title: Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya.
abstract: BACKGROUND
  Despite a substantial disease burden, there is little descriptive epidemiology of acute pneumonia in sub-Saharan Africa. We did this study to define the aetiology of acute pneumonia, to estimate mortality at convalescence, and to analyse mortality risk-factors.
  
  
  METHODS
  We studied 281 Kenyan adults who presented to two public hospitals (one urban and one rural) with acute radiologically confirmed pneumonia during 1994-96. We did blood and lung-aspirate cultures, mycobacterial cultures, serotype-specific pneumococcal antigen detection, and serology for viral and atypical agents.
  
  
  RESULTS
  Aetiology was defined in 182 (65%) patients. Streptococcus pneumoniae was the most common causative agent, being found in 129 (46%) cases; Mycobacterium tuberculosis was found in 26 (9%). Of 255 patients followed up for at least 3 weeks, 25 (10%) died at a median age of 33 years. In multivariate analyses, risk or protective factors for mortality were age (odds ratio 1.51 per decade [95% CI 1.04-2.19]), unemployment (4.42 [1.21-16.1]), visiting a traditional healer (5.26 [1.67-16.5]), visiting a pharmacy (0.30 [0.10-0.91]), heart rate (1.64 per 10 beats [1.24-2.16]), and herpes labialis (15.4 [2.22-107]). HIV-1 seropositivity, found in 52%, was not associated with mortality. Death or failure to recover after 3 weeks was more common in patients with pneumococci of intermediate resistance to benzylpenicillin, which comprised 28% of pneumococcal isolates, than in those infected with susceptible pneumococci (5.60 [1.33-23.6]).
  
  
  CONCLUSIONS
  We suggest that tuberculosis is a sufficiently common cause of acute pneumonia in Kenyan adults to justify routine sputum culture, and that treatment with benzylpenicillin remains appropriate for clinical failure due to M. tuberculosis, intermediate-resistant pneumococci, and other bacterial pathogens. However, interventions restricted to hospital management will fail to decrease mortality associated with socioeconomic, educational, and behavioural factors.
authors.affiliation: Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, UK. ascott@kilifi.mimcom.net
authors.forename: J A
authors.initials: JA
authors.lastname: Scott
authors.forename: A J
authors.initials: AJ
authors.lastname: Hall
authors.forename: C
authors.initials: C
authors.lastname: Muyodi
authors.forename: B
authors.initials: B
authors.lastname: Lowe
authors.forename: M
authors.initials: M
authors.lastname: Ross
authors.forename: B
authors.initials: B
authors.lastname: Chohan
authors.forename: K
authors.initials: K
authors.lastname: Mandaliya
authors.forename: E
authors.initials: E
authors.lastname: Getambu
authors.forename: F
authors.initials: F
authors.lastname: Gleeson
authors.forename: F
authors.initials: F
authors.lastname: Drobniewski
authors.forename: K
authors.initials: K
authors.lastname: Marsh
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000401:mortality; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011014:Pneumonia / Q000097:blood / Q000382:microbiology* / Q000401:mortality*; D011018:Pneumonia, Pneumococcal / Q000401:mortality; D012307:Risk Factors; D017678:Sex Distribution; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000401:mortality