiratory signs/symptoms (more than one symptoms) and 132 (17.9%) had underline illnesses. About 633 (85.4%) of patients were improved after treatment, and 109 (14.7%) of them ended with poor clinical outcome after completion of their treatment. Age of the patients and presence of comorbid conditions such as HIV/AIDS infections and bronchial asthma were identified as the risk factors for poor outcome of patients with suspected pneumonia. The clinical outcome of patients with suspected pneumonia at the three hospitals in Southwest district of Ethiopia was not satisfactory. Our findings highlight that in order to reduce poor clinical outcome related to suspected pneumonia, the efforts should be focused on some factors like management and prevention of chronic comorbidities. Increasing clinicians’ awareness on early management of suspected pneumonia cases is also essential in reducing the burden of the disease .

The Deep Learning LSTM and MTD Models Best Predict Acute Respiratory Infection among Under-Five-Year Old Children in Somaliland

The most effective techniques for predicting time series patterns include machine learning and classical time series methods. The aim of this study is to search for the best artificial intelligence and classical forecasting techniques that can predict the spread of acute respiratory infection (ARI) and pneumonia among under-five-year old children in Somaliland. The techniques used in the study include seasonal autoregressive integrated moving averages (SARIMA), mixture transitions distribution (MTD), and long short term memory (LSTM) deep learning. The data used in the study were monthly observations collected from five regions in Somaliland from 2011–2014. Prediction results from the three best competing models are compared by using root mean square error (RMSE) and absolute mean deviation (MAD) accuracy measures. Results have shown that the deep learning LSTM and MTD models slightly outperformed the classical SARIMA model in predicting ARI values.

Predictors of Treatment Outcomes among Pediatric Patients Hospitalized with Pneumonia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background

Pneumonia remains the leading cause of hospitalization and mortality in young children in low- and middle-income countries. This study is aimed to assess predictors of treatment outcomes among pediatric patients hospitalized with pneumonia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A facility-based retrospective cross-sectional study was conducted among pediatric patients admitted with pneumonia, considering patient medical charts recorded for a 1-year period from February 2017 to February 2018. The sample size was computed based on a single population proportion formula and giving a total sample size of 207. The systematic random sampling method was employed to select patient cards from the sampling frame. The data extraction format was used to extract any relevant information from patient chart. The processed data were analyzed by using Statistical Package for Social Sciences (SPSS, version 21). Descriptive statistics were used to summarize the patients' baseline characteristics and related information. The logistic regression model was fitted to determine factors associated with treatment outcomes. To identify predictors of poor treatment outcome, the level of significance was set at P < 0.05.

Results

From a total of 207 patient charts reviewed, more than half (55.6%) of the study participants were males. Majority of patients, 130 (62.8%), were in the age range of 1 month–11 months. Furthermore, 191 (92.3%) patients had good treatment outcome. Patients who treated with ceftriaxone + azithromycin were less likely to have poor treatment outcome compared with patients who were placed on crystalline penicillin (AOR = 0.86, 95% CI 0.01–0.83). On the contrary, patients who stayed ≥ 8 days were about 14.3 times more likely to have poor treatment outcome compared with patients who stayed ≤ 3 days (AOR = 14.3, 95% CI 1.35–151.1).

Conclusion

Even though the study revealed good treatment outcome among the pediatric patients, particular consideration should be given to children in need of other interventions.

Clinical and Epidemiological Determinants of Lower Respiratory Tract Infections in Hospitalized Pediatric Patients

Background

Lower respiratory tract infection (LRTI) is the main cause of pediatric mortality and morbidity in low- and middle-income countries.

Purpose

This study was carried out to determine the clinical and epidemiological characteristics of children with LRTI.

Method

A retrospective study was conducted on all pediatric patients who were hospitalized due to LRTI in Abuzar Hospital (Ahvaz, Iran) during one year. Incomplete medical records and children who were treated on an outpatient basis, as well as infants younger than 1 month of age, were excluded. The patients were evaluated in terms of epidemiological, clinical, and paraclinical characteristics.

