Diagnosis of pneumonia and malaria in Nigerian hospitals: A prospective cohort study
Hamish Graham1,2, Ayobami A Bakare3, Adejumoke I Ayede2,4
1Centre for International Child Health, MCRI, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.
Insights
Pneumonia and malaria are leading causes of child mortality. Many severe cases were missed, impacting treatment and survival. Early diagnosis of pneumonia is crucial for all sick children with respiratory symptoms.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Pneumonia and malaria are primary drivers of childhood mortality worldwide.
- Accurate diagnosis and timely treatment are critical for improving child survival rates.
Purpose of the Study:
- To describe the clinical presentation of children with pneumonia and/or malaria.
- To identify potential missed diagnoses and predictors for these conditions in Nigerian children.
Main Methods:
- A prospective cohort study was conducted in 12 Nigerian hospitals from November 2015 to October 2017.
- Children aged 28 days to 15 years were analyzed for malaria and pneumonia diagnoses using WHO criteria.
- Logistic regression identified associations between clinical features and severe diagnoses.
Main Results:
- Over 98% of 16,432 admitted children had usable data; 65.4% were diagnosed with malaria and/or pneumonia.
- Significant proportions of severe pneumonia (41.4%) and severe malaria (15.9%) cases were initially missed.
- Detected severe pneumonia cases received more antibiotics and had lower mortality; detected severe malaria cases had significantly lower mortality.
Conclusions:
- Pneumonia diagnosis should be prioritized in all severely ill children presenting with respiratory signs.
- Addressing missed diagnoses of severe pneumonia and malaria can improve treatment and reduce mortality in pediatric patients.
- Identifying diagnostic predictors is key to enhancing clinical management of these common childhood illnesses.
Background:
Pneumonia and malaria are the leading causes of global childhood mortality. We describe the clinical presentation of children diagnosed with pneumonia and/or malaria, and identify possible missed cases and diagnostic predictors.
Methods:
Prospective cohort study involving children (aged 28 days to 15 years) admitted to 12 secondary-level hospitals in south-west Nigeria, from November 2015 to October 2017. We described children diagnosed with malaria and/or pneumonia on admission and identified potential missed cases using WHO criteria. We used logistic regression models to identify associations between clinical features and severe pneumonia and malaria diagnoses.
Results:
Of 16 432 admitted children, 16 184 (98.5%) had adequate data for analysis. Two-thirds (10 561, 65.4%) of children were diagnosed with malaria and/or pneumonia by the admitting doctor; 31.5% (567/1799) of those with pneumonia were also diagnosed with malaria. Of 1345 (8.3%) children who met WHO severe pneumonia criteria, 557 (41.4%) lacked a pneumonia diagnosis. Compared with "potential missed" diagnoses of severe pneumonia, children with "detected" severe pneumonia were more likely to receive antibiotics (odds ratio [OR], 4.03; 2.63-6.16, P < .001), and less likely to die (OR, 0.72; 0.51-1.02, P = .067). Of 2299 (14.2%) children who met WHO severe malaria criteria, 365 (15.9%) lacked a malaria diagnosis. Compared with "potential missed" diagnoses of severe malaria, children with "detected" severe malaria were less likely to die (OR, 0.59; 0.38-0.91, P = 0.017), with no observed difference in antimalarial administration (OR, 0.29; 0.87-1.93, P = .374). We identified predictors of severe pneumonia and malaria diagnosis.
Conclusion:
Pneumonia should be considered in all severely unwell children with respiratory signs, regardless of treatment for malaria or other conditions.
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