Affiliations: Department of Pediatrics and Child Health, Obafemi
Awolowo University, Ile-Ife, Nigeria | Medical Research Council, Gambian Unit, Atlantic
Boulevard, Fajara, Banjul, The Gambia
Note: [] Correspondence: Bankole Peter Kuti, Department of Pediatrics and
Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria. Tel.: +234 803 456
9848; E-mail: kutitherapy@yahoo.com
Abstract: Pneumonia is a major killer of children worldwide. It is responsible
for 19% of under-five-year-old mortality, of which 70% occurs in sub-Saharan
Africa and South East Asia. A substantial proportion of deaths attributed to
pneumonia is caused by failure to recognise factors at presentation that affect
prognosis. The present study was aimed to assess for factors at presentation
that determine mortality among children with WHO ARI defined severe pneumonia.
This was a prospective observational study of consecutive children aged 2 to 59
months admitted with severe pneumonia at a major health centre in rural Gambia
to determine the risk factors for mortality using logistic regression analysis.
Four hundred and twenty (27.6%) out of the 1517 under- five admissions during
the study period fulfilled the criteria of severe pneumonia using the WHO ARI
criteria. Fifteen of the 420 cases died giving case fatality of 36 per 1000
admissions, with pneumonia accounting for 21.4% of all 70 deaths during the
period. Although age ranges 12–23 months and 36–47 months, overcrowding,
hypothermia at presentation, oedematous PEM, severe wasting, grunting
respiration, convulsion, somnolence and hypoxaemia were significantly
associated with mortality (p < 0.05); only convulsions (OR=16.64, 95%
CI 1.028–1.033) and severe wasting (OR=5.05, 95% CI 1.459–20.484,) were
independent determinants of mortality. We conclude that children with severe
pneumonia who in addition have severe wasting and convulsion are at increased
risks of dying and should be managed in better equipped secondary or tertiary health facilities.
