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Factors Predicting Mortality in Hospitalised Hiv-Negative Children with Lower-Chest-Wall Indrawing Pneumonia and Implications for Management

29 Pages Posted: 5 Aug 2021

See all articles by Katherine E. Gallagher

Katherine E. Gallagher

London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health

Juliet O. Awori

KEMRI-Wellcome Trust

Maria D. Knoll

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Julia Rhodes

Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration - Global Disease Detection Center

Melissa M. Higdon

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Laura L. Hammitt

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Christine Prosperi

Johns Hopkins University - International Vaccine Access Center

Henry Baggett

Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration - Global Disease Detection Center

W. Abdullah Brooks

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Nicholas Fancourt

Charles Darwin University - Menzies School of Health Research

Daniel R. Feikin

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Stephen R. C. Howie

University of Auckland; Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine

Karen L. Kotloff

University of Maryland - Department of Pediatrics

Milagritos D. Tapia

University of Maryland - Department of Pediatrics

Orin S. Levine

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Shabir Ahmed Madhi

Chris Hani Baragwanath Academic Hospital - Vaccines and Infectious Diseases Analytics Research Unit; Johns Hopkins University - Department of International Health, International Vaccine Access Center

David R. Murdoch

University of Otago - Department of Pathology and Biomedical Sciences

Katherine O'Brien

World Health Organization (WHO); Johns Hopkins University - Department of International Health, International Vaccine Access Center

Donald M. Thea

Boston University - Department of Global Health

Vicky L. Baillie

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

Bernard E. Ebruke

Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine

alice kamau

KEMRI-Wellcome Trust

David P. Moore

University of the Witwatersrand; University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

Lawrence Mwananyanda

Boston University - Department of Global Health

Oluyinka E. Olutunde

Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine

Phil Seidenberg

Boston University - Department of Global Health and Development

Samba O. Sow

Centre pour le Développement des Vaccins (CVD-Mali)

Somsak Thamthitiwat

Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration - Global Disease Detection Center

Anthony Scott

London School of Hygiene & Tropical Medicine - Department of Infectious Disease and Epidemiology

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Abstract

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

Suggested Citation

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

Katherine E. Gallagher (Contact Author)

London School of Hygiene & Tropical Medicine - Faculty of Epidemiology and Population Health ( email )

London, WC1E 7HT
United Kingdom

Juliet O. Awori

KEMRI-Wellcome Trust ( email )

Kenyatta Hospital Estate
Nairobi, 80108
Kenya

Maria D. Knoll

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Julia Rhodes

Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration - Global Disease Detection Center ( email )

United States

Melissa M. Higdon

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Laura L. Hammitt

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Christine Prosperi

Johns Hopkins University - International Vaccine Access Center ( email )

Baltimore, MD
United States

Henry Baggett

Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration - Global Disease Detection Center ( email )

United States

W. Abdullah Brooks

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Nicholas Fancourt

Charles Darwin University - Menzies School of Health Research ( email )

Darwin
Australia

Daniel R. Feikin

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Stephen R. C. Howie

University of Auckland

Private Bag 92019
Auckland Mail Centre
Auckland, 1142
New Zealand

Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine ( email )

Basse
Gambia

Karen L. Kotloff

University of Maryland - Department of Pediatrics ( email )

United States

Milagritos D. Tapia

University of Maryland - Department of Pediatrics ( email )

United States

Orin S. Levine

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Shabir Ahmed Madhi

Chris Hani Baragwanath Academic Hospital - Vaccines and Infectious Diseases Analytics Research Unit ( email )

Bertsham
South Africa

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

David R. Murdoch

University of Otago - Department of Pathology and Biomedical Sciences ( email )

New Zealand

Katherine O'Brien

World Health Organization (WHO)

20 Avenue Appia
Geneva 27, CH-1211
Switzerland

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

Donald M. Thea

Boston University - Department of Global Health ( email )

Boston, MA
United States

Vicky L. Baillie

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

Bernard E. Ebruke

Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine ( email )

Basse
Gambia

Alice Kamau

KEMRI-Wellcome Trust ( email )

Kenyatta Hospital Estate
Nairobi, 80108
Kenya

David P. Moore

University of the Witwatersrand

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

Lawrence Mwananyanda

Boston University - Department of Global Health ( email )

Boston, MA
United States

Oluyinka E. Olutunde

Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine ( email )

Basse
Gambia

Phil Seidenberg

Boston University - Department of Global Health and Development ( email )

United States

Samba O. Sow

Centre pour le Développement des Vaccins (CVD-Mali) ( email )

Bamako
Mali

Somsak Thamthitiwat

Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration - Global Disease Detection Center ( email )

United States

Anthony Scott

London School of Hygiene & Tropical Medicine - Department of Infectious Disease and Epidemiology