title: Potentially Modifiable Factors Associated with Death of Infants and Children with Severe Pneumonia Routinely Managed in District Hospitals in Malawi.
abstract: OBJECTIVE
  To investigate recognised co-morbidities and clinical management associated with inpatient pneumonia mortality in Malawian district hospitals.
  
  
  METHODS
  Prospective cohort study, of patient records, carried out in Malawi between 1st October 2000 and 30th June 2003. The study included all children aged 0-59 months admitted to the paediatric wards in sixteen district hospitals throughout Malawi with severe and very severe pneumonia. We compared individual factors between those that survived (n = 14 076) and those that died (n = 1 633).
  
  
  RESULTS
  From logistic regression analysis, predictors of death in hospital, adjusted for age, sex and severity grade included comorbid conditions of meningitis (OR =2.49, 95% CI 1.50-4.15), malnutrition (OR =2.37, 95% CI 1.94-2.88) and severe anaemia (OR =1.41, 95% CI 1.03-1.92). Requiring supplementary oxygen (OR =2.16, 95% CI 1.85-2.51) and intravenous fluids (OR =3.02, 95% CI 2.13-4.28) were associated with death while blood transfusion was no longer significant (OR =1.10, 95% CI 0.77-1.57) when the model included severe anaemia.
  
  
  CONCLUSIONS
  This study identified a number of challenges to improve outcome for Malawian infants and children hospitalised with pneumonia. These included improved assessment of co-morbidities and more rigorous application of standard case management.
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Penelope M
authors.initials: PM
authors.lastname: Enarson
authors.affiliation: Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gie
authors.affiliation: Ministry of Health, Lilongwe, Malawi.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Mwansambo
authors.affiliation: Ministry of Health, Lilongwe, Malawi.
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Chalira
authors.affiliation: Ministry of Health, Lilongwe, Malawi.
authors.forename: Norman N
authors.initials: NN
authors.lastname: Lufesi
authors.affiliation: UNICEF Malawi, Lilongwe, Malawi.
authors.forename: Ellubey R
authors.initials: ER
authors.lastname: Maganga
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Enarson
authors.affiliation: Division of Community Health, The Department of Interdisciplinary Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Cameron
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000740:Anemia / Q000150:complications*; D019090:Case Management; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008581:Meningitis / Q000150:complications*; D011014:Pneumonia / Q000150:complications* / Q000175:diagnosis; D011446:Prospective Studies; D012720:Severity of Illness Index