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      Time to recovery and predictors of severe community-acquired pneumonia among pediatric patients in Debre Markos referral hospital, North West Ethiopia: A retrospective follow-up study

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          Abstract

          Introduction

          Globally, pneumonia is a major cause of morbidity and mortality among children which leads to over 156 million episodes and 14.9 million hospitalizations each year. Besides this fact, the recovery time and predictors of children’s hospitalization related to severe community-acquired pneumonia is not well known. Therefore, the aim of this study was to estimate the median time to recovery and its predictors among severe community-acquired pneumonia patients admitted to the pediatric ward, Debre Markos referral hospital, North West Ethiopia.

          Methods

          An institution-based retrospective follow-up study was employed among 352 records of children who were admitted starting from January 2016 to December 2018. Patients' charts were retrieved using a structured data extraction tool. Cox proportional hazard model assumption and model fitness was checked. Stratified Cox regression was fitted as a final model. Hazard ratio with its 95% confidence interval was used and P-value < 0.05 was considered as a statistically significant association.

          Result

          The overall median recovery time was 4 days IQR (3–7). Recovery rate from severe community acquired pneumonia was 16.25 (95% CI: 14.54–18.15) per 100 person day observation. Age (AHR; 0.94 95% CI (0.90–0.98)), being stunted (AHR; 0.62 95% CI (0.43–0.91)), presence of danger sign at admission (AHR; 0.61 95% CI (0.40–0.94)), late presentation to seek care(AHR; 0.64 95% CI (0.47–0.88)) and co-morbidity (AHR; 0.45 95% CI (0.35–0.58)) were significant predictors of recovery time.

          Conclusion

          The median recovery time from severe community-acquired pneumonia was long so that measures to reduce recovery time should be strengthened.

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          Most cited references15

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          British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011.

          The British Thoracic Society first published management guidelines for community acquired pneumonia in children in 2002 and covered available evidence to early 2000. These updated guidelines represent a review of new evidence since then and consensus clinical opinion where evidence was not found. This document incorporates material from the 2002 guidelines and supersedes the previous guideline document.
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            Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study

            Abstract. Pneumonia is the leading cause of death in children. The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. A multicenter, observational study was conducted in five hospitals, from India (Lucknow, Vadu), Madagascar (Antananarivo), Mali (Bamako), and Paraguay (San Lorenzo). Children aged 2–60 months with radiologically confirmed pneumonia were enrolled prospectively. Respiratory and whole blood specimens were collected, identifying viruses and bacteria by real-time multiplex polymerase chain reaction (PCR). Microbiological agents linked with hypoxemia at admission (oxygen saturation < 90%) were analyzed by multivariate logistic regression, and factors associated with 14-day in-hospital mortality were assessed by bivariate Cox regression. Overall, 405 pneumonia cases (3,338 hospitalization days) were analyzed; 13 patients died within 14 days of hospitalization. Hypoxemia prevalence was 17.3%. Detection of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) in respiratory samples was independently associated with increased risk of hypoxemia (adjusted odds ratio [aOR] = 2.4, 95% confidence interval [95% CI] = 1.0–5.8 and aOR = 2.5, 95% CI = 1.1–5.3, respectively). Lower chest indrawing and cyanosis were predictive of hypoxemia (positive likelihood ratios = 2.3 and 2.4, respectively). Predictors of death were Streptococcus pneumoniae detection by blood PCR (crude hazard ratio [cHR] = 4.6, 95% CI = 1.5–14.0), procalcitonin ≥ 50 ng/mL (cHR = 22.4, 95% CI = 7.3–68.5) and hypoxemia (cHR = 4.8, 95% CI = 1.6–14.4). These findings were consistent on bivariate analysis. hMPV and RSV in respiratory samples were linked with hypoxemia, and S. pneumoniae in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries.
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              Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco

              Highlights • Pneumonia remains one of the major killers of children in a middle-income country such as Morocco. • A history of prematurity, a history of fever, leaving in a house with smokers, impaired consciousness, cyanosis, pallor, having ronchi on auscultation and human metapneumovirus infection are all independent risk factors for an adverse outcome. • A history of asthma is independently associated with a positive outcome. • Early identification of risk factors for an adverse outcome could improve overall prognosis.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: SoftwareRole: Writing – original draft
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 September 2020
                2020
                : 15
                : 9
                : e0239655
                Affiliations
                [1 ] Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
                [2 ] Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
                University of Notre Dame Australia, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0363-8777
                Article
                PONE-D-20-03326
                10.1371/journal.pone.0239655
                7518609
                32976491
                f4d23a38-33ae-4adf-920b-b645bb5335b0
                © 2020 Mengist et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 February 2020
                : 10 September 2020
                Page count
                Figures: 4, Tables: 4, Pages: 15
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Pneumonia
                Medicine and Health Sciences
                Pediatrics
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Computer and Information Sciences
                Data Management
                Data Visualization
                Infographics
                Charts
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Nosocomial Infections
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Pediatric Infections
                Medicine and Health Sciences
                Pediatrics
                Pediatric Infections
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Custom metadata
                The data sets used for this study are available as Supporting Information.

                Uncategorized
                Uncategorized

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