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Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study

Moses M Ngari^1,2, Greg Fegan^1,3, Martha K Mwangome^1,2

¹KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.

Paediatric and Perinatal Epidemiology

|March 21, 2017

Insights

Children with severe pneumonia face high mortality post-discharge, especially those with malnutrition or HIV. Understanding these risks is crucial for reducing deaths after hospital treatment.

Area of Science:

Pediatrics
Infectious Diseases
Global Health

Background:

Severe pneumonia is a major cause of child mortality.
Post-discharge deaths are understudied, particularly concerning malnutrition and HIV.
This study investigates 1-year mortality and risk factors after severe pneumonia hospitalization.

Purpose of the Study:

To determine the 1-year post-discharge mortality rate in children treated for severe pneumonia.
To identify key risk factors, including malnutrition and HIV status, associated with this mortality.
To inform strategies for reducing mortality in vulnerable children.

Main Methods:

A cohort study of children aged 1-59 months with severe pneumonia was conducted.
Data were collected from Kilifi County Hospital (2007-2012).
Post-discharge survival was tracked for up to 1 year using the Kilifi Health and Demographic Surveillance System.

Main Results:

Of 4184 children, 8.7% died in-hospital; 3.1% of 2279 discharged children died within 1 year.
Post-discharge mortality was higher after severe pneumonia compared to other conditions (HR 2.5).
Malnutrition (low mid-upper arm circumference) and HIV significantly increased post-discharge mortality risk.

Conclusions:

Severe pneumonia admission indicates high vulnerability.
Malnutrition and HIV are critical factors driving post-discharge mortality.
Improved risk stratification and targeted interventions are needed for undernourished children.

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Abstract

Background:

Although pneumonia is a leading cause of inpatient mortality, deaths may also occur after discharge from hospital. However, prior studies have been small, in selected groups or did not fully evaluate risk factors, particularly malnutrition and HIV. We determined 1-year post-discharge mortality and risk factors among children diagnosed with severe pneumonia.

Methods:

A cohort study of children aged 1-59 months admitted to Kilifi County Hospital with severe pneumonia (2007-12). The primary outcome was death <1 year after discharge, determined through Kilifi Health and Demographic Surveillance System (KHDSS) quarterly census rounds.

Results:

Of 4184 children (median age 9 months) admitted with severe pneumonia, 1041 (25%) had severe acute malnutrition (SAM), 267 (6.4%) had a positive HIV antibody test, and 364 (8.7%) died in hospital. After discharge, 2279 KHDSS-resident children were followed up; 70 (3.1%) died during 2163 child-years: 32 (95% confidence interval (CI) 26, 41) deaths per 1000 child years. Post-discharge mortality was greater after admission for severe pneumonia than for other diagnoses, hazard ratio 2.5 (95% CI 1.2, 5.3). Malnutrition, HIV status, age and prolonged hospitalisation, but not signs of pneumonia severity, were associated with post-discharge mortality. Fifty-two per cent (95% CI 37%, 63%) of post-discharge deaths were attributable to low mid-upper arm circumference and 11% (95% CI 3.3%, 18%) to a positive HIV test.

Conclusions:

Admission with severe pneumonia is an important marker of vulnerability. Risk stratification and better understanding of the mechanisms underlying post-discharge mortality, especially for undernourished children, are needed to reduce mortality after treatment for pneumonia.

Keywords:

children mortality post-discharge severe pneumonia

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