Clinico-Aetiological Study of Severe and Very Severe Pneumonia in Two Months to Five Years Children in a Tertiary Health Care Centre in Odisha, India SC06-SC10

摘要

Introduction: Pneumonia is a major cause of mortality under five-year-old children. In spite of recent advances in management, there is paucity of data on clinical, aetiological profile of severe and very severe pneumonia among under five-year-old children in developing countries.Aim: To determine the clinico-aetiological factors of severe and very severe pneumonia and its outcome in children aged two -months to five-years in a tertiary health care centre in Odisha, India.Materials and Methods: This was a prospective observational study. All the patients between two-months to five-years age admitted to SCB Medical College, Cuttack, Odisha, India, were screened for features of severe and very severe pneumonia based on WHO diagnostic criteria, over a one year period. Out of 10300 patients admitted to our hospital during the study period; 141 cases were included in the study. Their clinical parameters were recorded and were followed up till discharge or death. Continous variables was analyzed using Student t-test or Mann-Whitney U test whereas categorical data were analyzed using Pearson Chi square test or Fischer Exact test.Results: Out of 141 patients included in the study, cough, tachypnea, and chest retractions were present in 100% cases while fever in 97.1% (137) cases. In 17% (24) cases, bacterial pathogen was isolated. Most common organism being Staphylococcus aureus 8.51% (12) followed by Streptococcus pneumonie 6.4% (9). Higher mortality 11.34% (16) was found among patients presenting after three days of illness (p=0.048). About 17% (24) patients developed complications. Common complications were sepsis 5.6% (8), CCF 4.2% (6) and empyema 4.2% (6). Higher mortality 22 (15.6%) was observed in very severe pneumonia group (p=0.003).Conclusion: The incidence of severe and very severe pneumonia was higher in infancy. Rainy and winter season was associated with higher incidence of disease. Bottle feeding practice and smoking were significantly associated with more severe disease. Death rate was high among patients admitted to hospital after three days of onset of illness, so early referral is indicated for better outcome.