Abstract
Pneumonia is a major killer of children worldwide. It is responsible for 19% of under-five-year-old
mortality, of which 70% occurs in sub-Saharan Africa and South East Asia. A substantial
proportion of deaths attributed to pneumonia is caused by failure to recognise factors
at presentation that affect prognosis. The present study was aimed to assess for factors
at presentation that determine mortality among children with WHO ARI defined severe
pneumonia. This was a prospective observational study of consecutive children aged
2 to 59 months admitted with severe pneumonia at a major health centre in rural Gambia
to determine the risk factors for mortality using logistic regression analysis. Four
hundred and twenty (27.6%) out of the 1517 under-five admissions during the study
period fulfilled the criteria of severe pneumonia using the WHO ARI criteria. Fifteen
of the 420 cases died giving case fatality of 36 per 1000 admissions, with pneumonia
accounting for 21.4% of all 70 deaths during the period. Although age ranges 12–23
months and 36–47 months, overcrowding, hypothermia at presentation, oedematous PEM,
severe wasting, grunting respiration, convulsion, somnolence and hypoxaemia were significantly
associated with mortality (p < 0.05); only convulsions (OR = 16.64, 95% CI 1.028–1.033) and severe wasting (OR
= 5.05, 95% CI 1.459–20.484,) were independent determinants of mortality. We conclude
that children with severe pneumonia who in addition have severe wasting and convulsion
are at increased risks of dying and should be managed in better equipped secondary
or tertiary health facilities.
Keywords
Childhood - Gambia - mortality - pneumonia - risk factors