Results

A total of 303 hospitalized children and infants were identified. Their mean age was 29.09 ± 38.96 months (range 1 month-15 years), and 59.4% of them were males. The highest frequency of patients was at the age below one year (50.8%, n = 154). Pneumonia and bronchitis were the most common LRTIs. Respiratory (54.6%) and neurological (21.6%) diseases were the most prevalent underlying medical conditions. Admission was more common in winter (n = 120, 39.6%) and spring (n = 79, 26.1%). The mean length of stay (LOS) in the hospital was 8.2 ± 5.5 days, and the overall mortality rate was 11.6%. In addition, 65 patients were severely underweight and 271 patients were malnourished. Moreover, there was a significant association between mortality and disease diagnosis (p < 0.05). Furthermore, there was a significant association between having an underlying disease and consanguineous parents (p < 0.01), as well as the frequency of hospitalization (p < 0.001).

Conclusion

Additional studies are required to determine factors contributing to disease severity among children with LRTI to develop appropriate preventive and therapeutic strategies.

Risk factors for mortality from severe community-acquired pneumonia in hospitalized children transferred to the pediatric intensive care unit

BACKGROUND

Some children hospitalized due to severe community-acquired pneumonia (CAP) require to the pediatric intensive care unit (PICU) because of severe complications. The purpose of this study was to identify the risk factors for mortality in this patient population.

METHODS

This study evaluated the medical records of 113 hospitalized children with severe CAP, who were transferred to the PICU within 48 h of admission at the Guangzhou Women and Children's Medical Center between 2013 and 2017.

RESULTS

The study group consisted of 87 boys (77%) and 26 girls (33%), aged between 1 month and 9 years; 72.6% (82/113) of patients were aged <12 months. The mortality rate was 12.3% (14/113). The most common viral and bacterial pathogens isolated were adenovirus (17.7%, 20/113) and Haemophilus influenzae (8.8%, 10/113). Wheezing, cyanosis, oxygen saturation <90%, Pediatric Early Warning Score (PEWS) >3 on admission, not receiving corticosteroid therapy prior to admission, the need for mechanical ventilation, septic shock, multi-organ dysfunction (MODS), and acute renal failure (ARF) occurring prior to transfer to the PICU, increased alanine aminotransferase (ALT) and aspartate transaminase (AST) levels, and decreased hemoglobin and albumin (ALB) levels were associated with mortality (P < 0.05). Non-survivors were more likely to have an oxygen saturation <90% on admission and lower levels of ALB prior to transfer to the PICU than survivors (P < 0.05).

CONCLUSIONS

Our results showed that hospitalized children with severe CAP who were transferred to the PICU within 48 h of hospital admission were mainly aged <1 year. Additionally, an oxygen saturation <90% and decreased ALB levels were early prognostic variables independently associated with death.

Time to recovery and predictors of severe community-acquired pneumonia among pediatric patients in Debre Markos referral hospital, North West Ethiopia: A retrospective follow-up study

Introduction

Globally, pneumonia is a major cause of morbidity and mortality among children which leads to over 156 million episodes and 14.9 million hospitalizations each year. Besides this fact, the recovery time and predictors of children’s hospitalization related to severe community-acquired pneumonia is not well known. Therefore, the aim of this study was to estimate the median time to recovery and its predictors among severe community-acquired pneumonia patients admitted to the pediatric ward, Debre Markos referral hospital, North West Ethiopia.

Methods

An institution-based retrospective follow-up study was employed among 352 records of children who were admitted starting from January 2016 to December 2018. Patients' charts were retrieved using a structured data extraction tool. Cox proportional hazard model assumption and model fitness was checked. Stratified Cox regression was fitted as a final model. Hazard ratio with its 95% confidence interval was used and P-value < 0.05 was considered as a statistically significant association.

Result

The overall median recovery time was 4 days IQR (3–7). Recovery rate from severe community acquired pneumonia was 16.25 (95% CI: 14.54–18.15) per 100 person day observation. Age (AHR; 0.94 95% CI (0.90–0.98)), being stunted (AHR; 0.62 95% CI (0.43–0.91)), presence of danger sign at admission (AHR; 0.61 95% CI (0.40–0.94)), late presentation to seek care(AHR; 0.64 95% CI (0.47–0.88)) and co-morbidity (AHR; 0.45 95% CI (0.35–0.58)) were significant predictors of recovery time.

Conclusion

The median recovery time from severe community-acquired pneumonia was long so that measures to reduce recovery time should be strengthened.

Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia's demographic and health surveys (1996-2014)

Introduction

acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under the age of five years globally accounting for 16% of deaths. In Zambia, ARI accounts for 30-40% of children's outpatient attendance and 20-30% of hospital admissions. We assessed trends and factors associated with ARI among under-five children in Zambia from 1996 to 2014.

Methods

we analysed the Zambia demographic and health survey data for 1996, 2002, 2007 and 2014 of under five children and their mothers. We extracted data using a data extraction tool from the women's file. We analysed trends using chi square for trends. We conducted a complex survey multivariable logistic regression analysis, reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values.

Results

we included a total of 6,854 and 2,389 (8%) had symptoms consistent with ARI. A 2% upward trend was noted between the 1996 and 2002 surveys but a sharp decline of 10% occurred in 2007. The chi2 trend test was significant p < 0.001. Children whose mothers had secondary or higher education were less likely to have ARI (AOR 0.30 95% CI 0.15-0.58) compared to those with no education. Underweight children had 1.50 times increased odds of having ARI (AOR 1.50 95% CI 1.25 - 1.68) compared with children who were not. Use of biomass fuels such as charcoal (AOR 2.67 95% CI 2.09 - 3.42) and wood (2.79 95% CI 2.45 -3.19) were associated with high odds for ARI compared to electricity.

Conclusion

the prevalence of ARI has declined in Zambia from 1996 to 2014. Factors associated with occurrence of ARI included being a child under one year, underweight, use of biomass fuel such as charcoal and wood. Interventions to reduce the burden of ARI should be targeted at scaling up nutrition programs, as well as promoting use of cleaner fuels.

Influenza epidemiology and risk factors for severe acute respiratory infection in Morocco during the 2016/2017 and 2017/2018 seasons

Introduction

in order to implement an influenza vaccination program for high-risk-groups in Morocco, as recommended by the World Health Organization, an epidemiological study indicating the influenza virus effect in the development of complicated influenza for subjects with co-morbidity was required. The present study aims to evaluate the risk factors for severe acute respiratory infections caused by influenza in risk groups.

Methods

this research is based on the epidemiological and virological surveillance data of severe acute respiratory infections and influenza-like illness during the 2016/2017 and 2017/2018 seasons. It was realized using a retrospective series study with a descriptive and analytical purpose.

Results

the over-recruitment of pediatric cases with a severe acute respiratory infection has been significantly rectified because cases of severe acute respiratory infections under 15 years old in the 2017/2018 season represent only 57.9%, whereas they represented 75.9% of the total cases of severe acute respiratory infections during the 2016/2017 season. The influenza positivity rate has increased globally and specifically by age group, clinical service and co-morbidity. The risk factors considered were significantly associated with hospitalization for influenza-associated severe acute respiratory infections. The multivariate logistic regression analysis considers male sex (OR=2.1), age ≥65 years (OR=5.4), presence of influenza cases in the surroundings (OR=0.1), diabetes (OR=7.5) and chronic respiratory disease (OR=10.9) as risk factors influenza-associated severe acute respiratory infections.

Conclusion

the risk assessment of influenza-associated severe acute respiratory infections in high-risk groups revealed national epidemiological findings, particularly for diabetics and the elderly. An influenza vaccination program for these high-risk-groups becomes much recommended in Morocco.

Pneumonia among under-five children in Alexandria, Egypt: a case-control study

Background

Pneumonia among under-five children constitutes a major public health concern. Studies examining risk factors for pneumonia in Egypt are limited.

Aim

To identify risk factors of pneumonia among under-five children in Alexandria, Egypt.

Methods

An observational case-control study was conducted over a 5-month period (September 2017–January 2018) in three main pediatric hospitals in Alexandria. A predesigned questionnaire was used to interview 660 mothers of under-five children (330 pneumonia cases and 330 control). The questionnaire included potential risk factors for pneumonia which were categorized into child-related factors, socio-demographic factors, and environmental factors.

