Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study
Identifieur interne : 001B13 ( Pmc/Corpus ); précédent : 001B12; suivant : 001B14Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study
Auteurs : Marzia Lazzerini ; Nadine Seward ; Norman Lufesi ; Rosina Banda ; Sophie Sinyeka ; Gibson Masache ; Bejoy Nambiar ; Charles Makwenda ; Anthony Costello ; Eric D. Mccollum ; Tim ColbournSource :
- The Lancet. Global health [ 2214-109X ] ; 2016.
Abstract
Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012.
Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed effects logistic regression models.
Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92.7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6.6% (95% CI 6.4–6.7). The case fatality rate significantly decreased between 2001 (15.2% [13.4–17.1]) and 2012 (4.5% [4.1–4.9]; ptrend<0.0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected
Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi.
Url:
DOI: 10.1016/S2214-109X(15)00215-6
PubMed: 26718810
PubMed Central: 5495601
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PMC:5495601Le document en format XML
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<author><name sortKey="Lazzerini, Marzia" sort="Lazzerini, Marzia" uniqKey="Lazzerini M" first="Marzia" last="Lazzerini">Marzia Lazzerini</name>
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<author><name sortKey="Seward, Nadine" sort="Seward, Nadine" uniqKey="Seward N" first="Nadine" last="Seward">Nadine Seward</name>
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<author><name sortKey="Lufesi, Norman" sort="Lufesi, Norman" uniqKey="Lufesi N" first="Norman" last="Lufesi">Norman Lufesi</name>
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<author><name sortKey="Banda, Rosina" sort="Banda, Rosina" uniqKey="Banda R" first="Rosina" last="Banda">Rosina Banda</name>
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<author><name sortKey="Sinyeka, Sophie" sort="Sinyeka, Sophie" uniqKey="Sinyeka S" first="Sophie" last="Sinyeka">Sophie Sinyeka</name>
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<author><name sortKey="Masache, Gibson" sort="Masache, Gibson" uniqKey="Masache G" first="Gibson" last="Masache">Gibson Masache</name>
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<author><name sortKey="Nambiar, Bejoy" sort="Nambiar, Bejoy" uniqKey="Nambiar B" first="Bejoy" last="Nambiar">Bejoy Nambiar</name>
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<author><name sortKey="Makwenda, Charles" sort="Makwenda, Charles" uniqKey="Makwenda C" first="Charles" last="Makwenda">Charles Makwenda</name>
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<author><name sortKey="Costello, Anthony" sort="Costello, Anthony" uniqKey="Costello A" first="Anthony" last="Costello">Anthony Costello</name>
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<author><name sortKey="Mccollum, Eric D" sort="Mccollum, Eric D" uniqKey="Mccollum E" first="Eric D" last="Mccollum">Eric D. Mccollum</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study</title>
<author><name sortKey="Lazzerini, Marzia" sort="Lazzerini, Marzia" uniqKey="Lazzerini M" first="Marzia" last="Lazzerini">Marzia Lazzerini</name>
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<author><name sortKey="Seward, Nadine" sort="Seward, Nadine" uniqKey="Seward N" first="Nadine" last="Seward">Nadine Seward</name>
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<author><name sortKey="Lufesi, Norman" sort="Lufesi, Norman" uniqKey="Lufesi N" first="Norman" last="Lufesi">Norman Lufesi</name>
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<author><name sortKey="Banda, Rosina" sort="Banda, Rosina" uniqKey="Banda R" first="Rosina" last="Banda">Rosina Banda</name>
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<author><name sortKey="Sinyeka, Sophie" sort="Sinyeka, Sophie" uniqKey="Sinyeka S" first="Sophie" last="Sinyeka">Sophie Sinyeka</name>
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<author><name sortKey="Masache, Gibson" sort="Masache, Gibson" uniqKey="Masache G" first="Gibson" last="Masache">Gibson Masache</name>
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<author><name sortKey="Nambiar, Bejoy" sort="Nambiar, Bejoy" uniqKey="Nambiar B" first="Bejoy" last="Nambiar">Bejoy Nambiar</name>
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<author><name sortKey="Makwenda, Charles" sort="Makwenda, Charles" uniqKey="Makwenda C" first="Charles" last="Makwenda">Charles Makwenda</name>
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<author><name sortKey="Mccollum, Eric D" sort="Mccollum, Eric D" uniqKey="Mccollum E" first="Eric D" last="Mccollum">Eric D. Mccollum</name>
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<series><title level="j">The Lancet. Global health</title>
<idno type="eISSN">2214-109X</idno>
<imprint><date when="2016">2016</date>
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<front><div type="abstract" xml:lang="en"><title>Summary</title>
<sec id="S1"><title>Background</title>
<p id="P1">Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed effects logistic regression models.</p>
</sec>
<sec id="S3"><title>Findings</title>
<p id="P3">Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92.7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6.6% (95% CI 6.4–6.7). The case fatality rate significantly decreased between 2001 (15.2% [13.4–17.1]) and 2012 (4.5% [4.1–4.9]; p<sub>trend</sub>
