Pneumococcal Disease in Angolan Children Under Five: Epidemiology and Antimicrobial Resistance Patterns

Streptococcus pneumoniae remains a leading cause of under-5 mortality worldwide, with a disproportionate impact in low- and middle-income countries. This study examined clinical, sociodemographic and microbiological predictors of mortality among Angolan children with pneumococcal disease.

A hospital-based, cross-sectional observational study was conducted at a national referral pediatric hospital in Luanda, Angola. Clinical, demographic and microbiological data were systematically collected. Multivariate logistic regression identified independent predictors of in-hospital mortality, adjusting for potential confounders.

A total of 463 children under 5 years of age with suspected or confirmed pneumococcal disease were enrolled. The median age was 24 months (interquartile range: 12-36); 315 (68.0%) had pneumonia, 101 (21.8%) meningitis and 47 (10.2%) sepsis. Of the total cases, 347 (74.9%) were clinically diagnosed and 116 (25.1%) were bacteriologically confirmed. Ninety children (19.4%) died during hospitalization. In multivariate analysis, independent predictors of in-hospital mortality included age <12 months, rural residence, maternal primary education, household crowding, meningitis or sepsis, malnutrition, unvaccinated status, symptom duration ≥14 days, hospital stay ≥48 hours and multidrug-resistant pneumococcal infection.

Mortality from pediatric pneumococcal disease in Luanda is driven by a convergence of clinical severity, sociodemographic vulnerability and antimicrobial resistance. These findings underscore the urgent need for targeted immunization strategies, early diagnostic intervention, nutritional support and improved access to care in high-risk settings.