Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya
IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk facto...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Grace Irimu [verfasserIn] Morris Ogero [verfasserIn] David Gathara [verfasserIn] Mike English [verfasserIn] Jalemba Aluvaala [verfasserIn] Liana Macpherson [verfasserIn] Ambrose Agweyu [verfasserIn] Mercy Chepkirui [verfasserIn] Abraham Lagat [verfasserIn] Sylvia Omoke [verfasserIn] Cynthia Khazenzi [verfasserIn] Basil Okola [verfasserIn] Shadrack Muema [verfasserIn] Paul Mwaniki [verfasserIn] Lucas Malla [verfasserIn] Emma Namulala [verfasserIn] Juma Vitalis [verfasserIn] Samuel Ng’arng’ar [verfasserIn] Peter Aduro Kidaha [verfasserIn] Rachel Inginia [verfasserIn] Melab Musabi [verfasserIn] Grace Ochieng [verfasserIn] Lydia Thuranira [verfasserIn] Magdaline Kuria [verfasserIn] Samuel Otido [verfasserIn] Esther Njiru [verfasserIn] Charles Nzioki [verfasserIn] Supa Tonje [verfasserIn] Caren Emadau [verfasserIn] Cecelia Mutiso [verfasserIn] Peninah Mwangi [verfasserIn] Christine Manyasi [verfasserIn] David Kimutai [verfasserIn] Celia Muturi [verfasserIn] Agnes Mithamo [verfasserIn] Anne Kamunya [verfasserIn] Alice Kariuki [verfasserIn] Grace Wachira [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2019 |
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| Übergeordnetes Werk: |
In: BMJ Global Health - BMJ Publishing Group, 2018, 4(2019), 5 |
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| Übergeordnetes Werk: |
volume:4 ; year:2019 ; number:5 |
| Links: |
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| DOI / URN: |
10.1136/bmjgh-2019-001715 |
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| Katalog-ID: |
DOAJ008747660 |
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| 245 | 1 | 0 | |a Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya |
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| 520 | |a IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. | ||
| 653 | 0 | |a Medicine (General) | |
| 653 | 0 | |a Infectious and parasitic diseases | |
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| 700 | 0 | |a David Gathara |e verfasserin |4 aut | |
| 700 | 0 | |a Mike English |e verfasserin |4 aut | |
| 700 | 0 | |a Jalemba Aluvaala |e verfasserin |4 aut | |
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| 700 | 0 | |a Emma Namulala |e verfasserin |4 aut | |
| 700 | 0 | |a Juma Vitalis |e verfasserin |4 aut | |
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10.1136/bmjgh-2019-001715 doi (DE-627)DOAJ008747660 (DE-599)DOAJ74304274c27f432ba0f80f3e8f3697e4 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Grace Irimu verfasserin aut Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. Medicine (General) Infectious and parasitic diseases Morris Ogero verfasserin aut David Gathara verfasserin aut Mike English verfasserin aut Jalemba Aluvaala verfasserin aut Liana Macpherson verfasserin aut Ambrose Agweyu verfasserin aut Mercy Chepkirui verfasserin aut Abraham Lagat verfasserin aut Sylvia Omoke verfasserin aut Cynthia Khazenzi verfasserin aut Basil Okola verfasserin aut Shadrack Muema verfasserin aut Paul Mwaniki verfasserin aut Lucas Malla verfasserin aut Emma Namulala verfasserin aut Juma Vitalis verfasserin aut Samuel Ng’arng’ar verfasserin aut Peter Aduro Kidaha verfasserin aut Rachel Inginia verfasserin aut Melab Musabi verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Magdaline Kuria verfasserin aut Samuel Otido verfasserin aut Esther Njiru verfasserin aut Charles Nzioki verfasserin aut Supa Tonje verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Peninah Mwangi verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 4(2019), 5 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:4 year:2019 number:5 https://doi.org/10.1136/bmjgh-2019-001715 kostenfrei https://doaj.org/article/74304274c27f432ba0f80f3e8f3697e4 kostenfrei https://gh.bmj.com/content/4/5/e001715.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 4 2019 5 |