Results

The mean age of the children was 23.14 ± 18.61 months with a range of 1–59 months. Nearly two-thirds (58.5%) were boys. Nine factors were found to be independently associated with pneumonia: age ≤ 12 months (OR = 1.925; 95% CI, 1.356–2.733; P < 0.001), male gender (OR = 1.646; 95% CI, 1.162–2.332; P = 0.005), birth order ≥ 4 (OR = 2.154; 95% CI, 1.282–3.617; P = 0.004), low birth weight (OR = 2.562; 95% CI, 1.718–3.821; P < 0.001), prematurity (OR = 2.019; 95% CI, 1.154–3.531; P = 0.014), place of delivery either at home (OR = 5.669; 95% CI, 1.063–30.237; P = 0.042) or at a public hospital (OR = 1.616; 95% CI, 1.131–2.310; P = 0.008), presence of concomitant illness (OR = 1.902; 95% CI, 1.043–3.469; P = 0.036), poor home aeration (OR = 3.586; 95% CI, 1.971–6.522; P < 0.001), and exposure to outdoor air pollution (OR = 2.403; 95% CI, 1.417–4.076; P = 0.001).

Conclusion

Several risk factors were significantly related to pneumonia among under-five children. Identifying such factors is important for developing interventions to reduce pneumonia burden among under-five in Egypt.

Incidence and Risk Factors for Severe Pneumonia in Children Hospitalized with Pneumonia in Ujjain, India

Childhood pneumonia is a major public health problem. The aim of this prospective hospital-based study is to determine the incidence and risk factors for community-acquired severe pneumonia in children in Ujjain, India. The study includes 270 children, 161 (60%) boys and 109 (40%) girls, aged between 2 months and 5 years with World Health Organization defined and radiologically confirmed severe pneumonia. Considering the 270 children, 64% (95% confidence interval (CI) 57.9–69.4) have severe pneumonia. The following are identified as risk factors for severe pneumonia from the generalized logistic regression model: Born premature (adjusted odds ratio (AOR) 7.50; 95% CI 2.22–25.31; p = 0.001); history of measles (AOR 6.35; 95% CI 1.73–23.30; p = 0.005); incomplete vaccination (AOR 2.66; 95% CI 1.09–6.48; p = 0.031); acyanotic congenital heart disease (AOR 9.21; 95% CI 2.29–36.99; p = 0.002); home treatment tried (AOR 3.84; 95% CI 1.42–10.39; p = 0.008); living in a kuchha house (AOR 3.89; 95% CI 1.51–10.01; p = 0.027); overcrowding (AOR 4.50; 95% CI 1.75–11.51; p = 0.002);poor ventilation in living area (AOR 16.37; 95% CI 4.67–57.38; p < 0.001); and practicing open defecation (AOR 16.92; 95% CI 4.95–57.85; p < 0.001). Awareness of these risk factors can reduce mortality due to severe pneumonia.

Determinants of Under-Five Pneumonia at Gondar University Hospital, Northwest Ethiopia: An Unmatched Case-Control Study

Background

Pneumonia causes about two million under-five deaths each year, accounting for nearly one in five child deaths globally. Knowing the determinants of under-five pneumonia is useful for prevention and intervention programs that are aimed to control the disease. Thus, the main aim of this study was to assess the determinants of under-five pneumonia at Gondar University Hospital, Ethiopia.

Methods

An institution-based unmatched case-control study was carried out from April 1 to April 30, 2015, taking a sample size of 435 study participants (145 cases and 290 controls). The researchers used a systematic random sampling technique for selecting cases and controls. Data were entered and cleaned using Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable analysis was performed, and variables with a p value less than 0.2 were entered into multivariable logistic regression. Determinant factors were identified based on p value less than 0.05 and adjusted odds ratio with 95% confidence interval (AOR with 95% CI).

Results

An increased odds of pneumonia was associated with children who had diarrhea in the past fifteen days of data collection (AOR = 6.183; 95% CI: 3.482, 10.977), children's mothers who did not hear about how to handle domestic smoking (AOR = 5.814; 95% CI: 2.757, 12.261), and children of mothers who did not follow proper handwashing practice (AOR = 3.469; 95% CI: 1.753, 6.863).

Conclusions

Being infected with diarrhea, not knowing how to handle domestic smoking, and poor compliance with proper handwashing practice were identified as determinants of pneumonia. Dedicated, coordinated, and integrated intervention needs to be taken to enhance proper handwashing practice by mothers/caregivers, improve the indoor air quality, and prevent diarrheal diseases at the community level.

