Magnitude of Co-morbidities Among Children Aged 6 Months to 12 Years Rehospitalised With Pneumonia at the Kenyatta National Hospital

Abstract

Background: Globally pneumonia is the leading cause of death in children under 5 years and it’s the leading cause of hospital readmissions. Readmissions are common in children with underlying chronic diseases such as asthma, congenital heart disease, primary immunodeficiency, rickets, HIV and malnutrition. However, there is very limited data in our setting on paediatric readmissions due to pneumonia and the underlying co-morbidities seen. Understanding the common co-morbidities seen in this population is important to inform interventions to reduce avoidable hospital readmissions which are associated with longer duration of stay ultimately leading to high hospital expenditure. The aim of this study is to characterise the common underlying co-morbidities and provide more information on the in-hospital outcomes seen in these patients. Objectives: The primary objective is to determine the proportion of children aged 6months to 12 years readmitted with pneumonia at KNH who have selected underlying co-morbidities. The secondary objective is to determine the in-hospital clinical outcomes among children readmitted with pneumonia and to compare outcomes between children with and those without co-morbidities. Methodology: This was a longitudinal study recruited participants aged 6 months to 12 years from KNH paediatrics wards with a previous history of admission due to pneumonia and a current diagnosis of pneumonia. A structured paper-based questionnaire was used to obtain data on relevant medical history, physical examination and nutritional assessment was conducted on all participants and relevant laboratory / radiological investigations done. Presence of underlying co-morbidities was determined based on history, physical examination findings and results of investigations. Data Analysis: STATA 13 was used. Descriptive statistics was summarized as medians (IQR) or proportions as appropriate. The frequency of comorbidities was summarized as proportions. Outcomes were summarized as means (+SD), medians (IQR) or proportions as appropriate. Results:97% of children readmitted with pneumonia had an underlying comorbidity and most common comorbidities seen included GERD (61%) aspiration pneumonia (46%), congenital heart disease (41%), rickets (40%), severe acute malnutrition (35%), and HIV (1.3%). The mortality rate among children rehospitalised due to pneumonia was 15% and they had a long duration of stay with a median of 29days. Conclusion and recommendation: Majority of children rehospitalised due to pneumonia have an underlying comorbidity, and the most common comorbidities are GERD, aspiration pneumonia, congenital heart disease, rickets and severe acute malnutrition. There needs to be a high index of suspicion with early diagnosis and treatment of these underlying conditions. There is need to create a structured system where children with pneumonia readmissions can be identified early and treated to prevent morbidity and mortality.