title: Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco.
abstract: OBJECTIVE
  Data on prognostic factors among children with severe pneumonia are scarce in middle-income countries. We investigated prognostic factors for an adverse outcome among children admitted to the Hôpital d'Enfants de Rabat, Morocco with World Health Organization-defined clinically severe pneumonia (CSP).
  
  
  METHODS
  Children aged 2-59 months admitted to the hospital and fulfilling the CSP definition were recruited into this 13-month prospective study. A poor prognosis was defined as death, a need for intensive care, or a Respiratory Index of Severity in Children (RISC) score ≥3. Multivariate logistic regression was performed to ascertain independent predictive factors for a poor prognosis.
  
  
  RESULTS
  Of the 689 children included in this analysis, 55 (8.0%) required intensive care and 28 died (4.0%). Five hundred and two (72.8%) children were classified as having a good prognosis and 187 (27.2%) as having a poor prognosis. A history of prematurity (odds ratio (OR) 2.50, 95% confidence interval (CI) 1.24-5.04), of fever (OR 2.25, 95% CI 1.32-3.83), living in a house with smokers (OR 1.79, 95% CI 1.18-2.72), impaired consciousness (OR 10.96, 95% CI 2.88-41.73), cyanosis (OR 2.09, 95% CI 1.05-4.15), pallor (OR 2.27, 95% CI 1.34-3.84), having rhonchi on auscultation (OR 2.45, 95% CI 1.58-3.79), and human metapneumovirus infection (OR 2.13, 95% CI 1.13-4.02) were all independent risk factors for an adverse outcome, whereas a history of asthma (OR 0.46, 95% CI 0.25-0.84) was the only independent risk factor for a positive outcome.
  
  
  CONCLUSIONS
  The early identification of factors associated with a poor prognosis could improve management strategies and the likelihood of survival of Moroccan children with severe pneumonia.
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain; Ecole Nationale de Santé Publique (ENSP), Ministère de la Santé, Rabat, Morocco.
authors.forename: Imane
authors.initials: I
authors.lastname: Jroundi
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco.
authors.forename: Chafiq
authors.initials: C
authors.lastname: Mahraoui
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain.
authors.forename: Rachid
authors.initials: R
authors.lastname: Benmessaoud
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain.
authors.forename: Cinta
authors.initials: C
authors.lastname: Moraleda
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco.
authors.forename: Houssain
authors.initials: H
authors.lastname: Tligui
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco.
authors.forename: Myriam
authors.initials: M
authors.lastname: Seffar
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco.
authors.forename: Salma Ech-Cherif El
authors.initials: SE
authors.lastname: Kettani
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco.
authors.forename: Badr Sououd
authors.initials: BS
authors.lastname: Benjelloun
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain; Centre Hôpitalier Universitaire (CHU) Ibn Sina, Rabat, Morocco.
authors.forename: Saad
authors.initials: S
authors.lastname: Chaacho
authors.affiliation: University Hospital Sant Joan de Déu, Esplugues, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz-Almagro
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain. Electronic address: quique.bassat@cresib.cat.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
mesh_terms: D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D009018:Morocco; D011014:Pneumonia / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
keywords: Acute respiratory infections; Morocco; Paediatrics; Pneumonia; Prognosis; Risk factors