Pneumonia in severely malnourished children in developing countries – mortality risk, aetiology and validity of WHO clinical signs: a systematic review

Abstract

Pneumonia and malnutrition are two of the biggest killers in childhood. Guidelines for the care of children with pneumonia and malnutrition need to take into account this strong and often lethal association if they are to contribute to the UN Millennium Development Goal 4, aiming for substantial reductions in childhood mortality. Additional data regarding the optimal diagnostic approach to and management of pneumonia and malnutrition are required from regions where death from these two diseases is common.

Predictors of Death in Under-Five Children with Sepsis Attending an Urban Diarrheal Treatment Centre in Bangladesh

“…Our finding of the association of severe malnutrition, lobar pneumonia and hypoxemia as predictors of death in SCW is similar to earlier reports [13,14]. Severely malnourished children have depressed cell mediated as well as humoral immune responses, and they are more susceptible to infection often with serious ramification such as fatal outcome [15].…”

“…Lobar consolidation is usually associated with bacterial pneumonia which is often associated with fatal outcome especially in children under five in developing countries like Bangladesh [13], mostly due to overwhelming hypoxemia resulting from ventilation perfusion mismatch from para-pneumonic shunting. [14,16,17]. Sepsis may be the consequences of lobar pneumonia, as observed in our cases, frequently associated with high case-fatality rate [14].…”

“…[14,16,17]. Sepsis may be the consequences of lobar pneumonia, as observed in our cases, frequently associated with high case-fatality rate [14].…”

Diagnostic and Prognostic Value of Procalcitonin and C-Reactive Protein in Malnourished Children

“…1,2 In children hospitalized with SAM plus a medical complication, clinical diagnosis of infection is complicated by the paucity of clinical signs; classic symptoms of infection (eg, fever in response to bacteremia, or respiratory symptoms in children with pneumonia) are not always present in children with SAM, who instead often present with unspecific apathy. 3,4 Furthermore, laboratory diagnostic capacity is often limited in regions with the highest burdens of malnutrition. Consequently, treatment is empirical, and broad-spectrum antibiotics are recommended for all hospitalized children with complicated SAM.…”

Risk factors for mortality in children hospitalized with pneumonia

“…Pneumonia is more common and more likely to be fatal in children with severe malnutrition. These observations assume even greater importance because validity of WHO recommended clinical signs has been reported to be less sensitive as predictors of radiographic pneumonia in severely malnourished children [9]. Results of a study from Gambia [10] suggest that the lower limiting values of respiratory rates in malnourished children with pneumonia must be five breaths less per minute than the respiratory rates in well-nourished children.…”