Comorbidities Associated With Increased Risk of Death among Children Aged 2-59 Months with Severe Pneumonia in Western Kenya

Abstract

Background:  Globally, severe pneumonia remains the leading infectious cause of death in children younger than 5 years. Comorbidities increase the risk  of death among children with severe pneumonia across age groups and regions; however, the data is scanty on specific comorbidities. The study,  therefore, was aimed at improving an understanding of the risk of death due to different comorbidities among children with severe pneumonia. The  findings will not only inform the clinical practices but also improve the interventions. Methodology: We conducted a hospital-based cross-sectional study of 141 children aged 2-59 months in Bondo Sub-County hospital in Western Kenya  using inpatient data health records of children admitted to the pediatric ward. Both descriptive and inferential statistics were used to determine the  occurrence of comorbidities and the risk of death due to comorbidities. Results: The findings show that 57.5% of the children had at least one type of  comorbidity including 36.5% malnutrition, 28.6% HIV exposed uninfected,  25.4% sickle cell disease, 7.9% HIV infected and 1.6% other comorbidities. Our findings showed that a child admitted to the hospital with comorbidities  had six times increased risk of death compared to a child with severe pneumonia only [OR 6.06 (1.32-27.78) P = 0.02]. We also observed four times increased risk of death among HIV-exposed uninfected children [OR 3.92 95% CI (1.18- 13.04) P = 0.03] and the risk of death increased six times when  children had both HIV-exposed uninfected and malnutrition as comorbidities [OR 6.02 95% CI (1.61-22.58) P = 0.008] Conclusion: High comorbidities  among children with severe pneumonia and increased risk of death, in HIV-exposed uninfected and malnourished children. There is a need for improved clinical practice and intervention for severe pneumonia, HIV exposed uninfected children. There should be a review of the immunization schedule for  pneumonia among HIV-exposed uninfected children.