Potentially Modifiable Factors Associated with Death of Infants and Children with Severe Pneumonia Routinely Managed in District Hospitals in Malawi

Penelope M Enarson; Robert P Gie; Charles C Mwansambo; Alfred E Chalira; Norman N Lufesi; Ellubey R Maganga; Donald A Enarson; Neil A Cameron; Stephen M Graham

doi:10.1371/journal.pone.0133365

Potentially Modifiable Factors Associated with Death of Infants and Children with Severe Pneumonia Routinely Managed in District Hospitals in Malawi

PLoS One. 2015 Aug 3;10(8):e0133365. doi: 10.1371/journal.pone.0133365. eCollection 2015.

Authors

Penelope M Enarson¹, Robert P Gie², Charles C Mwansambo³, Alfred E Chalira³, Norman N Lufesi³, Ellubey R Maganga⁴, Donald A Enarson¹, Neil A Cameron⁵, Stephen M Graham⁶

Affiliations

¹ International Union Against Tuberculosis and Lung Disease, Paris, France; Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa.
² Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
³ Ministry of Health, Lilongwe, Malawi.
⁴ UNICEF Malawi, Lilongwe, Malawi.
⁵ Division of Community Health, The Department of Interdisciplinary Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
⁶ International Union Against Tuberculosis and Lung Disease, Paris, France; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.

Abstract

Objective: To investigate recognised co-morbidities and clinical management associated with inpatient pneumonia mortality in Malawian district hospitals.

Methods: Prospective cohort study, of patient records, carried out in Malawi between 1st October 2000 and 30th June 2003. The study included all children aged 0-59 months admitted to the paediatric wards in sixteen district hospitals throughout Malawi with severe and very severe pneumonia. We compared individual factors between those that survived (n = 14 076) and those that died (n = 1 633).

Results: From logistic regression analysis, predictors of death in hospital, adjusted for age, sex and severity grade included comorbid conditions of meningitis (OR =2.49, 95% CI 1.50-4.15), malnutrition (OR =2.37, 95% CI 1.94-2.88) and severe anaemia (OR =1.41, 95% CI 1.03-1.92). Requiring supplementary oxygen (OR =2.16, 95% CI 1.85-2.51) and intravenous fluids (OR =3.02, 95% CI 2.13-4.28) were associated with death while blood transfusion was no longer significant (OR =1.10, 95% CI 0.77-1.57) when the model included severe anaemia.

Conclusions: This study identified a number of challenges to improve outcome for Malawian infants and children hospitalised with pneumonia. These included improved assessment of co-morbidities and more rigorous application of standard case management.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anemia / complications*
Case Management
Child, Preschool
Female
Hospitalization
Hospitals
Hospitals, District
Humans
Infant
Infant, Newborn
Malawi
Male
Malnutrition / complications*
Meningitis / complications*
Pneumonia / complications*
Pneumonia / diagnosis
Prospective Studies
Severity of Illness Index

Grants and funding

The CLHP was primarly funded by the MoH of Malawi, who contributed 69% of the running costs comprising facilities and human resources that are part of the existing health system. The Bill and Melinda Gates Foundation funded the remaining 31% of the costs, 21% of which was investment and 79% operating costs. The Bill & Melinda Gates Foundation grant ID#: 413 http://www.gatesfoundation.org/Pages/home.aspx). The external funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.