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CC BY-NC-ND 4.0 · J Pediatr Infect Dis 2023; 18(03): 153-162
DOI: 10.1055/s-0043-1767815
Original Article

Low Mortality among Under-5 Children with Severe Community-Acquired Pneumonia: A 5-Year Retrospective Analysis of 588 Admissions in Ibadan, Nigeria

Olugbenga Oyewumi Akinrinoye 
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
,
Adeyinka Adeyemi Labaeka
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
,
Kayode Raphael Fowobaje
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
,
Hamish Graham
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
2   Centre for International Child Health, The Royal Children's Hospital, Murdoch Children Research Institute, University of Melbourne, Parkville, Australia
,
Adegoke Gbadegesin Falade
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
3   Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Abstract

Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials.

Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression.

Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged ≤12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1–7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0–5.6]) were independently associated with antibiotics change. The CFR was 1.36%.

Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.

Keywords

community-acquired pneumonia - children - antibiotics guideline - Nigeria

Supplementary Material



Publication History

Received: 20 July 2022

Accepted: 02 March 2023

Article published online:
04 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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  • References

  • 1 WHO. Children: Reducing mortality. Geneva, Switzerland: World Health Organisation; 2019. Accessed March 16, 2020 at: https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality
    PubMed
  • 2 WHO. World Pneumonia Day 2016 Geneva, Switzerland: World Health Organisation; 2016. Accessed March 16, 2020 at: https://www.who.int/life-course/news/events/world-pneumonia-day-2016/en/
    PubMed
  • 3 UNICEF. Nigeria contributes highest number to global pneumonia child deaths, New York City, United States: United Nations International Children Emergency Fund. 2019. Accessed March 16, 2020 at: https://www.unicef.org/nigeria/press-releases/nigeria-contributes-highest-number-global-pneumonia-child-deaths
    PubMed
  • 4 UNICEF. Two million children in Nigeria could die in the next decade unless more is done to fight pneumonia. Nigeria. 2020. Accessed April 17, 2020 at: https://www.unicef.org/nigeria/press-releases/two-million-children-nigeria-could-die-next-decade-unless-more-done-fight-pneumonia
    PubMed
  • 5 Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86 (05) 408-416
    CrossrefPubMedGoogle Scholar
  • 6 Falade AG, Ayede AI. Epidemiology, aetiology and management of childhood acute community-acquired pneumonia in developing countries—a review. Afr J Med Med Sci 2011; 40 (04) 293-308
    PubMedGoogle Scholar
  • 7 GAVI. Nigeria launches pentavalent vaccine. Geneva, Switzerland: The Global Alliance for Vaccines and Immunizations; 2012. Accessed April 17, 2020 at: https://www.gavi.org/news/media-room/nigeria-launches-pentavalent-vaccine
    PubMed
  • 8 Nascimento-Carvalho CM. Etiology of childhood community acquired pneumonia and its implications for vaccination. Braz J Infect Dis 2001; 5 (02) 87-97
    CrossrefPubMedGoogle Scholar
  • 9 Olowu A, Elusiyan JBE, Esangbedo D. et al. Management of community-acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatrics Association of Nigeria (PAN). Niger J Paediatr 2015; 42: 283-292
    CrossrefPubMedGoogle Scholar
  • 10 WHO. Revised WHO classification and treatment of childhood pneumonia at health facilities: evidence summaries, Scientific basis of WHO recommendations for treatment of pneumonia Geneva, Switzerland: World Health Organisation; 2014. Accessed January 20, 2021 at: https://www.ncbi.nlm.nih.gov/books/NBK264159/
    PubMed
  • 11 World Health Organization. (2013). 2nd ed. Pocket Book of Hospital Care for Children: Guidelines for the management of common illnesses with limited resources. pp. 76–90. Accessed March 16, 2023 at: https://apps.who.int/iris/handle/10665/81170
    PubMed
  • 12 WHO. Pneumonia. Geneva, Switzerland: World Health Organisation; 2019. Accessed April 20, 2021 at: https://www.who.int/news-room/fact-sheets/detail/pneumonia
    PubMed
  • 13 Shattock FM. Classification of infantile malnutrition. Lancet 1971; 1 (7699): 597
    CrossrefPubMedGoogle Scholar
  • 14 Oyedeji GA. Socio-economic and cultural background of hospitalised children in Ilesha. Niger J Paediatr 1985; 12: 111-117
    PubMedGoogle Scholar
  • 15 Abdulkarim A, Ibraheem R, Adegboye A. et al. Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria. Niger J Paediatr 2013; 40: 284-289
    PubMedGoogle Scholar
  • 16 Ujunwa F, Ezeonu C. Risk factors for acute respiratory tract infections in under-five children in Enugu southeast Nigeria. Ann Med Health Sci Res 2014; 4 (01) 95-99
    CrossrefPubMedGoogle Scholar
  • 17 Ibraheem RM, Johnson WB, Abdulkarim AA. Hypoxaemia in hospitalised under-five Nigerian children with pneumonia. West Afr J Med 2014; 33 (01) 37-43
