Prevalence, incidence and associated factors of pneumonia among severely malnourished children hospitalized in Mulago National Referral Hospital, Uganda.

backgroundPneumonia is still a burden in children hospitalized with severe acute malnutrition (SAM). However, there is limited published information on the magnitude and characteristics of those who present with or develop pneumonia during hospitalization. We determined the prevalence and incidence of pneumonia, and associated factors among children aged 6-59 months hospitalized with SAM.

methodsThis study employed 2 study designs; cross sectional for prevalence of pneumonia and single arm retrospective cohort design for incidence of pneumonia. We used secondary data collected as part of the ProbiSAM trial that assessed the effect of Probiotics on diarrhea in children with severe acute malnutrition conducted at Mwanamugimu Nutrition Unit Mulago Hospital. Children aged 6-59 months hospitalized with SAM were assessed for prevalence and incidence of pneumonia. Prevalence of pneumonia was the proportion of pneumonia cases at the time of enrolment or within the first 48 hours of admission. 2)Incidence of pneumonia was the proportion who developed clinical signs of pneumonia for the first time during hospitalization among those who did not have pneumonia at enrolment or within 48 hours after admission.

results400 children were included in the study and of these, 58% were males. Most (87%) of the children were aged 24 months and below. The prevalence of pneumonia was 28% (95% CI: 24-33). In multivariable analysis, factors associated with prevalence of pneumonia include: female sex (Adjusted PR: 1.72, 95% CI: 1.20-2.45), stunting (Adjusted PR: 1.60, 95% CI: 1.12-2.30) and presumptive TB (Adjusted PR: 1.95, 95% CI: 1.34-2.82). Incident pneumonia was estimated at 356 (95% CI: 305-416) per 1000 hospital admissions of children with SAM. In multivariable analysis, children at risk of pneumonia were: young age 6 to 12 months (Adjusted RR: 1.89, 95% CI: 1.10-3.29), stunting (Adjusted RR: 1.59, 95% CI: 1.15-2.20), HIV infection (Adjusted RR: 1.59, 95% CI: 1.08-2.33), presumptive TB (Adjusted RR: 1.73, 95% CI: 1.23-2.43), used a nasogastric tube for feeding (RR: 1.38, 95% CI: 1.00-1.89) and prolonged hospitalization of 15 days or more (Adjusted RR: 2.16, 95% CI: 1.39-3.35). CONCLUSION AND SIGNIFICANCE: This study identified that prevalence of pneumonia among children hospitalized with SAM is still high and similar to previous studies done in different settings in Uganda. In addition, this study showed that the risk of incident pneumonia among children hospitalized with SAM is high. These findings point out the need to develop guidelines to monitor, detect and treat incident pneumonia among children hospitalized with SAM. Stunting as factor associated with both prevalence and incidence of pneumonia underscores the importance of further research to evaluate how stunting relates to pneumonia.