Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study.
Although pneumonia is a leading cause of inpatient mortality, deaths may also occur after discharge from hospital. However, prior studies have been small, in selected groups or did not fully evaluate risk factors, particularly malnutrition and HIV. We determined 1-year post-discharge mortality and risk factors among children diagnosed with severe pneumonia.



A cohort study of children aged 1-59 months admitted to Kilifi County Hospital with severe pneumonia (2007-12). The primary outcome was death <1 year after discharge, determined through Kilifi Health and Demographic Surveillance System (KHDSS) quarterly census rounds.



Of 4184 children (median age 9 months) admitted with severe pneumonia, 1041 (25%) had severe acute malnutrition (SAM), 267 (6.4%) had a positive HIV antibody test, and 364 (8.7%) died in hospital. After discharge, 2279 KHDSS-resident children were followed up; 70 (3.1%) died during 2163 child-years: 32 (95% confidence interval (CI) 26, 41) deaths per 1000 child years. Post-discharge mortality was greater after admission for severe pneumonia than for other diagnoses, hazard ratio 2.5 (95% CI 1.2, 5.3). Malnutrition, HIV status, age and prolonged hospitalisation, but not signs of pneumonia severity, were associated with post-discharge mortality. Fifty-two per cent (95% CI 37%, 63%) of post-discharge deaths were attributable to low mid-upper arm circumference and 11% (95% CI 3.3%, 18%) to a positive HIV test.



Admission with severe pneumonia is an important marker of vulnerability. Risk stratification and better understanding of the mechanisms underlying post-discharge mortality, especially for undernourished children, are needed to reduce mortality after treatment for pneumonia.
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
Moses M
MM
Ngari
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|Swansea Trials Unit, Swansea University Medical School, Swansea, UK.
Greg
0000-0002-2663-2765
G
Fegan
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
Martha K
MK
Mwangome
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
Mwanajuma J
MJ
Ngama
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
Neema
N
Mturi
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|London School of Hygiene & Tropical Medicine, London, UK.
John Anthony Gerard
JAG
Scott
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
Evasius
E
Bauni
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|School of Life Sciences, University of Warwick, Coventry, UK.
David James
DJ
Nokes
KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.|The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.|Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK.
James A
0000-0002-1236-849X
JA
Berkley
D002423:Cause of Death; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000401:mortality*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000401:mortality*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population; D012720:Severity of Illness Index; D013997:Time Factors
children; mortality; post-discharge; severe pneumonia