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Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study

BACKGROUND: Little attention has been paid to asthma in ‘under-fives’ in Sub-Saharan Africa. In ‘under-fives’, acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. The mortality ass...

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Autores principales: Nantanda, Rebecca, Ostergaard, Marianne S, Ndeezi, Grace, Tumwine, James K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254222/
https://www.ncbi.nlm.nih.gov/pubmed/25431036
http://dx.doi.org/10.1186/s12887-014-0285-4
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author Nantanda, Rebecca
Ostergaard, Marianne S
Ndeezi, Grace
Tumwine, James K
author_facet Nantanda, Rebecca
Ostergaard, Marianne S
Ndeezi, Grace
Tumwine, James K
author_sort Nantanda, Rebecca
collection PubMed
description BACKGROUND: Little attention has been paid to asthma in ‘under-fives’ in Sub-Saharan Africa. In ‘under-fives’, acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. The mortality associated with acute respiratory diseases in Uganda is high but improving, dropping from 24% in 2004 to 11.9% in 2012. We describe the immediate clinical outcomes of children with acute asthma and pneumonia and document the factors associated with prolonged hospitalization and mortality. METHODS: We enrolled 614 children aged 2 to 59 months with acute respiratory symptoms presenting at the emergency paediatric unit of Mulago hospital. Clinical histories, physical examination, blood and radiological tests were done. Children with asthma and bronchiolitis were collectively referred to as ‘Asthma syndrome’. Hospitalized children were monitored every 12 hours for a maximum of 7 days. Survival analysis was done to compare outcome of children with asthma and pneumonia. Cox regression analysis was done to determine factors associated with prolonged hospitalization and mortality. RESULTS: Overall mortality was 3.6%. The highest case fatality was due to pneumocystis jirovecii pneumonia (2/4) and pulmonary tuberculosis (2/7). None of the children with asthma syndrome died. Children with ‘asthma syndrome’ had a significantly shorter hospital stay compared to those with pneumonia (p<0.001). Factors independently associated with mortality included hypoxemia (HR = 10.7, 95% CI 1.4- 81.1) and severe malnutrition (HR = 5.7, 95% CI 2.1- 15.8). Factors independently associated with prolonged hospitalization among children with asthma syndrome included age less than 12 months (RR = 1.2, 95% CI 1.0-1.4), hypoxemia (RR = 1.4, 95% CI 1.2-1.7), and severe malnutrition (RR = 1.5 95% CI 1.3-1.8). Similar factors were associated with long duration of hospital stay among children with pneumonia. CONCLUSION: This study identified a sharp decline in acute respiratory mortality compared to the previous studies in Mulago hospital. This may be related to focus on and treatment of asthma in this study, and will be analysed in a later study. Bacterial pneumonia is still associated with high case fatality. Hypoxemia, severe malnutrition, and being an infant were associated with poor prognosis among children with acute asthma and pneumonia and need to be addressed in the management protocols. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12887-014-0285-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-42542222014-12-04 Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study Nantanda, Rebecca Ostergaard, Marianne S Ndeezi, Grace Tumwine, James K BMC Pediatr Research Article BACKGROUND: Little attention has been paid to asthma in ‘under-fives’ in Sub-Saharan Africa. In ‘under-fives’, acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. The mortality associated with acute respiratory diseases in Uganda is high but improving, dropping from 24% in 2004 to 11.9% in 2012. We describe the immediate clinical outcomes of children with acute asthma and pneumonia and document the factors associated with prolonged hospitalization and mortality. METHODS: We enrolled 614 children aged 2 to 59 months with acute respiratory symptoms presenting at the emergency paediatric unit of Mulago hospital. Clinical histories, physical examination, blood and radiological tests were done. Children with asthma and bronchiolitis were collectively referred to as ‘Asthma syndrome’. Hospitalized children were monitored every 12 hours for a maximum of 7 days. Survival analysis was done to compare outcome of children with asthma and pneumonia. Cox regression analysis was done to determine factors associated with prolonged hospitalization and mortality. RESULTS: Overall mortality was 3.6%. The highest case fatality was due to pneumocystis jirovecii pneumonia (2/4) and pulmonary tuberculosis (2/7). None of the children with asthma syndrome died. Children with ‘asthma syndrome’ had a significantly shorter hospital stay compared to those with pneumonia (p<0.001). Factors independently associated with mortality included hypoxemia (HR = 10.7, 95% CI 1.4- 81.1) and severe malnutrition (HR = 5.7, 95% CI 2.1- 15.8). Factors independently associated with prolonged hospitalization among children with asthma syndrome included age less than 12 months (RR = 1.2, 95% CI 1.0-1.4), hypoxemia (RR = 1.4, 95% CI 1.2-1.7), and severe malnutrition (RR = 1.5 95% CI 1.3-1.8). Similar factors were associated with long duration of hospital stay among children with pneumonia. CONCLUSION: This study identified a sharp decline in acute respiratory mortality compared to the previous studies in Mulago hospital. This may be related to focus on and treatment of asthma in this study, and will be analysed in a later study. Bacterial pneumonia is still associated with high case fatality. Hypoxemia, severe malnutrition, and being an infant were associated with poor prognosis among children with acute asthma and pneumonia and need to be addressed in the management protocols. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12887-014-0285-4) contains supplementary material, which is available to authorized users. BioMed Central 2014-11-28 /pmc/articles/PMC4254222/ /pubmed/25431036 http://dx.doi.org/10.1186/s12887-014-0285-4 Text en © Nantanda et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nantanda, Rebecca
Ostergaard, Marianne S
Ndeezi, Grace
Tumwine, James K
Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study
title Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study
title_full Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study
title_fullStr Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study
title_full_unstemmed Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study
title_short Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study
title_sort clinical outcomes of children with acute asthma and pneumonia in mulago hospital, uganda: a prospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254222/
https://www.ncbi.nlm.nih.gov/pubmed/25431036
http://dx.doi.org/10.1186/s12887-014-0285-4
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