Impact of severe malnutrition on clinical signs of pneumonia in under-5-year-old children: A hospital based study

Abstract

Background: Pneumonia is a major cause of under-5-year mortality in developing countries including Bangladesh. Malnourished children are more vulnerable to develop pneumonia and pneumonia associated case morbidity and mortality. Objectives: To evaluate the impact of severe malnutrition on clinical signs of pneumonia in children and the outcome. Method: A total of 150 eligible children aged 2 months to 5 years was enrolled in this descriptive case control study. Of them 75 were included as cases in Group A with severe malnutrition with pneumonia and in Group B, 75 well-nourished children having pneumonia were included as controls. Age range of Cases and Controls was 2 months to 5 years. Results: The mean weight-for-height/length Z score of cases was -3.25 ± 1.68 and in controls was -0.35 ±0.89. The mean height-for-age Z score of cases was -1.93 ±1.52 and in controls was -0.82 ± 0.72. In group A, 50 (67%) children had bipedal symmetrical oedema. In Group A, 50 (67%) cases had no fast breathing in comparison to three (04%) in Group B. Fast breathing was twenty times less likely to be present in pneumonia with severe malnutrition (OR=20.18).This study also showed that chest indrawing was present only in 23 (30%) cases in comparison to 59 (79%) controls. Chest indrawing was ten times less likely to be present in pneumonia with severe malnutrition (OR= 10.06). Conclusions: It can be concluded from this study that the definitions of fast breathing and chest indrawing recommended by Integrated Management of Childhood Illness (IMCI) are not sufficiently reliable predictors of pneumonia in severely malnourished children. The study supports the recommendation of IMCI for referring severely malnourished children with an acute illness with cough and/or difficult breathing to hospital with or without fast breathing or chest indrawing