Potentially Modifiable Factors Associated with Death of Infants and Children with Severe Pneumonia Routinely Managed in District Hospitals in Malawi
Identifieur interne : 002988 ( Main/Exploration ); précédent : 002987; suivant : 002989Potentially Modifiable Factors Associated with Death of Infants and Children with Severe Pneumonia Routinely Managed in District Hospitals in Malawi
Auteurs : Penelope M. Enarson [France, Afrique du Sud] ; Robert P. Gie [Afrique du Sud] ; Charles C. Mwansambo [Malawi] ; Alfred E. Chalira [Malawi] ; Norman N. Lufesi [Malawi] ; Ellubey R. Maganga [Malawi] ; Donald A. Enarson [France, Afrique du Sud] ; Neil A. Cameron [Afrique du Sud] ; Stephen M. Graham [France, Australie]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Descripteurs français
- KwdFr :
- Anémie (), Enfant d'âge préscolaire, Femelle, Hospitalisation, Humains, Hôpitaux, Hôpitaux de district (USA), Indice de gravité médicale, Malawi, Malnutrition (), Mâle, Méningite (), Nourrisson, Nouveau-né, Pneumopathie infectieuse (), Pneumopathie infectieuse (diagnostic), Prise en charge personnalisée du patient, Études prospectives.
- MESH :
- diagnostic : Pneumopathie infectieuse.
- Anémie, Enfant d'âge préscolaire, Femelle, Hospitalisation, Humains, Hôpitaux, Hôpitaux de district (USA), Indice de gravité médicale, Malawi, Malnutrition, Mâle, Méningite, Nourrisson, Nouveau-né, Pneumopathie infectieuse, Prise en charge personnalisée du patient, Études prospectives.
- Wicri :
- geographic : Malawi.
English descriptors
- KwdEn :
- 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.
- MESH :
- geographic : Malawi.
- complications : Anemia, Malnutrition, Meningitis, Pneumonia.
- diagnosis : Pneumonia.
- Case Management, Child, Preschool, Female, Hospitalization, Hospitals, Hospitals, District, Humans, Infant, Infant, Newborn, Male, Prospective Studies, Severity of Illness Index.
Abstract
To investigate recognised co-morbidities and clinical management associated with inpatient pneumonia mortality in Malawian district hospitals.
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).
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.
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.
Url:
DOI: 10.1371/journal.pone.0133365
PubMed: 26237222
PubMed Central: 4523211
Affiliations:
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Gie</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu TB Centre, Stellenbosch University, Tygerberg</wicri:regionArea><wicri:noRegion>Tygerberg</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg</wicri:regionArea><wicri:noRegion>Tygerberg</wicri:noRegion></affiliation></author><author><name sortKey="Mwansambo, Charles C" sort="Mwansambo, Charles C" uniqKey="Mwansambo C" first="Charles C." last="Mwansambo">Charles C. Mwansambo</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Ministry of Health, Lilongwe, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>Ministry of Health, Lilongwe</wicri:regionArea><wicri:noRegion>Lilongwe</wicri:noRegion></affiliation></author><author><name sortKey="Chalira, Alfred E" sort="Chalira, Alfred E" uniqKey="Chalira A" first="Alfred E." last="Chalira">Alfred E. Chalira</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Ministry of Health, Lilongwe, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>Ministry of Health, Lilongwe</wicri:regionArea><wicri:noRegion>Lilongwe</wicri:noRegion></affiliation></author><author><name sortKey="Lufesi, Norman N" sort="Lufesi, Norman N" uniqKey="Lufesi N" first="Norman N." last="Lufesi">Norman N. 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Enarson</name><affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Union Against Tuberculosis and Lung Disease, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu TB Centre, Stellenbosch University, Tygerberg</wicri:regionArea><wicri:noRegion>Tygerberg</wicri:noRegion></affiliation></author><author><name sortKey="Cameron, Neil A" sort="Cameron, Neil A" uniqKey="Cameron N" first="Neil A." last="Cameron">Neil A. Cameron</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Division of Community Health, The Department of Interdisciplinary Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Division of Community Health, The Department of Interdisciplinary Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg</wicri:regionArea><wicri:noRegion>Tygerberg</wicri:noRegion></affiliation></author><author><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name><affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Union Against Tuberculosis and Lung Disease, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anemia (complications)</term><term>Case Management</term><term>Child, Preschool</term><term>Female</term><term>Hospitalization</term><term>Hospitals</term><term>Hospitals, District</term><term>Humans</term><term>Infant</term><term>Infant, Newborn</term><term>Malawi</term><term>Male</term><term>Malnutrition (complications)</term><term>Meningitis (complications)</term><term>Pneumonia (complications)</term><term>Pneumonia (diagnosis)</term><term>Prospective Studies</term><term>Severity of Illness Index</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Anémie ()</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Hospitalisation</term><term>Humains</term><term>Hôpitaux</term><term>Hôpitaux de district (USA)</term><term>Indice de gravité médicale</term><term>Malawi</term><term>Malnutrition ()</term><term>Mâle</term><term>Méningite ()</term><term>Nourrisson</term><term>Nouveau-né</term><term>Pneumopathie infectieuse ()</term><term>Pneumopathie infectieuse (diagnostic)</term><term>Prise en charge personnalisée du patient</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Malawi</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Anemia</term><term>Malnutrition</term><term>Meningitis</term><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Pneumopathie infectieuse</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Case Management</term><term>Child, Preschool</term><term>Female</term><term>Hospitalization</term><term>Hospitals</term><term>Hospitals, District</term><term>Humans</term><term>Infant</term><term>Infant, Newborn</term><term>Male</term><term>Prospective Studies</term><term>Severity of Illness Index</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Anémie</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Hospitalisation</term><term>Humains</term><term>Hôpitaux</term><term>Hôpitaux de district (USA)</term><term>Indice de gravité médicale</term><term>Malawi</term><term>Malnutrition</term><term>Mâle</term><term>Méningite</term><term>Nourrisson</term><term>Nouveau-né</term><term>Pneumopathie infectieuse</term><term>Prise en charge personnalisée du patient</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Malawi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Objective</title><p>To investigate recognised co-morbidities and clinical management associated with inpatient pneumonia mortality in Malawian district hospitals.</p></sec><sec id="sec002"><title>Methods</title><p>Prospective cohort study, of patient records, carried out in Malawi between 1<sup>st</sup> October 2000 and 30<sup>th</sup> 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).</p></sec><sec id="sec003"><title>Results</title><p>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.</p></sec><sec id="sec004"><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lozano, R" uniqKey="Lozano R">R Lozano</name></author><author><name sortKey="Naghavi, M" uniqKey="Naghavi M">M Naghavi</name></author><author><name sortKey="Foreman, K" uniqKey="Foreman K">K Foreman</name></author><author><name sortKey="Lim, S" uniqKey="Lim S">S Lim</name></author><author><name sortKey="Shibuya, K" uniqKey="Shibuya K">K Shibuya</name></author><author><name sortKey="Aboyans, V" uniqKey="Aboyans V">V Aboyans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rudan, I" uniqKey="Rudan I">I Rudan</name></author><author><name sortKey="Boschi Pinto, C" uniqKey="Boschi Pinto C">C Boschi-Pinto</name></author><author><name sortKey="Biloglav, Z" uniqKey="Biloglav Z">Z Biloglav</name></author><author><name sortKey="Mulholland, K" 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Enarson</name></region><name sortKey="Enarson, Donald A" sort="Enarson, Donald A" uniqKey="Enarson D" first="Donald A." last="Enarson">Donald A. Enarson</name><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Enarson, Penelope M" sort="Enarson, Penelope M" uniqKey="Enarson P" first="Penelope M." last="Enarson">Penelope M. Enarson</name></noRegion><name sortKey="Cameron, Neil A" sort="Cameron, Neil A" uniqKey="Cameron N" first="Neil A." last="Cameron">Neil A. Cameron</name><name sortKey="Enarson, Donald A" sort="Enarson, Donald A" uniqKey="Enarson D" first="Donald A." last="Enarson">Donald A. Enarson</name><name sortKey="Gie, Robert P" sort="Gie, Robert P" uniqKey="Gie R" first="Robert P." last="Gie">Robert P. Gie</name><name sortKey="Gie, Robert P" sort="Gie, Robert P" uniqKey="Gie R" first="Robert P." last="Gie">Robert P. Gie</name></country><country name="Malawi"><noRegion><name sortKey="Mwansambo, Charles C" sort="Mwansambo, Charles C" uniqKey="Mwansambo C" first="Charles C." last="Mwansambo">Charles C. Mwansambo</name></noRegion><name sortKey="Chalira, Alfred E" sort="Chalira, Alfred E" uniqKey="Chalira A" first="Alfred E." last="Chalira">Alfred E. Chalira</name><name sortKey="Lufesi, Norman N" sort="Lufesi, Norman N" uniqKey="Lufesi N" first="Norman N." last="Lufesi">Norman N. Lufesi</name><name sortKey="Maganga, Ellubey R" sort="Maganga, Ellubey R" uniqKey="Maganga E" first="Ellubey R." last="Maganga">Ellubey R. Maganga</name></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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