Improvements in nutritional management as a determinant of reduced mortality from community-acquired lower respiratory tract infection in hospitalized children from rural central Africa.
BACKGROUND
In-hospital mortality from lower respiratory tract infections (LTRI) is unacceptably high in developing countries where LTRI are still a leading cause of death.


OBJECTIVE
To identify new approaches to reduce in-hospital mortality of LRTI through the improvement of its management.


METHODS
The prospectively collected database of children admitted during an 11-year period with LRTI in a pediatric rural hospital in Central Africa was reviewed to determine the predictors of death and to evaluate the impact on mortality of 4 different protocols for the management of malnutrition.


RESULTS
During the study period, 859 children were admitted with a nonmeasles severe LRTI. In the 3-year period during which blood cultures were obtained, 29.0% of the children with LRTI were bacteremic, and multiresistant Enterobacteriaceae were recovered in 81.4% of positive blood cultures. Independent predictors of death in children without edema were age <24 months, dehydration and hepatomegaly with adjusted odds ratios (numbers in parentheses, 95% confidence interval) of 3.47 (1.70-7.08), 4.24 (2.11-8.50) and 2.90 (1.43-5.85), respectively. In those with edema, a significantly increased risk of death was noted for girls [4.31 (1.71-10.90)], in children with z-score of weight to height < or = -3 [5.45 (1.67-17.79)] and when the serum albumin was <16 g/l [2.58 (1.01-6.58)]. The improvement in the management of malnutrition was followed by a reduction of LRTI-related mortality in children with edema from 32.4 to 8.9% (P < 0.001). In children without edema, the LRTI-related mortality decreased from approximately 12% to 3.5% when their diet was supplemented with micronutrients.


CONCLUSIONS
This study indicates that the improvement of the management of underlying nutritional deficiencies is crucial for the reduction of the high in-hospital case fatality rate associated with severe nonmeasles LRTI. The empiric antibiotic regimen should be modified to cover for multiresistant Enterobacteriaceae.
Bahwere
Paluku
P
Centre de Recherche en Sciences Naturelles (CRSN), Lwiro, Democratic Republic of Congo. Paluku.Bahwere@ulb.ac.be
De Mol
Patrick
P
Donnen
Philippe
P
Dramaix-Wilmet
Michèle
M
Butzler
Jean Paul
JP
Hennart
Philippe
P
Levy
Jack
J
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003223:Congo / Q000453:epidemiology; D016208:Databases, Factual; D003681:Dehydration; D004487:Edema / Q000150:complications; D005260:Female; D006529:Hepatomegaly; D017052:Hospital Mortality / Q000639:trends*; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000628:therapy*; D009752:Nutritional Status; D018529:Nutritional Support; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000401:mortality* / Q000517:prevention & control*; D012307:Risk Factors; D012424:Rural Population