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Treatment failure among Kenyan children with severe pneumonia--a cohort study

Clare Webb1, Mwanajuma Ngama, Anthony Ngatia

  • 1Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Kilifi, Kenya.

The Pediatric Infectious Disease Journal
|June 14, 2012
PubMed

Insights

Childhood pneumonia treatment failure is a concern in Africa. While uncomplicated cases show good outcomes, severe cases with complications like HIV or malnutrition have higher failure and mortality rates.

Area of Science:

  • Pediatric Infectious Diseases
  • Global Health
  • Clinical Medicine

Background:

  • Pneumonia is a leading cause of death in children globally.
  • The World Health Organization (WHO) recommends presumptive treatment for pneumonia based on clinical signs.
  • Concerns exist regarding high rates of treatment failure in African settings.

Purpose of the Study:

  • To evaluate the frequency and predictors of treatment failure in children with severe or very severe pneumonia in Kenya.
  • To assess outcomes for children treated according to WHO guidelines.

Main Methods:

  • Prospective data collection from children aged 2-59 months with severe/very severe pneumonia admitted to Kilifi District Hospital, Kenya.
  • Treatment administered following WHO guidelines.
  • Primary outcome: treatment failure at 48 hours.

Main Results:

  • Overall, 20% of children failed treatment at 48 hours, with a 6.0% mortality rate.
  • Children with severe pneumonia without HIV or severe malnutrition had a 12% failure rate at 48 hours.
  • Children with severe pneumonia complicated by HIV/malnutrition or very severe pneumonia had a 32% failure rate at 48 hours and a 16% mortality rate.
  • Factors associated with treatment failure included shock, bacteremia, very severe pneumonia, low oxygen saturation, severe malnutrition, HIV, and age under 1 year.

Conclusions:

  • Uncomplicated severe pneumonia has low treatment failure and mortality rates under current WHO guidelines in this setting.
  • Most deaths occurred early, suggesting potential for reduction through improved prevention, prehospital care, and sepsis management.
  • Children with severe pneumonia and complications (HIV, malnutrition) or very severe pneumonia face significantly higher risks.
Abstract

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