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

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.

Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country

INTRODUCTION AND OBJECTIVES

Acute respiratory infections (ARI), a major cause of childhood mortality and morbidity, place substantial burden on health services worldwide. Due to scarce data regarding respiratory illnesses requiring Pediatric intensive care unit (PICU) admissions (especially in low income/developing countries), we studied the burden of respiratory illnesses in the PICU and the risk factors contributing to mortality.

METHODS

This prospective observational study was conducted over 18 months. Children (aged 1 month to 12 years) admitted to the PICU for acute respiratory/cardiorespiratory illnesses were enrolled. Demographic and clinical details of the study population were recorded and tabulated. Risk factors contributing to mortality (severity of illness [PRISM III score], diagnosis/etiology, need for mechanical ventilation, immunocompromised status, malnutrition, and length of stay [LOS]) were analyzed (using the χ² test or Fischer Exact test).

RESULTS

Two hundred and ninety-three children were enrolled (median age: 5 months; range, 1-132 months; male/female: 181/112). Mean LOS in PICU was 5.25 ± 5.48 days and mean length of hospital stay of 14.82 ± 13.35 days. Mechanical ventilation was required in 62.8% cases. Pneumonia contributed to 66.89% of respiratory admissions and 91% of mortality. Ninety patients (30.7%) died; mortality being higher in cardiorespiratory cases (52.7%). PRISM III score and shock (respiratory cases) and age below 1 year (cardiorespiratory group) were significantly associated with higher mortality ( P < 0.05).

CONCLUSIONS

Respiratory illnesses are a significant contributor to PICU admissions and are associated with significant mortality risk in presence of high PRISM III score and shock (respiratory group); and age below 1 year (cardiorespiratory group).

Does atopy affect the course of viral pneumonia?

Background

The presence of atopy is considered as a risk factor for severe respiratory symptoms in children. The objective of this study was to examine the effect of atopy on the course of disease in children hospitalised with viral pneumonia.

Methods

Children between the ages of 1 and 6 years hospitalised due to viral pneumonia between the years of 2013 and 2016 were included to this multicentre study. Patients were classified into two groups as mild–moderate and severe according to the course of pneumonia. Presence of atopy was evaluated with skin prick tests. Groups were compared to evaluate the risk factors associated with severe viral pneumonia.

Results

A total of 280 patients from nine centres were included in the study. Of these patients, 163 (58.2%) were male. Respiratory syncytial virus (29.7%), Influenza A (20.5%), rhinovirus (18.9%), adenovirus (10%), human metapneumovirus (8%), parainfluenza (5.2%), coronavirus (6%), and bocavirus (1.6%) were isolated from respiratory samples. Eighty-five (30.4%) children had severe pneumonia. Atopic sensitisation was found in 21.4% of the patients. Ever wheezing (RR: 1.6, 95% CI: 1.1–2.4), parental asthma (RR: 1.5, 95% CI: 1.1–2.2), other allergic diseases in the family (RR: 1.8, 95% CI: 1.2–2.9) and environmental tobacco smoke (RR: 1.6, 95% CI: 1.1–3.5) were more common in the severe pneumonia group.

Conclusions

When patients with mild–moderate pneumonia were compared to patients with severe pneumonia, frequency of atopy was not different between the two groups. However, parental asthma, ever wheezing and environmental tobacco smoke exposure are risk factors for severe viral pneumonia in children.

Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study

BACKGROUND

Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital.

METHODS

We did a retrospective cohort study of children aged 2-59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia).

FINDINGS

We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1-6·8), mild to moderate pallor (3·4, 3·0-3·8), and weight-for-age Z score (WAZ) less than -3 SD (3·8, 3·4-4·3). Additional factors that were independently associated with death were: WAZ less than -2 to -3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more.

INTERPRETATION

In settings of high mortality, WAZ less than -3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making.

FUNDING

Wellcome Trust.

Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit

AIMS

To describe the epidemiology of children with severe pneumonia and identify risk factors for poor outcomes.

METHODS

We conducted a retrospective study of children admitted to pediatric intensive care unit (PICU) from 2010 to 2014 with a diagnosis of pneumonia. Clinical microbiological, ventilation and other pertinent PICU data were collected. Primary outcome was PICU mortality. Univariate and multivariate logistic regression model were used to identify risk factors for mortality.

