Abstract:
Introduction: There 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.
Methods: We 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.
Results: 1832 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).
Conclusion: Children >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.