Risk Factors of Mortality among Children Admitted with Severe Pneumonia at a Reference Hospital in Khartoum, Sudan

摘要

Introduction: Pneumonia is the leading cause of mortality among under-five children. Previous studies have documented factors of mortality. These factors were not addressed in this country. This study aimed to determine risk factors of death among children hospitalized for severe pneumonia. Methodology: This cross-sectional hospital-based study was conducted in Khartoum Children Emergency Hospital among children with severe pneumonia aged 2-59 months from August 2010 to April 2012. Management outcome (died/survived) were recorded within 5 days. History and physical examination were recorded, chest radiograph and a sample of 5 ml of venous blood was collected for white blood cells count, hemoglobin level and serum level of albumin, urea, creatinine and C-reactive protein. Blood samples were cultured in appropriate media. Data were analysed using SPSS software for windows version 16.0. Results: Of the195 recruited children, 33 died (16.9% case fatality). Children who died were younger compared to survivals (n=162) (p<0.001). Malnutrition, dehydration and chest in drawing were frequent among dead compared to survivals; p<0.001, p=0.033 and p=0.017, respectively. The dead had lower mean hemoglobin (p=0.010) and lower mean serum albumin level (p<0.001) and significantly high mean C-reactive protein concentration (p<0.001) and high blood urea (p<0.001). Independent risk factors of mortality were: young age (OR 1.07; 95% CI 1.02-1.12), chest in drawing (OR 8.63; 95% CI 2.08-35.83) and history of bronchial asthma (OR 10.31; 95% CI 2.25-47.22), a low concentration of C-reactive protein (OR 0.49; 95% CI 0.37-0.66) and increased hemoglobin concentration (OR 0.55; 95% CI 0.32-0.49). Conclusions: improvement of management policies and settings of severe pneumonia to decrease mortality. In addition, primary prevention, health education programs and strategies to combat co morbidities. Addressing the risk factors of increased mortality of children with severe pneumonia. These are young age, history of bronchial asthma, high C-reactive protein and anemia.