W. A. Brooks, United States of America

Johns Hopkins Bloomberg School of Public Health Department of International Health

Author Of 1 Presentation

CHILDREN ADMITTED TO HOSPITAL WITH LOWER-CHEST-WALL INDRAWING PNEUMONIA IN SEVEN LOW AND MIDDLE-INCOME COUNTRIES: WHO DIED AND WHO SURVIVED? (ID 758)

Abstract

Background

In 2013, to increase effective distribution of antibiotics, WHO revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based-treatment with oral antibiotics rather than hospital-based management. We analysed the implications of this policy in the PERCH study, where all children were hospitalised.

Methods

In PERCH, 2113 children aged 2-59 months were admitted with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh and Thailand. We analysed their mortality risk, and risk factors for mortality using logistic regression.

Results

Among cases with LCWI pneumonia, 76 (3.6%) died in hospital or within 7 days of discharge. Factors associated with fatal outcome included age (aOR 2.03 (95%CI 1.05-3.93) for infants vs older children), absence of cough, oxygen saturation (80-91% oxygen aOR 2.04 (1.07-3.90), <80% aOR 6.51 (2.82-15.0)), low anthropometric scores and HIV exposure.

Conclusions

Despite hospital admission, 3.6% of children with LCWI pneumonia died; mortality may be higher among similar children if treated in the community. Among children with LCWI pneumonia presenting to hospital, selective admission for those who also have hypoxia, features of malnutrition and young age may ensure that those with the greatest risk of death receive optimal supportive therapy.

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