title: Stunting is associated with poor outcomes in childhood pneumonia.
abstract: OBJECTIVE
  Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials.
  
  
  METHODS
  We analysed data from two WHO and USAID-sponsored inpatient treatment trials, the Severe Pneumonia Evaluation Antimicrobial Research study (n = 958) and the Amoxicillin Penicillin Pneumonia International Study (n = 1702), which enrolled children aged 2-59 months across 16 sites in LMICs. We assessed the effect of stunting (height-for-age Z score < -2) on treatment outcome and time to resolution of hypoxaemic pneumonia.
  
  
  RESULTS
  Among 2542 (96%) children with valid data for height, 28% were stunted and 12.8% failed treatment by 5 days. The failure rate among stunted patients was 16.0% vs. 11.5% among non-stunted patients [unadjusted RR = 1.24 (95% CI 1.08, 1.41); adjusted RR = 1.28 (95% CI 1.10, 1.48)]. An inverse relationship was observed between height and failure rates, even among non-stunted children. Among 845 patients with hypoxaemic pneumonia, stunting was associated with a lower probability of normalisation of respiratory rate [HR = 0.63 (95% CI 0.52, 0.75)] and oxygen saturation [HR = 0.74 (95% CI 0.61, 0.89)].
  
  
  CONCLUSIONS
  Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Moschovis
authors.affiliation: Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Emmanuel O D
authors.initials: EO
authors.lastname: Addo-Yobo
authors.affiliation: Al-Sabeen Hospital for Women & Children, Sana'a University, Sana'a, Yemen.
authors.forename: Salem
authors.initials: S
authors.lastname: Banajeh
authors.affiliation: World Bank, Washington, DC, USA.
authors.forename: Noel
authors.initials: N
authors.lastname: Chisaka
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Hayden
authors.affiliation: University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Prakash
authors.initials: P
authors.lastname: Jeena
authors.affiliation: Boston University, Boston, MA, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
authors.affiliation: Children's Hospital Dr Francisco de Ycaza Bustamante, Guayaquil, Ecuador.
authors.forename: Greta
authors.initials: G
authors.lastname: Mino
authors.affiliation: Lata Medical Research Foundation, Indira Gandhi Government Medical College, Nagpur, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Shamim
authors.initials: S
authors.lastname: Qazi
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.affiliation: Boston University, Boston, MA, USA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D010406:Penicillins / Q000008:administration & dosage*; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000658:Amoxicillin
keywords: desnutrición; fallo terapéutico; global health; malnutrition; neumonía; pneumonia; pneumonie; salud global; santé mondiale; treatment failure; échec du traitement