Risk for Death among Children with Pneumonia, Afghanistan

Zabihullah, Rahmani; Dhoubhadel, Bhim Gopal; Rauf, Ferogh A.; Shafiq, Sahab A.; Suzuki, Motoi; Watanabe, Kiwao; Yoshida, Lay‐Myint; Yasunami, Michio; Zabihullah, Salihi; Parry, Christopher M.; Rabi, Mirwais; Ariyoshi, Koya

doi:10.3201/eid2308.151550

Cited by 6 publications

(6 citation statements)

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“…Feedback from healthcare workers suggested the observed reduction in case fatality in the early conflict period was due to better access to essential medications and supplies, and better support and morale of staff (who were required to reside on campus due to insecurity). (23) Similarly high CFRs were reported from urban hospitals in conflict-affected Liberia (12% in children under 15) [ 30 ], and Afghanistan (12% in children under 5) [ 26 ].…”

Section: Resultsmentioning

confidence: 93%

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Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review

et al. 2022

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Background Humanitarian emergencies increase many risk factors for pneumonia, including disruption to food, water and sanitation, and basic health services. This review describes pneumonia morbidity and mortality among children and adolescents affected by humanitarian emergencies. Methods We searched MEDLINE, EMBASE, and PubMed databases for publications reporting pneumonia morbidity or mortality among children aged 1 month to 17 years in humanitarian emergencies (eg, natural disaster, armed conflict, displacement) in low- and middle-income countries (LMICs). Results We included 22 papers published between January 2000 and July 2021 from 33 countries, involving refugee/displaced persons camps (n = 5), other conflict settings (n = 14), and natural disaster (n = 3). Population pneumonia incidence was high for children under 5 years of age (73 to 146 episodes per 100 patient-years); 6%-29% met World Health Organization (WHO) criteria for severe pneumonia requiring admission. Pneumonia accounted for 13%-34% of child and adolescent presentations to camp health facilities, 7%-48% of presentations and admissions to health facilities in other conflict settings, and 12%-22% of admissions to hospitals following natural disasters. Pneumonia related deaths accounted for 7%-30% of child and adolescent deaths in hospital, though case-fatality rates varied greatly (0.5%-17.2%). The risk for pneumonia was greater for children who are: recently displaced, living in crowded settings (particularly large camps), with deficient water and sanitation facilities, and those who are malnourished. Conclusion Pneumonia is a leading cause of morbidity and mortality in children and adolescents affected by humanitarian emergencies. Future research should address population-based pneumonia burden, particularly for older children and adolescents, and describe contextual factors to allow for more meaningful interpretation and guide interventions.

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Section: Resultsmentioning

confidence: 93%

“…Three of these studies reported on risk factors for death, adjusting for a variety of individual and social covariates, finding that mortality was associated with lower household socioeconomic status (eg, maternal education, house structure), malnutrition and other chronic conditions [ 22 , 26 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review

et al. 2022

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“…There is a risk of a vicious cycle of diarrhoea and malnutrition: repeated attacks of diarrhoea and infections leads to weight loss and compromise a child's nutritional status, which makes the child vulnerable to infections and cause further weight loss, eventually leading to severe malnutrition unless the cycle is stopped [21,22]. Association of malnutrition and respiratory infections in children is well known, and the association increases the risk of death [23,24]. Malnourished children have deranged immune system; therefore, viral and bacterial pathogens can easily cause various infections, including the respiratory infections.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for wasting among hospitalised children in Nepal

et al. 2022

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Background Malnutrition has various adverse effects in children. This study aimed to determine risk factors for malnutrition among hospitalised children, changes in nutritional status at admission and discharge and effects of use of systematic anthropometric measurement in identification of malnutrition. Methods We enrolled 426 children, aged between 6 months and 15 years, admitted to Siddhi Memorial Hospital, Bhaktapur, Nepal, from November 2016 to June 2017. Anthropometric measurements were performed at the time of admission and discharge. Risk factors were assessed by multivariable logistic regression models. Results Median age of children was 26 months (IQR: 13–49), and males were 58.7%. The prevalence of wasting was 9.2% (39/426) at admission and 8.5% (36/426) at discharge. Risk factors associated with wasting at admission were ethnic minority (aOR: 3.6, 95% CI 1.2–10.8), diarrhoeal diseases (aOR = 4.0; 95% CI 1.3–11.8), respiratory diseases (aOR: 3.4, 95% CI 1.4–8.1) and earthquake damage to house (aOR = 2.6; 95% CI 1.1–6.3). Clinical observation by care providers identified only 2 out of 112 malnutrition cases at admission and 4 out of 119 cases at discharge that were detected by the systematic anthropometric measurement. Conclusions Ethnic minority, diarrhoeal diseases, respiratory infections and house damage due to the earthquake were risk factors associated with wasting. Systematic anthropometric examination can identify significantly more malnourished children than simple observation of care providers.

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“…Twenty-six studies met our selection criteria (online supplemental figure 1). 20–45 All studies were hospital-based and, apart from one case–control study, were prospective or retrospective cohorts (online supplemental table 1). Study recruitment years ranged between 1981 and 2016 and included participants throughout Africa, Asia and South America.…”

Section: Resultsmentioning

confidence: 99%

The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis

et al. 2021

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IntroductionChildhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity.MethodsWe conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results.ResultsOur network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6–66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8–34.6) and 40.9% (range 14.7–69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively.ConclusionsThe risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.

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Risk for Death among Children with Pneumonia, Afghanistan

Cited by 6 publications

References 10 publications

Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review

Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review

Risk factors for wasting among hospitalised children in Nepal

The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis

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