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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Treatment failure among kenyan children with severe pneumonia-a cohort study
Pediatric Infectious Disease Journal, Volume 31, No. 9, Year 2012
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Description
Background: Pneumonia is the leading cause of childhood mortality worldwide. The World Health Organization recommends presumptive treatment based on clinical syndromes. Recent studies raise concerns over the frequency of treatment failure in Africa. Methods: We applied a definition of treatment failure to data prospectively collected from children who were 2-59 months of age with severe, or very severe, pneumonia admitted to Kilifi District Hospital, Kenya, from May 2007 through May 2008 and treated using World Health Organization guidelines. The primary outcome was treatment failure at 48 hours. Results: Of 568 children, median age 11 months, 165 (29%) had very severe pneumonia, 30 (5.3%) a positive HIV test and 62 (11%) severe malnutrition. One hundred eleven (20%; 95% confidence interval: 17-23%) children failed treatment at 48 hours and 34 (6.0%) died; 22 (65%) deaths occurred before 48 hours. Of 353 children with severe pneumonia, without HIV or severe malnutrition, 42 (12%) failed to respond at 48 hours, 15 (4.3%) failed at 5 days and 1 child (0.3%) died. Among 215 children with either severe pneumonia complicated by HIV or severe malnutrition, or very severe pneumonia, 69 (32%) failed to treatment at 48 hours, 47 (22%) failed at 5 days and 33 (16%) died. Treatment failure at 48 hours was associated with shock, bacteremia, very severe pneumonia, oxygen saturation in hemoglobin <95%, severe malnutrition, HIV and age <1 year in multivariable models. Conclusions: In this setting, few children with uncomplicated severe pneumonia fail treatment or die under current guidelines. Deaths mainly occurred early and may be reduced by improving prevention, prehospital care and treatment of sepsis. © 2012 by Lippincott Williams and Wilkins.
Authors & Co-Authors
Webb, Clare
Kenya, Kilifi
Centre for Geographic Medicine Research
Ngama, Mwanajuma J.
Kenya, Kilifi
Centre for Geographic Medicine Research
Ngatia, Antony
Kenya, Kilifi
Centre for Geographic Medicine Research
Shebbe, Mohammed
Kenya, Kilifi
Centre for Geographic Medicine Research
Morpeth, Susan Claire
Kenya, Kilifi
Centre for Geographic Medicine Research
Mwarumba, Salim
Kenya, Kilifi
Centre for Geographic Medicine Research
Bett, Anne
Kenya, Kilifi
Centre for Geographic Medicine Research
Nokes, David James
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Coventry
University of Warwick
Seale, Anna C.
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Coventry
University of Warwick
Kazungu, Sidi D.
Kenya, Kilifi
Centre for Geographic Medicine Research
Munywoki, Patrick Kiio
Kenya, Kilifi
Centre for Geographic Medicine Research
Hammitt, Laura L.
Kenya, Kilifi
Centre for Geographic Medicine Research
Scott, John Anthony Gerard
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Oxford
Nuffield Department of Medicine
Berkley, James A.
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Oxford
Nuffield Department of Medicine
Statistics
Citations: 33
Authors: 14
Affiliations: 3
Identifiers
Doi:
10.1097/INF.0b013e3182638012
ISSN:
08913668
e-ISSN:
15320987
Research Areas
Food Security
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Qualitative
Quantitative
Study Locations
Kenya