PROGNOSTIC FACTORS FOR THE OUTCOME OF THE MANAGEMENT OF SEVERE PNEUMONIA IN CHILDREN UNDER FIVE YEARS ADMITTED AT PLATEAU STATE SPECIALIST HOSPITAL, JOS

Abstract

Severe pneumonia is a major cause of morbidity and mortality in Nigeria
and the world over. It takes most of its toll in children under five years of
age. While several studies have investigated the occurrence of childhood
pneumonia, very little is known of childhood pneumonia in under fives in
north central Nigeria. This study aims at elucidating the clinical features of
severe pneumonia in under-fives in Jos and to identify some prognostic
factors affecting the outcome of its management in this age group. The
study was carried out in Plateau State Specialist Hospital, Jos.
One hundred and seventy six under-five children admitted with severe
pneumonia were analyzed during the study period.
The main symptoms of severe pneumonia in the study subjects were fever,
cough, breathlessness and poor feeding. The main clinical signs were
dyspnoea, lower chest in drawing, tachypnoea, crepitations and grunting
respirations. The commonest complication was cardiac failure. The
associated illnesses in this study were PEM, malaria, measles, sickle cell
disease, HIV/AIDS and aspiration.
Severe pneumonia occurred more in children less than two years with
slight male preponderance. The male to female ratio was 1.5:1.
Twenty six (15.0%) subjects died before discharge. The case fatality varies
depending on the exposed risk factors. Children less than 2 years were 4
times more likely to die than children with none of this factor. Malnourished
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children and non-exclusive breastfed children had more than 2 times risk
of dying from severe pneumonia when compared with those without these
risk factors. Children exposed to wood smoke had 2.5 times the risk of
dying from severe pneumonia compared to unexposed children. Delay in
presentation to hospital, cyanosis, grunting respiration, hepatomegaly and
oxygen saturation level less than 90% increase the risk of dying from
severe pneumonia 2-11 fold compared to those without these risk factors.
The occurrence of heart failure as complication of severe pneumonia
increased the risk of dying from this disease by more than 6 times.
Predictors of death from severe pneumonia in children under-five in this
study were delayed presentation to hospital (OR 1.43) and hepatomegaly
(OR 33.66).

PROGNOSTIC FACTORS FOR THE OUTCOME OF THE MANAGEMENT OF SEVERE PNEUMONIA IN CHILDREN UNDER FIVE YEARS ADMITTED AT PLATEAU STATE SPECIALIST HOSPITAL, JOS