RESULTS

Severe pneumonia consisted of 237/3539 (6.7%) of PICU admissions. Of these, 162/237 (68.4%) required mechanical ventilation. 32/237 (13.5%) patients died. The majority of patients had no organisms identified 82/237 (34.6%). A sole bacterial or viral pathogen was identified in 48/237 (20.1%) and 41/237 (17.9%) patients, respectively. Patients with viral pneumonias were more likely to develop acute respiratory distress syndrome compared to other etiologies (7/41[17.1%] vs 8/196 [4.0%]; P = 0.006). Bacterial pneumonias were associated with lung abscess (4/48 [8.3%] vs 2/189 [1.5%]; P = 0.016) and necrotizing pneumonia (18/48 [37.5%] vs 15/189 [7.9%]; P < 0.001) compared to other etiologies. Co-detections (>1 respiratory pathogens isolated) occurred in 62/237 (26.2%) patients and were associated a higher rate of mechanical ventilation, and decreased ventilator and PICU free days. After adjusting for severity of illness, risk factors for mortality were: hospital acquired pneumonia (HAP) (aOR: 2.92 [95%CI 1.15, 7.40]; P = 0.024) and bacteremia (aOR: 5.03 [95%CI 1.77, 14.35]; P = 0.003).

CONCLUSIONS

Severe pediatric pneumonia accounts for a significant number of PICU admissions and is associated with significant mortality risk. The presence of co-morbidities, HAP and bacteremia were early prognostic variables independently associated with poor clinical outcomes.

Exploring pneumonia risk factors in Vietnamese infants: a survey of new mothers

OBJECTIVE

To understand the prevalence of pneumonia risk factors and perceived barriers to risk factor reduction among Vietnamese infants.

METHODS

We conducted a cross-sectional survey of mothers in the postnatal wards of Da Nang Hospital for Women and Children in central Vietnam from 10 February 2017 to 24 February 2017.

RESULTS

Of 286 mothers surveyed, 259 (91%) initiated breast feeding and 207 (72%) intended to continue exclusive breast feeding for 6 months. No mother smoked cigarettes, but 42% of fathers did. Mothers' decision not to smoke was motivated by concerns for their own health and that of their baby. Households rarely used wood or coal for cooking (6%). Mothers indicated near universal (99%) uptake of the National Expanded Program of Immunization vaccinations. Few (64; 22%) mothers knew about the pneumococcal conjugate vaccine; 56/64 (88%) indicated that they would purchase it for their infants. Family members rarely influenced mothers' decisions about breast feeding or vaccination, except in two instances where fathers were concerned about vaccine-related adverse effects.

CONCLUSION

Modifiable pneumonia risk factors were uncommon among newborn babies in central Vietnam, apart from paternal cigarette smoke exposure. Successful local implementation of the WHO Essential Newborn Care package as well as high levels of maternal education and decision autonomy was observed.

Risk factors for child pneumonia - focus on the Western Pacific Region

Pneumonia is a major cause of disease and death in infants and young children (aged <5 years) globally, as it is in the World Health Organization Western Pacific region. A better understanding of the underlying risk factors associated with child pneumonia is important, since pragmatic primary prevention strategies are likely to achieve major reductions in pneumonia-associated morbidity and mortality in children. This review focuses on risk factors with high relevance to the Western Pacific region, including a lack of exclusive breastfeeding, cigarette smoke and air pollution exposure, malnutrition and conditions of poverty, as well as common co-morbidities. Case management and vaccination coverage have been considered elsewhere.

Human metapneumovirus in patients hospitalized with acute respiratory infections: A meta-analysis

