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

• Published in: PloS one 2015-08, Vol.10 (8), p.e0133365-e0133365
• Main Authors: Enarson, Penelope M, Gie, Robert P, Mwansambo, Charles C, Chalira, Alfred E, Lufesi, Norman N, Maganga, Ellubey R, Enarson, Donald A, Cameron, Neil A, Graham, Stephen M
• Format: Article
• Language: English
• Subjects: Age; Anemia; Anemia - complications; Antibiotics; Blood transfusion; Case Management; Causes of; Child, Preschool; Children; Children & youth; Childrens health; Computational fluid dynamics; Death; Demographic aspects; Female; Health sciences; HIV; Hospitalization; Hospitals; Hospitals, District; Human immunodeficiency virus; Humans; Illnesses; Infant; Infant mortality; Infant, Newborn; Infants; Intravenous administration; Lung diseases; Malaria; Malawi; Male; Malnutrition; Malnutrition - complications; Meningitis; Meningitis - complications; Morbidity; Mortality; Oxygen; Pneumonia; Pneumonia - complications; Pneumonia - diagnosis; Prognosis; Prospective Studies; Regression analysis; Severity of Illness Index; Streptococcus infections; Streptococcus pneumoniae; Transfusion; Tuberculosis; Tutu, Desmond
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0133365

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