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Mortality after inpatient treatment for severe pneumonia in children : a cohort study.
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Ngari, Moses M., Fegan, Greg, Mwangome, Martha K., Ngama, Mwanajuma J., Mturi, Neema, Scott, John Anthony Gerard, Bauni, Evasius, Nokes, D. James and Berkley, James A. (2017) Mortality after inpatient treatment for severe pneumonia in children : a cohort study. Paediatric and Perinatal Epidemiology, 31 (3). pp. 233-242. doi:10.1111/ppe.12348 ISSN 0269-5022.
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Official URL: http://dx.doi.org/10.1111/ppe.12348
Abstract
Background:
Although pneumonia is a leading cause of inpatient mortality, deaths may also occur after discharge from hospital. However, prior studies have been small, in selected groups or did not fully evaluate risk factors, particularly malnutrition and HIV. We determined 1-year post-discharge mortality and risk factors among children diagnosed with severe pneumonia.
Methods:
A cohort study of children aged 1–59 months admitted to Kilifi County Hospital with severe pneumonia (2007–12). The primary outcome was death <1 year after discharge, determined through Kilifi Health and Demographic Surveillance System (KHDSS) quarterly census rounds.
Results:
Of 4184 children (median age 9 months) admitted with severe pneumonia, 1041 (25%) had severe acute malnutrition (SAM), 267 (6.4%) had a positive HIV antibody test, and 364 (8.7%) died in hospital. After discharge, 2279 KHDSS-resident children were followed up; 70 (3.1%) died during 2163 child-years: 32 (95% confidence interval (CI) 26, 41) deaths per 1000 child years. Post-discharge mortality was greater after admission for severe pneumonia than for other diagnoses, hazard ratio 2.5 (95% CI 1.2, 5.3). Malnutrition, HIV status, age and prolonged hospitalisation, but not signs of pneumonia severity, were associated with post-discharge mortality. Fifty-two per cent (95% CI 37%, 63%) of post-discharge deaths were attributable to low mid-upper arm circumference and 11% (95% CI 3.3%, 18%) to a positive HIV test.
Conclusions:
Admission with severe pneumonia is an important marker of vulnerability. Risk stratification and better understanding of the mechanisms underlying post-discharge mortality, especially for undernourished children, are needed to reduce mortality after treatment for pneumonia.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RJ Pediatrics | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) | ||||||||
Library of Congress Subject Headings (LCSH): | Pneumonia in children -- Kenya, Pediatric respiratory diseases -- Kenya, Pneumonia in children -- Mortality -- Kenya | ||||||||
Journal or Publication Title: | Paediatric and Perinatal Epidemiology | ||||||||
Publisher: | Wiley-Blackwell Publishing, Inc. | ||||||||
ISSN: | 0269-5022 | ||||||||
Official Date: | May 2017 | ||||||||
Dates: |
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Volume: | 31 | ||||||||
Number: | 3 | ||||||||
Page Range: | pp. 233-242 | ||||||||
DOI: | 10.1111/ppe.12348 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 27 April 2017 | ||||||||
Date of first compliant Open Access: | 3 May 2017 | ||||||||
Funder: | Wellcome Trust (London, England) | ||||||||
Grant number: | 098532 (WT), 092654 (WT), 084633 (WT), 083579 (WT) |
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