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Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi

OBJECTIVE: Although HIV infection, severe malnutrition and hypoxaemia are associated with high mortality in children with WHO-defined severe pneumonia in sub-Saharan Africa, many do not have these conditions and yet mortality remains elevated compared with high-resource settings. Further stratifying...

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Autores principales: Eckerle, Michelle, Mvalo, Tisungane, Smith, Andrew G, Kondowe, Davie, Makonokaya, Don, Vaidya, Dhananjay, Hosseinipour, Mina C, McCollum, Eric D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020281/
https://www.ncbi.nlm.nih.gov/pubmed/36053605
http://dx.doi.org/10.1136/bmjpo-2021-001330
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author Eckerle, Michelle
Mvalo, Tisungane
Smith, Andrew G
Kondowe, Davie
Makonokaya, Don
Vaidya, Dhananjay
Hosseinipour, Mina C
McCollum, Eric D
author_facet Eckerle, Michelle
Mvalo, Tisungane
Smith, Andrew G
Kondowe, Davie
Makonokaya, Don
Vaidya, Dhananjay
Hosseinipour, Mina C
McCollum, Eric D
author_sort Eckerle, Michelle
collection PubMed
description OBJECTIVE: Although HIV infection, severe malnutrition and hypoxaemia are associated with high mortality in children with WHO-defined severe pneumonia in sub-Saharan Africa, many do not have these conditions and yet mortality remains elevated compared with high-resource settings. Further stratifying mortality risk for children without these conditions could permit more strategic resource utilisation and improved outcomes. We therefore evaluated associations between mortality and clinical characteristics not currently recognised by the WHO as high risk among children in Malawi with severe pneumonia but without HIV (including exposure), severe malnutrition and hypoxaemia. METHODS: Between May 2016 and March 2018, we conducted a prospective observational study alongside a randomised controlled trial (CPAP IMPACT) at Salima District Hospital in Malawi. Children aged 1–59 months hospitalised with WHO-defined severe pneumonia without severe malnutrition, HIV and hypoxaemia were enrolled. Study staff assessed children at admission and ascertained hospital outcomes. We compared group characteristics using Student’s t-test, rank-sum test, χ(2) test or Fisher’s exact test as appropriate. RESULTS: Among 884 participants, grunting (10/112 (8.9%) vs 11/771 (1.4%)), stridor (2/14 (14.2%) vs 19/870 (2.1%)), haemoglobin <50 g/L (3/27 (11.1%) vs 18/857 (2.1%)) and malaria (11/204 (5.3%) vs 10/673 (1.4%)) were associated with mortality compared with children without these characteristics. Children who survived had a 22 g/L higher mean haemoglobin and 0.7 cm higher mean mid-upper arm circumference (MUAC) than those who died. CONCLUSION: In this single-centre study, our analysis identifies potentially modifiable risk factors for mortality among hospitalised Malawian children with severe pneumonia: specific signs of respiratory distress (grunting, stridor), haemoglobin <50 g/L and malaria infection. Significant differences in mean haemoglobin and MUAC were observed between those who survived and those who died. These factors could further stratify mortality risk among hospitalised Malawian children with severe pneumonia lacking recognised high-risk conditions.
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spelling pubmed-90202812022-05-04 Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi Eckerle, Michelle Mvalo, Tisungane Smith, Andrew G Kondowe, Davie Makonokaya, Don Vaidya, Dhananjay Hosseinipour, Mina C McCollum, Eric D BMJ Paediatr Open Tropical Paediatrics OBJECTIVE: Although HIV infection, severe malnutrition and hypoxaemia are associated with high mortality in children with WHO-defined severe pneumonia in sub-Saharan Africa, many do not have these conditions and yet mortality remains elevated compared with high-resource settings. Further stratifying mortality risk for children without these conditions could permit more strategic resource utilisation and improved outcomes. We therefore evaluated associations between mortality and clinical characteristics not currently recognised by the WHO as high risk among children in Malawi with severe pneumonia but without HIV (including exposure), severe malnutrition and hypoxaemia. METHODS: Between May 2016 and March 2018, we conducted a prospective observational study alongside a randomised controlled trial (CPAP IMPACT) at Salima District Hospital in Malawi. Children aged 1–59 months hospitalised with WHO-defined severe pneumonia without severe malnutrition, HIV and hypoxaemia were enrolled. Study staff assessed children at admission and ascertained hospital outcomes. We compared group characteristics using Student’s t-test, rank-sum test, χ(2) test or Fisher’s exact test as appropriate. RESULTS: Among 884 participants, grunting (10/112 (8.9%) vs 11/771 (1.4%)), stridor (2/14 (14.2%) vs 19/870 (2.1%)), haemoglobin <50 g/L (3/27 (11.1%) vs 18/857 (2.1%)) and malaria (11/204 (5.3%) vs 10/673 (1.4%)) were associated with mortality compared with children without these characteristics. Children who survived had a 22 g/L higher mean haemoglobin and 0.7 cm higher mean mid-upper arm circumference (MUAC) than those who died. CONCLUSION: In this single-centre study, our analysis identifies potentially modifiable risk factors for mortality among hospitalised Malawian children with severe pneumonia: specific signs of respiratory distress (grunting, stridor), haemoglobin <50 g/L and malaria infection. Significant differences in mean haemoglobin and MUAC were observed between those who survived and those who died. These factors could further stratify mortality risk among hospitalised Malawian children with severe pneumonia lacking recognised high-risk conditions. BMJ Publishing Group 2022-04-19 /pmc/articles/PMC9020281/ /pubmed/36053605 http://dx.doi.org/10.1136/bmjpo-2021-001330 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Tropical Paediatrics
Eckerle, Michelle
Mvalo, Tisungane
Smith, Andrew G
Kondowe, Davie
Makonokaya, Don
Vaidya, Dhananjay
Hosseinipour, Mina C
McCollum, Eric D
Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi
title Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi
title_full Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi
title_fullStr Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi
title_full_unstemmed Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi
title_short Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi
title_sort identifying modifiable risk factors for mortality in children aged 1–59 months admitted with who-defined severe pneumonia: a single-centre observational cohort study from rural malawi
topic Tropical Paediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020281/
https://www.ncbi.nlm.nih.gov/pubmed/36053605
http://dx.doi.org/10.1136/bmjpo-2021-001330
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