Risk factors associated with mortality in children with severe pneumonia

Authors

  • Aishwarya Tekam Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • Sharmila Ramteke Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • Rashmi Randa Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20231761

Keywords:

Severe pneumonia, Pneumonia-related mortality, Risk factors

Abstract

Background: Pneumonia remains a global health problem; however, there are limited data available on the specific risk factors for pneumonia and pneumonia-related mortality in children. Aims and objectives were to analyze the risk factors and various demographic factors which are associated with mortality in children with severe pneumonia.

Methods: This observational cross-sectional study was conducted in a tertiary care PICU in central India on pediatric patients aged 2 months to 5 years admitted with severe pneumonia. Final outcome was measured in terms of discharge and death. Statistical analysis was done using the SPSS program for windows, version 25.

Results: The mortality rate in an upper-lower class of children was 51.9% and the association between mortality and SES was significant with a p<0.001. Also, lack of exclusive breastfeeding, delay in seeking medical care especially in >72 hours, delay in transport from the referral center, severe acute malnutrition among the children, and leucocytosis 61.5% were found to be significant predictors of mortality. The oxygen requirement association with mortality was significant (p=0.001), similar to the need for mechanical ventilation within 6 hours.

Conclusions: Factors like delay in seeking medical care for >72 hours, contact with COVID patients, lack of exclusive breastfeeding, and delay in transport are the risk factors that are significantly associated with pneumonia-related mortality.

References

WHO pneumonia fact-sheets. Available at: https://www.who.int/news-room/fact-sheets/detail/ pneumonia. Accessed on 22 March, 2023.

WHO. Global Burden of Disease Estimates 2000-2015; WHO: Geneva, Switzerland, 2016; Available at: http://www.who.int/healthinfo/globalburden-disease/estimates/en/index2.html. Accessed on 26 March, 2023.

UNICEF. One Is Too Many Ending Child Death from Pneumonia and Diarrhoea; UNICEF: New York, NY, USA. 2016. Available at: https://data.unicef.org/wpcontent/uploads/2016/11/UNICEF-Pneumonia-Diarrhoeareport2016-web-version_final.pdf. Accessed on 20 March 2023).

Hemagiri K, Sameena A, Aravind K, Khan W, Vasanta S. Risk factors for severe pneumonia in under five children–A hospital based study. Int J Res Health Sci. 2014;2(1):47-57.

McAllister DA, Liu L, Shi T, Chu Y, Reed C, Burrows J et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Global Health. 2019;7(1):e47-57.

Sonego M, Pellegrin MC, Becker G, Lazzerini M. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. Plos One. 2015;10(1):e0116380.

Jakhar SK, Pandey M, Shah D, Ramachandran VG, Saha R, Gupta N et al. Etiology and Risk Factors Determining Poor Outcome of Severe Pneumonia in Under-Five Children. Indian J Pediatr. 2017;1.

Mathew JL, Patwari AK, Gupta P, Shah D, Gera T, Gogia S et al. Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr. 2011;48:191-218.

Kasundriya SK, Dhaneria M, Mathur A, Pathak A. Incidence and risk factors for severe pneumonia in children hospitalized with pneumonia in Ujjain, India. Int J Environmental Res Publ Heal. 2020;17(13):4637.

Troeger CE, Khalil IA, Blacker BF, Biehl MH, Albertson SB, Zimsen SR et al. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis. 2020;20(1):60-79.

Shah VB, Mehta K. Study of risk factors for severe pneumonia among children between 2 months to 5 years of age. Int J Contemporary Pediatr. 2019;6(4).

Bokade CM, Madhura AD, Bagul AS, Thakre SB. Predictors of mortality in children due to severe and very severe pneum Zhang Q, Guo Z, Bai Z, macdonald NE. A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China. Pediatr Pulmonol. 2013;48(4):390-7.

Nasrin S, Tariqujjaman M, Sultana M, Zaman RA, Ali S, Chisti MJ et al. Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis. Plos One. 2022;17(3):e0265871.

Nirmolia N, Mahanta TG, Boruah M, Rasaily R, Kotoky RP, Bora R. Prevalence and risk factors of pneumonia in under five children living in slums of Dibrugarh town. Clin Epidemiol Global Heal. 2018;6(1):1-4.

Sutriana VN, Sitaresmi MN, Wahab A. Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia. Clin ExpPediatr. 2021;64(11):588.

Hastuti P, Wijayanti IT. Analisis deskriptif faktor yang mempengaruhi pengeluaran asi pada ibu nifas di desa sumber kecamatan sumber kabupaten rembang. URECOL. 2017;223-32.

Lamberti LM, Zakarija-Grković I, Fischer Walker CL, Theodoratou E, Nair H, Campbell H et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Pub Heal. 2013;13(3):1-8.

Greenberg D, Givon-Lavi N, Broides A, Blancovich I, Peled N, Dagan R. The contribution of smoking and exposure to tobacco smoke to Streptococcus pneumoniae and Haemophilus influenzae carriage in children and their mothers. Clin Infect Dis. 2006;42(7):897-903.

Kirolos A, Ayede AI, Williams LJ, Fowobaje KR, Nair H, Bakare AA et al. Care seeking behaviour and aspects of quality of care by caregivers for children under five with and without pneumonia in Ibadan. Nig J Global Heal. 2018;8(2).

Caulfield LE, de Onis M, Blössner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutrit. 2004;80(1):193-8.

Rady HI. Profile of patients admitted to pediatric intensive care unit, Cairo University Hospital: 1-year study. Ain-Shams J Anaesthesiol. 2014;7(4):500.

Tiewsoh K, Lodha R, Pandey RM, Broor S, Kalaivani M, Kabra SK. Factors determining the outcome of children hospitalized with severe pneumonia. BMC Pediatr. 2009;9(1):18.

Kasundriya SK, Dhaneria M, Mathur A, Pathak A. Incidence and risk factors for severe pneumonia in children hospitalized with pneumonia in Ujjain, India. Int J Environmental Res Pub Heal. 2020;17(13):4637.

Zhang Q, Guo Z, Bai Z, MacDonald NE. A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China. Pediatr Pulmonol. 2013;48(4):390-7.

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Published

2023-06-05

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Original Research Articles