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10.1136/bmjgh-2019-001715 doi (DE-627)DOAJ008747660 (DE-599)DOAJ74304274c27f432ba0f80f3e8f3697e4 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Grace Irimu verfasserin aut Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. Medicine (General) Infectious and parasitic diseases Morris Ogero verfasserin aut David Gathara verfasserin aut Mike English verfasserin aut Jalemba Aluvaala verfasserin aut Liana Macpherson verfasserin aut Ambrose Agweyu verfasserin aut Mercy Chepkirui verfasserin aut Abraham Lagat verfasserin aut Sylvia Omoke verfasserin aut Cynthia Khazenzi verfasserin aut Basil Okola verfasserin aut Shadrack Muema verfasserin aut Paul Mwaniki verfasserin aut Lucas Malla verfasserin aut Emma Namulala verfasserin aut Juma Vitalis verfasserin aut Samuel Ng’arng’ar verfasserin aut Peter Aduro Kidaha verfasserin aut Rachel Inginia verfasserin aut Melab Musabi verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Magdaline Kuria verfasserin aut Samuel Otido verfasserin aut Esther Njiru verfasserin aut Charles Nzioki verfasserin aut Supa Tonje verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Peninah Mwangi verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 4(2019), 5 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:4 year:2019 number:5 https://doi.org/10.1136/bmjgh-2019-001715 kostenfrei https://doaj.org/article/74304274c27f432ba0f80f3e8f3697e4 kostenfrei https://gh.bmj.com/content/4/5/e001715.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 4 2019 5 |
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10.1136/bmjgh-2019-001715 doi (DE-627)DOAJ008747660 (DE-599)DOAJ74304274c27f432ba0f80f3e8f3697e4 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Grace Irimu verfasserin aut Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. Medicine (General) Infectious and parasitic diseases Morris Ogero verfasserin aut David Gathara verfasserin aut Mike English verfasserin aut Jalemba Aluvaala verfasserin aut Liana Macpherson verfasserin aut Ambrose Agweyu verfasserin aut Mercy Chepkirui verfasserin aut Abraham Lagat verfasserin aut Sylvia Omoke verfasserin aut Cynthia Khazenzi verfasserin aut Basil Okola verfasserin aut Shadrack Muema verfasserin aut Paul Mwaniki verfasserin aut Lucas Malla verfasserin aut Emma Namulala verfasserin aut Juma Vitalis verfasserin aut Samuel Ng’arng’ar verfasserin aut Peter Aduro Kidaha verfasserin aut Rachel Inginia verfasserin aut Melab Musabi verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Magdaline Kuria verfasserin aut Samuel Otido verfasserin aut Esther Njiru verfasserin aut Charles Nzioki verfasserin aut Supa Tonje verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Peninah Mwangi verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 4(2019), 5 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:4 year:2019 number:5 https://doi.org/10.1136/bmjgh-2019-001715 kostenfrei https://doaj.org/article/74304274c27f432ba0f80f3e8f3697e4 kostenfrei https://gh.bmj.com/content/4/5/e001715.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 4 2019 5 |
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10.1136/bmjgh-2019-001715 doi (DE-627)DOAJ008747660 (DE-599)DOAJ74304274c27f432ba0f80f3e8f3697e4 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Grace Irimu verfasserin aut Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. Medicine (General) Infectious and parasitic diseases Morris Ogero verfasserin aut David Gathara verfasserin aut Mike English verfasserin aut Jalemba Aluvaala verfasserin aut Liana Macpherson verfasserin aut Ambrose Agweyu verfasserin aut Mercy Chepkirui verfasserin aut Abraham Lagat verfasserin aut Sylvia Omoke verfasserin aut Cynthia Khazenzi verfasserin aut Basil Okola verfasserin aut Shadrack Muema verfasserin aut Paul Mwaniki verfasserin aut Lucas Malla verfasserin aut Emma Namulala verfasserin aut Juma Vitalis verfasserin aut Samuel Ng’arng’ar verfasserin aut Peter Aduro Kidaha verfasserin aut Rachel Inginia verfasserin aut Melab Musabi verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Magdaline Kuria verfasserin aut Samuel Otido verfasserin aut Esther Njiru verfasserin aut Charles Nzioki verfasserin aut Supa Tonje verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Peninah Mwangi verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 4(2019), 5 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:4 year:2019 number:5 https://doi.org/10.1136/bmjgh-2019-001715 kostenfrei https://doaj.org/article/74304274c27f432ba0f80f3e8f3697e4 kostenfrei https://gh.bmj.com/content/4/5/e001715.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 4 2019 5 |
