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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 152-155

Pediatric community-acquired pneumonia in Federal Medical Center, Birnin Kudu, Jigawa State: Prevalence and outcome


Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria

Date of Submission10-Feb-2022
Date of Acceptance24-Nov-2022
Date of Web Publication11-Jan-2023

Correspondence Address:
Umma Abdullahi Idris
Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sujhs.sujhs_3_22

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  Abstract 


Context: Pediatric pneumonia is an important cause of morbidity and mortality among children in many hospitals in Nigeria. The relative contribution of this disease among children admitted to our facility has not yet been documented.
Aims: The aim was to determine the prevalence and outcome of pediatric community-acquired pneumonia (CAP).
Settings and Design: This was a cross-sectional study conducted at the Department of Pediatrics of FMCBKD.
Methods: One hundred and twenty-three children aged 2 months–14 years who were managed for CAP from January 2019 to December 2020 were studied.
Statistical Analysis Used: Data were analyzed using the Statistical Package for the Social Sciences software version 16. Continuous data were represented as mean or median as appropriate, while categorical data were presented as percentages. The Chi-square and Student's t-tests were used to identify the significant differences for categorical and continuous variables, respectively. P < 0.05 was considered statistically significant.
Results: The prevalence of pneumonia was 9.2%. Most of the children were aged 24 months and below with a male preponderance of 1.5:1. Bronchopneumonia was the most common form of clinical presentation, and 67 (71.3%) children presented with severe disease. The case fatality rate was 29.8% (28 deaths), and most of the deaths were among children <24 months of age, females, and those who presented with severe disease.
Conclusions: CAP is prevalent and causes a significant mortality in children in Jigawa State. Strengthening preventive measures to control pneumonia and increasing public awareness of early presentation to a health facility will reduce mortality.

Keywords: Community-acquired pneumonia, outcome, prevalence


How to cite this article:
Idris UA. Pediatric community-acquired pneumonia in Federal Medical Center, Birnin Kudu, Jigawa State: Prevalence and outcome. Santosh Univ J Health Sci 2022;8:152-5

How to cite this URL:
Idris UA. Pediatric community-acquired pneumonia in Federal Medical Center, Birnin Kudu, Jigawa State: Prevalence and outcome. Santosh Univ J Health Sci [serial online] 2022 [cited 2023 Jan 28];8:152-5. Available from: http://www.sujhs.org/text.asp?2022/8/2/152/367564




  Introduction Top


Community-acquired pneumonia (CAP) defined as a pneumonia symptom that originates from home, is an important cause of a child's visit to the hospital for consultation and if severe enough could lead to hospitalization.[1] It is estimated that globally, in 2018 alone, 802,000 cases of pneumonia-related death were reported among children; the vast of such was in the resource-limited setting, including Nigeria, where it contributed to about 19% of the total under-5 death in the same year putting at the spotlight as one of the two countries with the highest burden of the under-5 mortality rate.[2]

CAP is usually caused by viruses and bacteria, among the risk factors including lack of breastfeeding, undernutrition, lack of immunization and poor health-seeking behavior, indoor air pollution, and other environmental pollutants.[3] To address the increasing morbidity and mortality due to pneumonia, the Government of Nigeria at various levels has implemented the measures and interventions to reduce significantly the menace of pneumonia. Despite this huge investment, pneumonia still remains a significant cause of morbidity and mortality in the hospitals across the country.[4],[5],[6] However, no such study was conducted in our facility, and hence, this review was conducted to determine the relative contribution of pneumonia to the morbidity and mortality among children in our facility in Jigawa State.

It is hoped that the findings from this review will immensely benefit the administrators and policymakers to improve on their strategies in combating pneumonia in children.


  Methods Top


The study was conducted at the Emergency Pediatric Unit of the Federal Medical Centre, Birnin Kudu, Jigawa State. It is one of the tertiary health facilities in the state that was established in the year 2000 for the provision of health services, teaching, and research to cater to the needs of the local and wider community. Patients from other hospitals and clinics are referred here. The study was approved by the hospital's Ethical Research Committee of FMCBKD FMC/HREC/APP/CLN/001/1/213 ().

The diagnosis of CAP was made by the presence of age-specific tachypnea, cough, evidence of respiratory distress, and features of auscultatory findings suggestive of pneumonia with or without significant radiological findings.[3] These symptoms must be present at home before presenting or admission to the hospital.