    PubMedGoogle Scholar
  • 18 Schurz H, Salie M, Tromp G, Hoal EG, Kinnear CJ, Möller M. The X chromosome and sex-specific effects in infectious disease susceptibility. Hum Genomics 2019; 13 (01) 2-13
    CrossrefPubMedGoogle Scholar
  • 19 Dougherty L, Gilroy K, Olayemi A. et al. Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria. BMC Public Health 2020; 20 (01) 746
    CrossrefPubMedGoogle Scholar
  • 20 Silverman M, Stratton D, Diallo A, Egler LJ. Diagnosis of acute bacterial pneumonia in Nigerian children. Value of needle aspiration of lung of countercurrent immunoelectrophoresis. Arch Dis Child 1977; 52 (12) 925-931
    CrossrefPubMedGoogle Scholar
  • 21 Johnson AW, Osinusi K, Aderele WI, Gbadero DA, Olaleye OD, Adeyemi-Doro FA. Etiologic agents and outcome determinants of community-acquired pneumonia in urban children: a hospital-based study. J Natl Med Assoc 2008; 100 (04) 370-385
    PubMedGoogle Scholar
  • 22 Jain DL, Sarathi V, Jawalekar S. Predictors of treatment failure in hospitalized children [3-59 months] with severe and very severe pneumonia. Indian Pediatr 2013; 50 (08) 787-789
    CrossrefPubMedGoogle Scholar
  • 23 Basnet S, Sharma A, Mathisen M. et al. Predictors of duration and treatment failure of severe pneumonia in hospitalized young Nepalese children. PLoS One 2015; 10 (03) e0122052
    CrossrefPubMedGoogle Scholar
  • 24 Lawoyin TO, Olawuyi JF, Onadeko MO. Factors associated with exclusive breastfeeding in Ibadan, Nigeria. J Hum Lact 2001; 17 (04) 321-325
    CrossrefPubMedGoogle Scholar
  • 25 Kaur A, Singh K, Pannu MS, Singh P, Sehgal N, Kaur R. The effect of exclusive breastfeeding on hospital stay and morbidity due to various diseases in infants under 6 months of age: a prospective observational study. Int J Pediatr 2016; 2016: 7647054
    CrossrefPubMedGoogle Scholar
  • 26 Falade AG, Lagunju IA, Bakare RA, Odekanmi AA, Adegbola RA. Invasive pneumococcal disease in children aged <5 years admitted to 3 urban hospitals in Ibadan, Nigeria. Clin Infect Dis 2009; 48 (Suppl 2): S190-S196
    CrossrefPubMedGoogle Scholar
  • 27 Obaro S, Lawson L, Essen U. et al. Community acquired bacteremia in young children from central Nigeria—a pilot study. BMC Infect Dis 2011; 11: 137
    CrossrefPubMedGoogle Scholar
  • 28 Aderele W, Johnson W, Osinusi K. Acute Klebsiella, Pseudomonas and Proteus pneumonia in childhood. Niger J Paediatr 1992; 19: 80-88
    PubMedGoogle Scholar
  • 29 Adegbola RA, Falade AG, Sam BE. et al. The etiology of pneumonia in malnourished and well-nourished Gambian children. Pediatr Infect Dis J 1994; 13 (11) 975-982
    CrossrefPubMedGoogle Scholar
  • 30 Russell FM, Biribo SS, Selvaraj G. et al. As a bacterial culture medium, citrated sheep blood agar is a practical alternative to citrated human blood agar in laboratories of developing countries. J Clin Microbiol 2006; 44 (09) 3346-3351
    CrossrefPubMedGoogle Scholar
  • 31 Satzke C, Seduadua A, Chandra R, Carapetis JR, Mulholland EK, Russell FM. Comparison of citrated human blood, citrated sheep blood, and defibrinated sheep blood Mueller-Hinton agar preparations for antimicrobial susceptibility testing of Streptococcus pneumoniae isolates. J Clin Microbiol 2010; 48 (10) 3770-3772
    CrossrefPubMedGoogle Scholar
  • 32 Odeyemi AO, Odeyemi AO, Musa TL. Determinants of outcome among under-five children hospitalized with pneumonia at a tertiary health facility in South-West Nigeria. West Afr J Med 2021; 38 (02) 114-119
    PubMedGoogle Scholar
  • 33 Obiora UJ, Ekpebe PA, Okoye C, David-Idiapho CG. Audit of childhood death in a tertiary care center in Niger Delta region of Nigeria. West Afr J Med 2020; 37 (02) 113-117
    PubMedGoogle Scholar
  • 34 Mulholland K. Management of childhood pneumonia in Nigeria. Pediatr Pulmonol 2020; 55 (Suppl 1, Suppl 1): S34-S36
    CrossrefPubMedGoogle Scholar
  • 35 Graham HR, Ayede AI, Bakare AA. et al. Oxygen for children and newborns in non-tertiary hospitals in South-west Nigeria: a needs assessment. Afr J Med Med Sci 2016; 45 (01) 31-49
    PubMedGoogle Scholar
  • 36 Howie SRC, Ebruke BE, McLellan JL. et al. The etiology of childhood pneumonia in the Gambia: Findings from the Pneumonia Etiology Research for Child Health (PERCH) study. Pediatr Infect Dis J 2021; 40 (9S): S7-S17
    CrossrefPubMedGoogle Scholar
  • 37 Le Roux DM, Nicol MP, Vanker A, Nduru PM, Zar HJ. Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa. PLoS One 2021; 16 (08) e0255790
    CrossrefPubMedGoogle Scholar
  • 38 Guan X, Silk BJ, Li W. et al. Pneumonia incidence and mortality in Mainland China: systematic review of Chinese and English literature, 1985-2008. PLoS One 2010; 5 (07) e11721-e11721
    CrossrefPubMedGoogle Scholar
  • 39 Graham HR, Bakare AA, Ayede AI. et al. Oxygen systems to improve clinical care and outcomes for children and neonates: a stepped-wedge cluster-randomised trial in Nigeria. PLoS Med 2019; 16 (11) e1002951
    CrossrefPubMedGoogle Scholar
  • 40 Klein EY, Martinez EM, May L, Saheed M, Reyna V, Broniatowski DA. Categorical risk perception drives variability in antibiotic prescribing in the emergency department: a mixed methods observational study. J Gen Intern Med 2017; 32 (10) 1083-1089
    CrossrefPubMedGoogle Scholar