<0.0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected <italic>Pneumocystis jirovecii</italic>
infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2–11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11.8%), severe undernutrition (15.4%), severe acute malnutrition (34.8%), and symptom duration of more than 21 days (9.0%).</p>
</sec>
<sec id="S4"><title>Interpretation</title>
<p id="P4">Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">101613665</journal-id>
<journal-id journal-id-type="pubmed-jr-id">42402</journal-id>
<journal-id journal-id-type="nlm-ta">Lancet Glob Health</journal-id>
<journal-id journal-id-type="iso-abbrev">Lancet Glob Health</journal-id>
<journal-title-group><journal-title>The Lancet. Global health</journal-title>
</journal-title-group>
<issn pub-type="epub">2214-109X</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26718810</article-id>
<article-id pub-id-type="pmc">5495601</article-id>
<article-id pub-id-type="doi">10.1016/S2214-109X(15)00215-6</article-id>
<article-id pub-id-type="manuscript">NIHMS869645</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
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<title-group><article-title>Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Lazzerini</surname>
<given-names>Marzia</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A1">WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Seward</surname>
<given-names>Nadine</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A2">Institute for Global Health, University College London, London, UK</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Lufesi</surname>
<given-names>Norman</given-names>
</name>
<degrees>MPhil</degrees>
<aff id="A3">Acute Respiratory Infection Control Programme, Community Health Sciences Unit, Lilongwe, Malawi</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Banda</surname>
<given-names>Rosina</given-names>
</name>
<degrees>BScNE</degrees>
<aff id="A4">Parent and Child Health Initiative (PACHI), Lilongwe, Malawi</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Sinyeka</surname>
<given-names>Sophie</given-names>
</name>
<degrees>MSc</degrees>
<aff id="A5">Parent and Child Health Initiative (PACHI), Lilongwe, Malawi</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Masache</surname>
<given-names>Gibson</given-names>
</name>
<degrees>MSc</degrees>
<aff id="A6">Parent and Child Health Initiative (PACHI), Lilongwe, Malawi</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Nambiar</surname>
<given-names>Bejoy</given-names>
</name>
<degrees>MPH</degrees>
<aff id="A7">Institute for Global Health, University College London, London, UK</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Makwenda</surname>
<given-names>Charles</given-names>
</name>
<degrees>MSc</degrees>
<aff id="A8">Parent and Child Health Initiative (PACHI), Lilongwe, Malawi</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Costello</surname>
<given-names>Anthony</given-names>
</name>
<degrees>FMedSci</degrees>
<role>Prof.</role>
<aff id="A9">Institute for Global Health, University College London, London, UK</aff>
</contrib>
<contrib contrib-type="author"><name><surname>McCollum</surname>
<given-names>Eric D</given-names>
</name>
<degrees>MD</degrees>
<aff id="A10">Institute for Global Health, University College London, London, UK</aff>
<aff id="A11">Johns Hopkins School of Medicine, Department of Pediatrics, Division of Pulmonology, Baltimore, MD, USA</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Colbourn</surname>
<given-names>Tim</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A12">Institute for Global Health, University College London, London, UK</aff>
</contrib>
</contrib-group>
<author-notes><corresp id="FN1">Correspondence to: Dr Tim Colbourn, Institute for Global Health, University College London, London WC1N 1EH, UK, <email>t.colbourn@ucl.ac.uk</email>
</corresp>
<corresp id="FN2">Dr M Lazzerini, WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137, Trieste, Italy, <email>marzia.lazzerini@burlo.trieste.it</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>22</day>
<month>4</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="ppub"><month>1</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>03</day>
<month>7</month>
<year>2017</year>
</pub-date>
<volume>4</volume>
<issue>1</issue>
<fpage>e57</fpage>
<lpage>e68</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/S2214-109X(15)00215-6</pmc-comment>
<abstract><title>Summary</title>
<sec id="S1"><title>Background</title>
<p id="P1">Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed effects logistic regression models.</p>
</sec>
<sec id="S3"><title>Findings</title>
<p id="P3">Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92.7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6.6% (95% CI 6.4–6.7). The case fatality rate significantly decreased between 2001 (15.2% [13.4–17.1]) and 2012 (4.5% [4.1–4.9]; p<sub>trend</sub>
<0.0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected <italic>Pneumocystis jirovecii</italic>
infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2–11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11.8%), severe undernutrition (15.4%), severe acute malnutrition (34.8%), and symptom duration of more than 21 days (9.0%).</p>
</sec>
<sec id="S4"><title>Interpretation</title>
<p id="P4">Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi.</p>
</sec>
</abstract>
</article-meta>
</front>
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