Potentially Modifiable Factors Associated with Death of Infants and Children with Severe Pneumonia Routinely Managed in District Hospitals in Malawi

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Aug 4

PMID 26237222

Citations 15

Authors

Penelope M Enarson

Robert P Gie

Charles C Mwansambo

Alfred E Chalira

Norman N Lufesi

Ellubey R Maganga

Donald A Enarson

Neil A Cameron

Stephen M Graham

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate recognised co-morbidities and clinical management associated with inpatient pneumonia mortality in Malawian district hospitals.

Methods: Prospective cohort study, of patient records, carried out in Malawi between 1st October 2000 and 30th June 2003. The study included all children aged 0-59 months admitted to the paediatric wards in sixteen district hospitals throughout Malawi with severe and very severe pneumonia. We compared individual factors between those that survived (n = 14 076) and those that died (n = 1 633).

Results: From logistic regression analysis, predictors of death in hospital, adjusted for age, sex and severity grade included comorbid conditions of meningitis (OR =2.49, 95% CI 1.50-4.15), malnutrition (OR =2.37, 95% CI 1.94-2.88) and severe anaemia (OR =1.41, 95% CI 1.03-1.92). Requiring supplementary oxygen (OR =2.16, 95% CI 1.85-2.51) and intravenous fluids (OR =3.02, 95% CI 2.13-4.28) were associated with death while blood transfusion was no longer significant (OR =1.10, 95% CI 0.77-1.57) when the model included severe anaemia.

Conclusions: This study identified a number of challenges to improve outcome for Malawian infants and children hospitalised with pneumonia. These included improved assessment of co-morbidities and more rigorous application of standard case management.

Citing Articles

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

Cao L, Ji Z, Zhang P, Wang J Front Pediatr. 2023; 11:1031423.

PMID: 37033191 PMC: 10076704. DOI: 10.3389/fped.2023.1031423.

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

Wilkes C, Bava M, Graham H, Duke T J Glob Health. 2023; 13:05003.

PMID: 36825608 PMC: 9951126. DOI: 10.7189/jogh.13.05003.

Derivation and validation of a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality in 20 countries.

Rees C, Colbourn T, Hooli S, King C, Lufesi N, McCollum E BMJ Glob Health. 2022; 7(4).

PMID: 35428680 PMC: 9014031. DOI: 10.1136/bmjgh-2021-008143.

Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola.

Pelkonen T, Roine I, Kallio M, Jahnukainen K, Peltola H BMJ Open. 2022; 12(3):e057285.

PMID: 35288394 PMC: 8921951. DOI: 10.1136/bmjopen-2021-057285.

Prevalence and associated factors of pneumonia among under-fives with acute respiratory symptoms: a cross sectional study at a Teaching Hospital in Bushenyi District, Western Uganda.

Kiconco G, Turyasiima M, Ndamira A, Yamile O, Egesa W, Ndiwimana M Afr Health Sci. 2022; 21(4):1701-1710.

PMID: 35283986 PMC: 8889805. DOI: 10.4314/ahs.v21i4.25.

References

Duke T, Mgone C . Measles: not just another viral exanthem. Lancet. 2003; 361(9359):763-73. DOI: 10.1016/S0140-6736(03)12661-X. View

Nolan T, Angos P, Cunha A, Muhe L, Qazi S, Simoes E . Quality of hospital care for seriously ill children in less-developed countries. Lancet. 2001; 357(9250):106-10. DOI: 10.1016/S0140-6736(00)03542-X. View

Graham S, English M, Hazir T, Enarson P, Duke T . Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings. Bull World Health Organ. 2008; 86(5):349-55. PMC: 2647436. DOI: 10.2471/blt.07.048512. View

Liu L, Johnson H, Cousens S, Perin J, Scott S, Lawn J . Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012; 379(9832):2151-61. DOI: 10.1016/S0140-6736(12)60560-1. View

English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A . Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet. 2004; 363(9425):1948-53. DOI: 10.1016/S0140-6736(04)16408-8. View

Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T . The prevalence of hypoxaemia among ill children in developing countries: a systematic review. Lancet Infect Dis. 2009; 9(4):219-27. DOI: 10.1016/S1473-3099(09)70071-4. View

Rice A, Sacco L, Hyder A, Black R . Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ. 2000; 78(10):1207-21. PMC: 2560622. View

Graham S, Mtitimila E, Kamanga H, Walsh A, Hart C, Molyneux M . Clinical presentation and outcome of Pneumocystis carinii pneumonia in Malawian children. Lancet. 2000; 355(9201):369-73. DOI: 10.1016/S0140-6736(98)11074-7. View

Fenn B, Morris S, Black R . Comorbidity in childhood in northern Ghana: magnitude, associated factors, and impact on mortality. Int J Epidemiol. 2005; 34(2):368-75. DOI: 10.1093/ije/dyh335. View

10.

Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V . Indicators of life-threatening malaria in African children. N Engl J Med. 1995; 332(21):1399-404. DOI: 10.1056/NEJM199505253322102. View

11.

Enarson P, Gie R, Enarson D, Mwansambo C . Development and implementation of a national programme for the management of severe and very severe pneumonia in children in Malawi. PLoS Med. 2009; 6(11):e1000137. PMC: 2766047. DOI: 10.1371/journal.pmed.1000137. View

12.

Black R, Cousens S, Johnson H, Lawn J, Rudan I, Bassani D . Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010; 375(9730):1969-87. DOI: 10.1016/S0140-6736(10)60549-1. View

13.

Zachariah R, Spielmann M, Chinji C, Gomani P, Arendt V, Hargreaves N . Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo, Malawi. AIDS. 2003; 17(7):1053-61. DOI: 10.1097/00002030-200305020-00015. View

14.

Jackson S, Mathews K, Pulanic D, Falconer R, Rudan I, Campbell H . Risk factors for severe acute lower respiratory infections in children: a systematic review and meta-analysis. Croat Med J. 2013; 54(2):110-21. PMC: 3641871. DOI: 10.3325/cmj.2013.54.110. View

15.

Oliwa J, Karumbi J, Marais B, Madhi S, Graham S . Tuberculosis as a cause or comorbidity of childhood pneumonia in tuberculosis-endemic areas: a systematic review. Lancet Respir Med. 2015; 3(3):235-43. DOI: 10.1016/S2213-2600(15)00028-4. View

16.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V . Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2095-128. PMC: 10790329. DOI: 10.1016/S0140-6736(12)61728-0. View

17.

Chisti M, Tebruegge M, Vincente S, Graham S, Duke T . Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health. 2009; 14(10):1173-89. DOI: 10.1111/j.1365-3156.2009.02364.x. View

18.

Enarson P, Gie R, Mwansambo C, Maganga E, Lombard C, Enarson D . Reducing deaths from severe pneumonia in children in Malawi by improving delivery of pneumonia case management. PLoS One. 2014; 9(7):e102955. PMC: 4106861. DOI: 10.1371/journal.pone.0102955. View

19.

Everett D, Cornick J, Denis B, Chewapreecha C, Croucher N, Harris S . Genetic characterisation of Malawian pneumococci prior to the roll-out of the PCV13 vaccine using a high-throughput whole genome sequencing approach. PLoS One. 2012; 7(9):e44250. PMC: 3438182. DOI: 10.1371/journal.pone.0044250. View

20.

English M, Punt J, Mwangi I, McHugh K, Marsh K . Clinical overlap between malaria and severe pneumonia in Africa children in hospital. Trans R Soc Trop Med Hyg. 1996; 90(6):658-62. DOI: 10.1016/s0035-9203(96)90423-x. View