Related Experiment Video
Updated: Jun 26, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Characteristics of children readmitted with severe pneumonia in Kenyan hospitals
Diana Marangu-Boore1, Paul Mwaniki2, Lynda Isaaka2
1Paediatric Pulmonology Division, Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya. dmarangu@uonbi.ac.ke.
Insights
Severe pneumonia readmissions in children are common (11%) and linked to factors like malnutrition and age. Readmitted children had similar mortality rates but received different treatments, highlighting care gaps.
Area of Science:
- Pediatric infectious diseases
- Public health research
- Clinical epidemiology
Background:
- Pneumonia is a major cause of death in children globally.
- Hospital readmissions for severe pneumonia may indicate suboptimal care or unaddressed health issues.
Purpose of the Study:
- To determine the prevalence of severe pneumonia readmissions in Kenyan children.
- To identify risk factors associated with readmission and inpatient mortality.
- To describe clinical management practices for severe pneumonia.
Main Methods:
- Retrospective cohort study of children aged 2 months to 14 years hospitalized with severe pneumonia (2013-2021).
- Data collected from 20 primary referral hospitals in Kenya.
- Analysis included prevalence estimation, risk factor modeling for readmission and mortality.
Main Results:
- 11.0% of 20,603 children were readmitted with severe pneumonia.
- Risk factors for readmission included younger age, malnutrition, wheeze, and neurological disorders.
- Readmitted children received more chest X-rays, second-line antibiotics, TB medication, salbutamol, and prednisolone.
- Inpatient mortality was 12.8% for first admissions and 11.8% for readmissions.
- Mortality risk factors included malnutrition, anemia, and male sex; complete vaccination was protective.
Conclusions:
- Children readmitted with severe pneumonia represent a significant burden of disease.
- Further research is needed to optimize screening, management, and follow-up for high-risk children.
- Targeted interventions for children with risk factors are crucial to reduce readmissions and mortality.
Background:
Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities.
Methods:
We conducted a retrospective cohort study including children aged 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality.
Results:
Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6-11.5) were readmitted. Re-admission was independently associated with age (12-59 months vs. 2-11 months: adjusted odds ratio (aOR) 1.70, 1.54-1.87; >5 years vs. 2-11 months: aOR 1.85, 1.55-2.22), malnutrition (weight-for-age-z-score (WAZ) <-3SD vs. WAZ> -2SD: aOR 2.05, 1.84-2.29); WAZ - 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20-1.57), wheeze (aOR 1.17, 1.03-1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p < 0.001). Readmitted patients more frequently received second-line antibiotics (808/2,256 [35.8%] vs. 5,538/18,173 [30.5%], p < 0.001), TB medication (69/2,256 [3.1%] vs. 298/18,173 [1.6%], p < 0.001), salbutamol (530/2,256 [23.5%] vs. 3,707/18,173 [20.4%], p = 0.003), and prednisolone (157/2,256 [7.0%] vs. 764/18,173 [4.2%], p < 0.001). Inpatient mortality was 2,354/18,329 (12.8%) among children admitted with a first episode of severe pneumonia and 269/2,274 (11.8%) among those who were readmitted (adjusted hazard ratio (aHR) 0.93, 95% CI 0.82-1.07). Age (12-59 months vs. 2-11 months: aHR 0.62, 0.57-0.67), male sex (aHR 0.81, 0.75-0.88), malnutrition (WAZ <-3SD vs. WAZ >-2SD: aHR 1.87, 1.71-2.05); WAZ - 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31-1.63), complete vaccination (aHR 0.74, 0.60-0.91), wheeze (aHR 0.87, 0.78-0.98) and anaemia (aHR 2.14, 1.89-2.43) were independently associated with mortality.
Conclusions:
Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality.
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia III: Complications and Assessment
01:29Pneumonia II: Pathophysiology
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:17Pulmonary Cycle: Exhalation