title: Severe pneumonia in Mozambican young children: clinical and radiological characteristics and risk factors.
abstract: BACKGROUND
  Pneumonia is a leading cause of hospitalization and death among children in Africa. We describe the clinical presentation of severe pneumonia among hospitalized children in a malaria endemic area with a high prevalence of HIV infection.
  
  
  METHODS
  As part of a 2-year prospective study of radiologically confirmed pneumonia, chest radiographs, malaria parasite counts and bacterial blood cultures were systematically performed for children 0-23 months admitted with severe pneumonia. Radiographs were interpreted according to WHO guidelines. HIV tests were performed during a 12-month period.
  
  
  RESULTS
  Severe pneumonia accounted for 16% of 4838 hospital admissions among children 0-23 months; 43% of episodes had endpoint consolidation, 15% were associated with bacteremia and 11% were fatal. Fever, cough >3 days, crepitations, hypoxemia and absence of malaria parasitemia were associated with radiologically confirmed pneumonia. Nineteen per cent of children with severe pneumonia and 27% with radiologically confirmed pneumonia had clinical malaria. HIV-prevalence was 26% among children hospitalized with severe pneumonia and HIV-testing results. HIV infection, anaemia, malnutrition, hypoxemia and bacteremia were associated with fatal episodes of severe pneumonia.
  
  
  CONCLUSIONS
  Treatment of admitted children with severe pneumonia is complicated in settings with prevalent HIV and malaria. Children with severe pneumonia and clinical malaria require antibiotic and antimalarial treatment. In addition to vertical programs, integrated approaches may greatly contribute to reduction of pneumonia-related mortality.
authors.affiliation: Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique. betuel.sigauque@manhica.net
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigaúque
authors.forename: Anna
authors.initials: A
authors.lastname: Roca
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.forename: Luís
authors.initials: L
authors.lastname: Morais
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Anna
authors.initials: A
authors.lastname: Berenguera
authors.forename: Sónia
authors.initials: S
authors.lastname: Machevo
authors.forename: Azucena
authors.initials: A
authors.lastname: Bardaji
authors.forename: Manuel
authors.initials: M
authors.lastname: Corachan
authors.forename: Josep
authors.initials: J
authors.lastname: Ribó
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Montse
authors.initials: M
authors.lastname: Soriano-Gabarró
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
mesh_terms: D017677:Age Distribution; D000740:Anemia / Q000150:complications; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005334:Fever / Q000150:complications; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011014:Pneumonia / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D017678:Sex Distribution