This meta-analysis aimed to estimate the prevalence of human metapneumovirus (hMPV) infections in patients hospitalized for acute respiratory infection (ARI) and to study factors associated with this prevalence. Medline and ScienceDirect databases were searched for prospective observational studies that screened hospitalized patients with ARI for hMPV by RT-PCR, with data available at December 27, 2014. The risk of bias was assessed regarding participation rate, definition of ARI, description of diagnostic technique, method of inclusion identical for all subjects, standardized and identical sampling method for all subjects, analysis performed according to the relevant subgroups, and presentation of data sources. Random-effect meta-analysis with arcsine transformation and meta-regressions was used. In the 75 articles included, the prevalence of hMPV among hospitalized ARI was 6.24% (95% CI 5.25-7.30). An effect of the duration of the inclusion period was observed (p=0.0114), with a higher prevalence of hMPV in studies conducted during periods of 7-11 months (10.56%, 95% CI 5.97-16.27) or complete years (7.55%, 95% CI 5.90-9.38) than in periods of 6 months or less (5.36%, 95% CI 4.29-6.54). A significant increase in the incidence with increasing distance from the equator was observed (p=0.0384). hMPV should be taken into account as a possible etiology in hospitalized ARI.

A comparison of human metapneumovirus and respiratory syncytial virus WHO-defined severe pneumonia in Moroccan children

Acute respiratory infections remain the principal cause of morbidity and mortality in Moroccan children. Besides bacterial infections, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are prominent among other viruses due to their high prevalence and association with severe clinical episodes. We aimed to describe and compare RSV- and hMPV-associated cases of WHO-defined severe pneumonia in a paediatric population admitted to Morocco's reference hospital. Children aged 2-59 months admitted to the Hôpital d'Enfants de Rabat, Morocco meeting WHO-defined severe pneumonia criteria were recruited during 14 months and thoroughly investigated to ascertain a definitive diagnosis. Viral prevalence of RSV, hMPV and other viruses causing respiratory symptoms was investigated in nasopharyngeal aspirate samples through the use of molecular methods. Of the 683 children recruited and included in the final analysis, 61/683 (8·9%) and 124/683 (18·2%) were infected with hMPV and RSV, respectively. Besides a borderline significant tendency for higher age in hMPV cases, patients infected with either of the viruses behaved similarly in terms of demographics, patient history, past morbidity and comorbidity, vaccination history, socioeconomic background and family environment. Clinical presentation on arrival was also similar for both viruses, but hMPV cases were associated with more severity than RSV cases, had a higher risk of intensive care need, and received antibiotic treatment more frequently. RSV and hMPV are common and potentially life-threatening causes of WHO-defined pneumonia in Moroccan children. Both viruses show indistinctive clinical symptomatology, but in Moroccan children, hMPV was associated with a more severe evolution.

Knowledge gaps on paediatric respiratory infections in Morocco, Northern Africa

BACKGROUND

The burden of acute respiratory infections (ARI) among Moroccan children remains significant. However, scarce information is available regarding trends in its epidemiology and etiology, or regarding its associated prognostic factors. The purpose of this work was to review available data on the burden of ARI among children under five years of age in Morocco.

METHODS

A systematic review was conducted for the period 1997-2014 using the PRISMA proposed methodology. Various online databases were screened, in addition to physical libraries of Moroccan medical schools, and official reports of the Moroccan Ministry of Health. Search queries in English and French languages included: Respiratory Tract Infections, pneumonia, epidemiology, etiology, microbiology, mortality and Morocco. The documents were included for analysis when they reported original data on the incidence, distribution, or a clinical description of the diseases or their etiology or described clinical management or national preventive strategies.

RESULTS

Thirty-two documents were included in the final analysis. 21 of which had been published. In 2012, ARI caused 13% of paediatric deaths, half of the consultations at health facilities and third of the paediatric admissions. The microorganisms more frequently identified among hospitalized children were Streptococcus pneumoniae (38%) and Haemophilus influenza type b (Hib) (15%). The MOH introduced Hib vaccines into the national immunization program (PNI) in 2007and the 13-valent vaccine against pneumococcus in 2010. The national first line antibiotics recommended for non-severe ambulatory treatment is Amoxicillin. Studies of antibiotic resistance showed from 1998 to 2008 a 22% increase in the rate of penicillin non-susceptibility among Streptococcus pneumoniae isolates. Viral respiratory infections and the role attributed to air pollution in the incidence of ARI have been poorly characterized.

CONCLUSIONS

Further efforts should be made towards the development of adequate surveillance programs to better clarify the epidemiology, etiology, antimicrobial susceptibility patterns and the effectiveness of the preventives and curatives strategies in place against paediatric ARIs in Morocco. Additionally, a holistical approach should be used to identify the heath determinants of ARIs among children.