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Published on: February 23, 2014
Risk factors associated with disease severity among children hospitalised with community-acquired pneumonia in Angola
Linda Reitala1, Maija-Katri Lehto1, Satu Kekomäki1
1New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Insights
Severe community-acquired pneumonia (CAP) in Angolan children is linked to young age, seizures, and high C-reactive protein levels. Indoor cooking smoke and malnutrition also increase risks for prolonged hospital stays.
Area of Science:
- Pediatric infectious diseases
- Global health epidemiology
- Clinical risk factor analysis
Background:
- Community-acquired pneumonia (CAP) is a significant cause of child mortality globally, particularly in low- and middle-income countries.
- Angola lacks specific studies on risk factors for severe CAP in its pediatric population.
- Identifying these risk factors is crucial for reducing CAP-related illness and death in Angolan children.
Purpose of the Study:
- To identify demographic, environmental, clinical, laboratory, and radiologic risk factors associated with severe CAP in hospitalized Angolan children.
- To determine factors contributing to mortality and prolonged hospitalization (>7 days) due to CAP.
- To inform targeted interventions for improving CAP management and outcomes in Angola.
Main Methods:
- A prospective, observational study was conducted with 372 children (2 months to 13 years) hospitalized with CAP at Hospital Pediátrico David Bernardino in Luanda, Angola.
- Participants included children with and without comorbidities such as asthma, HIV, or sickle cell disease.
- Multivariable logistic regression analysis was employed to identify risk factors for mortality and prolonged hospitalization.
Main Results:
- Younger age (<1 year), seizures, and elevated C-reactive protein (≥150 mg/L) were significant risk factors for mortality.
- Cough prior to hospitalization emerged as a protective factor against mortality.
- Risk factors for prolonged hospitalization included indoor cooking with coal/wood, malnutrition, inability to drink upon admission, diminished breath sounds, and pleural effusion on chest X-ray.
Conclusions:
- Demographic factors (age), clinical signs (seizures, inability to drink, diminished breath sounds), environmental exposures (indoor cooking), nutritional status (malnutrition), laboratory findings (CRP), and radiological evidence (pleural effusion) are key determinants of CAP severity in Angolan children.
- These findings highlight the multifactorial nature of severe CAP and underscore the need for context-specific preventive and therapeutic strategies.
- The study provides critical data to guide public health initiatives aimed at mitigating the burden of CAP in Angola.
Background:
Community-acquired pneumonia (CAP) is a major cause of paediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries. Yet, to date, no studies have examined the risk factors for severe CAP in Angolan children. We aimed to identify these risk factors to improve CAP-associated morbidity and mortality.
Methods:
We conducted a prospective, observational study enrolling a convenience sample of children aged two months to 13 years hospitalised with CAP in the Hospital Pediátrico David Bernardino in Luanda, Angola. We included healthy children and those with asthma, human immunodeficiency virus, or sickle cell disease. We used multivariable logistic regression to assess risk factors associated with mortality as the primary outcome and prolonged hospitalisation as the secondary outcome.
Results:
From September 2019 to May 2021, we enrolled 372 patients hospitalised with CAP, confirmed by chest x-ray. Multivariable analysis identified age <1 year (adjusted odds ratio (aOR) = 7.51; 95% confidence interval (CI) = 1.72-34.12), seizures (aOR = 10.62; 95% CI = 1.17-80.71), and C-reactive protein ≥150 mg/L (aOR = 27.77; 95% CI = 4.48-575.26) as risk factors for mortality, while cough prior to hospitalisation was a protective factor (aOR = 0.05; 95% CI = 0.01-0.2). Cooking at home with coal or wood (aOR = 2.05; 95% CI = 1.13-3.80), malnutrition (aOR = 2.15; 95% CI = 1.17-4.01), inability to drink on admission (aOR = 2.43; 95% CI = 1.22-5.00), diminished breath sounds on auscultation (aOR = 2.67; 95% CI = 1.49-4.82), and pleural effusion on chest x-ray (aOR = 3.99; 95% CI = 2.23-7.27) were risk factors for prolonged hospitalisation (>7 days).
Conclusions:
We identified various demographic, environmental, clinical, laboratory, and radiologic findings as key risk factors for severe CAP in Angolan children.
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