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10.1136/bmjgh-2019-001715 doi (DE-627)DOAJ008747660 (DE-599)DOAJ74304274c27f432ba0f80f3e8f3697e4 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Grace Irimu verfasserin aut Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. Medicine (General) Infectious and parasitic diseases Morris Ogero verfasserin aut David Gathara verfasserin aut Mike English verfasserin aut Jalemba Aluvaala verfasserin aut Liana Macpherson verfasserin aut Ambrose Agweyu verfasserin aut Mercy Chepkirui verfasserin aut Abraham Lagat verfasserin aut Sylvia Omoke verfasserin aut Cynthia Khazenzi verfasserin aut Basil Okola verfasserin aut Shadrack Muema verfasserin aut Paul Mwaniki verfasserin aut Lucas Malla verfasserin aut Emma Namulala verfasserin aut Juma Vitalis verfasserin aut Samuel Ng’arng’ar verfasserin aut Peter Aduro Kidaha verfasserin aut Rachel Inginia verfasserin aut Melab Musabi verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Magdaline Kuria verfasserin aut Samuel Otido verfasserin aut Esther Njiru verfasserin aut Charles Nzioki verfasserin aut Supa Tonje verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Peninah Mwangi verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 4(2019), 5 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:4 year:2019 number:5 https://doi.org/10.1136/bmjgh-2019-001715 kostenfrei https://doaj.org/article/74304274c27f432ba0f80f3e8f3697e4 kostenfrei https://gh.bmj.com/content/4/5/e001715.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 4 2019 5 |
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Grace Irimu @@aut@@ Morris Ogero @@aut@@ David Gathara @@aut@@ Mike English @@aut@@ Jalemba Aluvaala @@aut@@ Liana Macpherson @@aut@@ Ambrose Agweyu @@aut@@ Mercy Chepkirui @@aut@@ Abraham Lagat @@aut@@ Sylvia Omoke @@aut@@ Cynthia Khazenzi @@aut@@ Basil Okola @@aut@@ Shadrack Muema @@aut@@ Paul Mwaniki @@aut@@ Lucas Malla @@aut@@ Emma Namulala @@aut@@ Juma Vitalis @@aut@@ Samuel Ng’arng’ar @@aut@@ Peter Aduro Kidaha @@aut@@ Rachel Inginia @@aut@@ Melab Musabi @@aut@@ Grace Ochieng @@aut@@ Lydia Thuranira @@aut@@ Magdaline Kuria @@aut@@ Samuel Otido @@aut@@ Esther Njiru @@aut@@ Charles Nzioki @@aut@@ Supa Tonje @@aut@@ Caren Emadau @@aut@@ Cecelia Mutiso @@aut@@ Peninah Mwangi @@aut@@ Christine Manyasi @@aut@@ David Kimutai @@aut@@ Celia Muturi @@aut@@ Agnes Mithamo @@aut@@ Anne Kamunya @@aut@@ Alice Kariuki @@aut@@ Grace Wachira @@aut@@ |
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However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (&gt;9 years) (aOR &gt;2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren &gt;5 years have high inpatient pneumonia mortality. 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risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in kenya |
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Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya |
| abstract |
IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. |
| abstractGer |
IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. |
| abstract_unstemmed |
IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population. |
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Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (&gt;9 years) (aOR &gt;2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren &gt;5 years have high inpatient pneumonia mortality. 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