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.
Centre de Recherche en Sciences Naturelles (CRSN), Lwiro, Democratic Republic of Congo. Paluku.Bahwere@ulb.ac.be
Paluku
P
Bahwere
Patrick
P
De Mol
Philippe
P
Donnen
Michèle
M
Dramaix-Wilmet
Jean Paul
JP
Butzler
Philippe
P
Hennart
Jack
J
Levy
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