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Factors Predicting Mortality in Hospitalised Hiv-Negative Children with Lower-Chest-Wall Indrawing Pneumonia and Implications for Management
Chris Hani Baragwanath Academic Hospital - Vaccines and Infectious Diseases Analytics Research Unit; Johns Hopkins University - Department of International Health, International Vaccine Access Center
Background: In 2013 the World Health Organization revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based treatment rather than hospital admission. We analysed data from children hospitalized with LCWI pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) study to identify sub-groups with high odds of mortality, who might continue to benefit from hospital management.
Methods: PERCH enrolled 2189 HIV-negative children aged 2-59 months who were admitted to hospital with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh, and Thailand. We analysed risk factors for mortality among these cases using logistic regression.
Findings: Among 2189 cases with LCWI pneumonia, 76 (3·6%) died. Mortality was higher in infants compared to children 12-59 months of age (OR 2·03, 95%CI 1·05-3·93), in children with oxygen saturation <92% (3·33, 1·99-5·99), in HIV negative but exposed (4·59, 1·81-11·7), and in malnourished children (6·85, 3·22-14·6). Among all cases, 807 (40%) had hypoxaemia or HIV exposure, or were malnourished (mid-upper-arm circumference <125mm or low/ very low weight for age) while 65 (86%) of the 76 deaths observed had at least one of these characteristics.
Interpretation: This study supports the suggestion that a subset of HIV-negative children with LCWI pneumonia, who are hypoxic, or malnourished or were born to HIV positive mothers, experience poorer outcomes than other children with chest-indrawing pneumonia and could benefit from hospital admission.
Funding: This work was supported by The Bill & Melinda Gates Foundation [grant number 48968]
Declaration of Interest: None to declare.
Ethical Approval: The PERCH study was approved by the relevant ethics committees overseeing each site and by the Johns Hopkins Bloomberg School of Public Health ethics committee
Gallagher, Katherine E. and Awori, Juliet O. and Knoll, Maria D. and Rhodes, Julia and Higdon, Melissa M. and Hammitt, Laura L. and Prosperi, Christine and Baggett, Henry and Brooks, W. Abdullah and Fancourt, Nicholas and Feikin, Daniel R. and Howie, Stephen R. C. and Kotloff, Karen L. and Tapia, Milagritos D. and Levine, Orin S. and Madhi, Shabir Ahmed and Murdoch, David R. and O'Brien, Katherine and Thea, Donald M. and Baillie, Vicky L. and Ebruke, Bernard E. and kamau, alice and Moore, David P. and Mwananyanda, Lawrence and Olutunde, Oluyinka E. and Seidenberg, Phil and Sow, Samba O. and Thamthitiwat, Somsak and Scott, Anthony, Factors Predicting Mortality in Hospitalised Hiv-Negative Children with Lower-Chest-Wall Indrawing Pneumonia and Implications for Management. Available at SSRN: https://ssrn.com/abstract=3899796 or http://dx.doi.org/10.2139/ssrn.3899796