Children with pneumonia and radiological evidence of fluid collection in the pleural cavity coupled with free flowing of fluid from the pleural space on the percutaneous pleural tap were adjudged to have pleural effusion.[7] Heart failure (HF) for this study was recorded as the presence of significant age-specific tachypnea, tachycardia, and tenderly enlarged liver.[8]

Children with chronic cough (>3 weeks), hospital-acquired pneumonia as well as those with bronchial asthma were excluded.

The cases were classified as either moderate or severe using the British Thoracic Society guidelines for the management of CAP in children.[9]

The following information were extracted from their case folders; i age, gender, diagnosis, vaccination status, presence of complications, duration of hospital stay, and outcome.

Data analysis

Data were analyzed using the Statistical Package for the Social Sciences software version 17 (SPSS Chicago, IL). The prevalence of CAP during the study was calculated from the proportion of children with pneumonia over the total childhood admission during the period. Continuous data were represented as mean or median as appropriate, while categorical data were presented as percentages. The Chi-square and Student's t-tests were used to identify the significant differences for categorical and continuous variables, respectively. P < 0.05 was considered statistically significant.


  Results Top


During the period under review, a total of 1342 children aged 1 month–14 years were admitted to the early pregnancy unit; of which 123 (9.2%) were managed for CAP comprising 73 (59.3%) males with an M: F of 1.5. Only 94 children had a complete record and were considered for analysis. [Table 1] shows the general characteristics of the study participants.
Table 1: General characteristics of the children with pneumonia (n=94)

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The mean standard deviation (SD) age of the children admitted with pneumonia was 23.7 (36.2) months. The majority of the children were <24 months old (76.2%) and from lower socioeconomic class, as shown in [Table 1]. Of the 94 children analyzed, only 20 (21.3%) and 18 (19.1%) were fully vaccinated for age and exclusively breastfed, respectively.

Seventy children (74.5%) presented to the hospital after 72 h of the onset of symptoms, and 49 (52.2%) had prior treatment before the presentation.

Seventy-six (80.8%) children were clinically diagnosed to have bronchopneumonia, while 18 had lobar pneumonia. Sixty (63.8%) children had chest X-rays (CXR) done; of which 42 (70%) had abnormal findings [Figure 1].
Figure 1: Radiological findings of 60 children with pneumonia

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[Table 2] shows the complications and associated conditions among children with pneumonia.
Table 2: Complications and associated conditions among children with pneumonia

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The mean (SD) duration of admission for the children with pneumonia was 5.15 (4.2), with a range of 1–28 days. Those who had severe disease and survivors spent long days on admission, P = 0.000 and P = 0.321, respectively [Table 3].
Table 3: Duration of hospitalization and hypoxemia in the children with pneumonia

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Outcome

Twenty-eight children with pneumonia died, giving the case fatality rate of 29.8%. The majority (85.7%) of the deaths were among children 24 months and below [Table 4].
Table 4: Outcome of children with pneumonia

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  Discussion Top


CAP accounted for about 10% of the total number of children admitted during the review. This finding is in keeping with the reported prevalence of 13.1% and 13.3% from Port Harcourt by Gabriel-Job and Azubogu[6] and authors[5] from the University of Ilorin Teaching Hospital, respectively. Oyelami and Kuti[4] reported a prevalence of 23.3% from Wesley guild hospital le-ife Nigeria, while Amaii and Aguero[10] reported a prevalence of 27.7% from the Federal Medical Center Makurdi, Benue State, Nigeria. This prevalence is, however, higher than the 10% documented prevalence in this study. The difference in prevalence may be due to the large sample size and varied methodology. It may also be due to differences in the health-seeking behavior of the population studied.

The majority of the children presenting with pneumonia in this review were children under 24 months of age, which is in keeping with the findings of the previous authors in Nigeria.[11],[4],[5],[6] Children under 2 years of age have immature immune systems, hence are vulnerable to infections, including pneumonia. It is therefore important to specifically target pneumonia control programmer.[12]

Exclusive breastfeeding and childhood immunization against childhood diseases are known to promote children's well-being and prevent them from childhood diseases, including pneumonia.[13],[14] Sadly, the practice is suboptimal among the children in this study, as it was observed by other authors in Nigeria.[4],[6]

Bronchopneumonia accounted for most of the pneumonia cases, which are in agreement with what was previously reported.[4],[5],[6] The majority of the children who had CXR done had a reported radiological evidence of pneumonia with or without complication. The finding is in agreement with that of Fancourt et al. in the Pneumonia Etiology Research for Child Health project, where more than 60% of cases had abnormal CXR findings.[15]

HF was the most common complication reported in this study; it complicates about 70% of all the cases, which is higher than the reported by authors from previous studies. The high proportion of children with HF may not be unrelated to most cases who had severe disease at presentation, which be attributed to the delay in health-seeking or late referral to our facility. HF among children with pneumonia is associated with increased mortality,[4],[5],[6],[7],[8] a finding that is corroborated by this review.

