Determinants Of Pneumonia Associated Readmissions Among Children Aged Under Five Admitted At Kenyatta National Hospital

Abstract

Background: Pneumonia, according to WHO, is the leading single cause of mortality in children worldwide, accounting for 16% of all deaths of under five children globally, with 95% of these episodes occurring in developing countries. Despite gains made in the management of pneumonia, pneumonia readmissions among under five children still remain high, exerting a huge burden on health care systems of many countries, Kenya included. Study objective: This study assessed the determinants of pneumonia associated readmissions among children aged under five admitted at KNH. Study design and site: This was a hospital based descriptive cross sectional study. The study was conducted in the Pediatric Unit of Kenyatta National Hospital. Participants and methods: Study population was caregivers of children aged under five readmitted with pneumonia in KNH’s Pediatric Unit. The study sample size comprised of 165 caregivers selected using census method. A validated researcher-administered questionnaire was used to collect the data. In data analysis, quantitative data was analyzed using descriptive statistics using the Statistical Package for Social Sciences version 23. Association between the variables was estimated using chi square statistics at a significance level of 5%. The study results were presented in tables, graphs and charts. Results: The patient related determinants of pneumonia associated readmissions among under five children admitted at KNH included - younger age (of ≤2 years) (p = 0.016); inadequate nutritional status (p = 0.007); having not been exclusively breastfed in the first six months (X2 = 5.797, df = 1, p = 0.015) and having other pre-existing illnesses (p = 0.023). The caregiver related determinants of pneumonia associated readmissions among under five children admitted at KNH included - low education level (p = 0.018); low household monthly income level (p = 0.029); lack of training on handling domestic/indoor smoking (p = 0.012) and lack of awareness about the signs and symptoms of pneumonia in children prior to the current admission (p = 0.006). The environmental related determinants of pneumonia associated readmissions among under five children admitted at KNH included - use of firewood, kerosene and charcoal as the main kinds of fuel for cooking (p = 0.013); inadequate house ventilation (p = 0.014) and living with domestic animals in the same house (p = 0.017). The health system related determinants of pneumonia associated readmissions among under five children admitted at KNH included - congestion in hospital’s children wards (p = 0.025); previous discharge before full recovery (, p = 0.009) and and low/poor quality of care offered to pediatric pneumonia patients (p = 0.012). Conclusion: There was a wide range of patient, caregiver, environmental and health system related determinants of pneumonia associated readmissions among under five children admitted at KNH. Recommendations: There should be awareness creation programs, at hospital and community levels, to enlighten caregivers, their households and communities on various patient, caregiver and environment factors that contribute to pediatric pneumonia incidences and possible ways of mitigating them. Further, policy makers should institute necessary local and national policy to decongest pediatric wards in the country.