About one in five children managed for pneumonia died in this review. This is unacceptably high compared to what was previously reported by authors from other centers of Nigeria.[4],[5],[6] The high mortality rate in this review may be explained by the differences in the socioeconomic, epidemiology, preponderance of the risk factors, poor and delayed health-seeking behavior, geographical location, and the small number of cases studied.

This study may be limited by its retrospective design and lack of documented etiological agents of pneumonia, as the diagnosis was clinical and/or radiological. Nonetheless, it was able to report the prevalence, pattern, and outcome of pneumonia in our facility.


  Conclusions Top


CAP is an important cause of morbidity and mortality in our setting. Therefore, more needs to be done to improve the public awareness on the benefits and practice of EBF and complete immunization for children. Health-care workers should be trained on effective case management of pneumonia and need to refer promptly to prevent delays as it usually leads to an unfavorable outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Regunath H, Oba Y. Community-Acquired Pneumonia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430749/. [Last accessed on 2022 Aug 08].  Back to cited text no. 1
    
2.
Nigeria contributes highest number to global pneumonia child deaths. Available at https://www.unicef.org/nigeria/press-releases/nigeria-contributes-highest-number-global-pneumonia-child-deaths. [Last accessed on 2022 Feb 10].  Back to cited text no. 2
    
3.
Olowu A, Elusiyan JB, Esangbedo D, Ekure EN, Esezobor C, Falade AG, et al. Management of community acquired pneumonia (CAP) in children : Clinical practice guidelines by the Paediatrics Association of Nigeria (PAN). Niger J Paediatr 2015;42:283-92.  Back to cited text no. 3
    
4.
Kuti BP. Childhood community – Acquired pneumonia at the Wesley Guild Hospital, Ilesa: Prevalence, pattern, and outcome determinants. Niger J Health Sci 2015;15:98-104.  Back to cited text no. 4
  [Full text]  
5.
Abdulkarim AA, Ibraheem RM, Adeboye MA. Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria. Niger J Paediatr 2013;40:284-9.  Back to cited text no. 5
    
6.
Gabriel-Job N, Azubogu US. Prevalence and pattern of pneumonia among children admitted into university of Port Harcourt Teaching Hospital : A two year review. Int J Trop Dis Health 2019;40:1-6.  Back to cited text no. 6
    
7.
Cherian T, Mulholland EK, Carlin JB, Ostensen H, Amin R, de Campo M, et al. Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 2005;83:353-9.  Back to cited text no. 7
    
8.
Sadoh WE, Osarogiagbon WO. Pneumonia complicated by congestive heart failure in Nigerian children. East Afr Med J 2012;89:322-6.  Back to cited text no. 8
    
9.
Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: Update 2011. Thorax 2011;66 Suppl 2:ii1-23.  Back to cited text no. 9
    
10.
Ibraheem RM, Johnson WB, Abdulkarim AA. Hypoxaemia in hospitalised under-five Nigerian children with pneumonia. West Afr J Med 2014;33:37-43.  Back to cited text no. 10
    
11.
Amai IU, Aguoru CU, Amai CU. Prevalence of Pneumonia in Children under Five Years Old Attending the Federal Medical Centre, Makurdi, Nigeria.Ijsrm.Human, 2018;10:141-51.  Back to cited text no. 11
    
12.
Galeas-Pena M, McLaughlin N, Pociask D. The role of the innate immune system on pulmonary infections. Biol Chem 2019;400:443-56.  Back to cited text no. 12
    
13.
Boccolini CS, Carvalho ML, Oliveira MI, Boccolini Pde M. Breastfeeding can prevent hospitalization for pneumonia among children under 1 year old. J Pediatr (Rio J) 2011;87:399-404.  Back to cited text no. 13
    
14.
Beletew B, Bimerew M, Mengesha A, Wudu M, Azmeraw M. Prevalence of pneumonia and its associated factors among under-five children in East Africa: A systematic review and meta-analysis. BMC Pediatr 2020;20:254.  Back to cited text no. 14
    
15.
Fancourt N, Deloria Knoll M, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, et al. Chest radiograph findings in childhood pneumonia cases from the multisite PERCH study. Clin Infect Dis 2017;64:S262-70.  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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