The University of Southampton
University of Southampton Institutional Repository

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

Pneumonia in severely malnourished children in developing countries - mortality rish, aetiology and validity of WHO clinical signs: a systematic review
Pneumonia in severely malnourished children in developing countries - mortality rish, aetiology and validity of WHO clinical signs: a systematic review
Objectives: to quantify the degree by which moderate and severe degrees of malnutrition increase the mortality risk in pneumonia, to identify potential differences in the aetiology of pneumonia between children with and without severe malnutrition, and to evaluate the validity of WHO-recommended clinical signs (age-specific fast breathing and chest wall indrawing) for the diagnosis of pneumonia in severely malnourished children.

Methods: systematic search of the existing literature using a variety of databases (Medline, EMBASE, the Web of Science, Scopus and CINAHL).

Results: mortality risk: sixteen relevant studies were identified, which universally showed that children with pneumonia and moderate or severe malnutrition are at higher risk of death. For severe malnutrition, reported relative risks ranged from 2.9 to 121.2; odds ratios ranged from 2.5 to 15.1. For moderate malnutrition, relative risks ranged from 1.2 to 36.5.

Aetiology: eleven studies evaluated the aetiology of pneumonia in severely malnourished children. Commonly isolated bacterial pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The spectrum and frequency of organisms differed from those reported in children without severe malnutrition. There are very few data on the role of respiratory viruses and tuberculosis. Clinical signs: Four studies investigating the validity of clinical signs showed that WHO-recommended clinical signs were less sensitive as predictors of radiographic pneumonia in severely malnourished children.

Conclusions: 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
1360-2276
1173-1189
Chisti, Mohammod Jobayer
22613325-215d-4675-9bce-65f50ca022b0
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
La Vincente, Sophia
80565e0f-f383-461f-8b99-bbcf3c4fd2cb
Graham, Stephen M.
415ae6e5-9615-4883-b745-29c5da244e21
Duke, Trevor
4be7b7a6-f12d-4881-881d-f0e86002e5a8
Chisti, Mohammod Jobayer
22613325-215d-4675-9bce-65f50ca022b0
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
La Vincente, Sophia
80565e0f-f383-461f-8b99-bbcf3c4fd2cb
Graham, Stephen M.
415ae6e5-9615-4883-b745-29c5da244e21
Duke, Trevor
4be7b7a6-f12d-4881-881d-f0e86002e5a8

Chisti, Mohammod Jobayer, Tebruegge, Marc, La Vincente, Sophia, Graham, Stephen M. and Duke, Trevor (2009) Pneumonia in severely malnourished children in developing countries - mortality rish, aetiology and validity of WHO clinical signs: a systematic review. Tropical Medicine & International Health, 14 (10), 1173-1189. (doi:10.1111/j.1365-3156.2009.02364.x). (PMID:19772545)

Record type: Article

Abstract

Objectives: to quantify the degree by which moderate and severe degrees of malnutrition increase the mortality risk in pneumonia, to identify potential differences in the aetiology of pneumonia between children with and without severe malnutrition, and to evaluate the validity of WHO-recommended clinical signs (age-specific fast breathing and chest wall indrawing) for the diagnosis of pneumonia in severely malnourished children.

Methods: systematic search of the existing literature using a variety of databases (Medline, EMBASE, the Web of Science, Scopus and CINAHL).

Results: mortality risk: sixteen relevant studies were identified, which universally showed that children with pneumonia and moderate or severe malnutrition are at higher risk of death. For severe malnutrition, reported relative risks ranged from 2.9 to 121.2; odds ratios ranged from 2.5 to 15.1. For moderate malnutrition, relative risks ranged from 1.2 to 36.5.

Aetiology: eleven studies evaluated the aetiology of pneumonia in severely malnourished children. Commonly isolated bacterial pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The spectrum and frequency of organisms differed from those reported in children without severe malnutrition. There are very few data on the role of respiratory viruses and tuberculosis. Clinical signs: Four studies investigating the validity of clinical signs showed that WHO-recommended clinical signs were less sensitive as predictors of radiographic pneumonia in severely malnourished children.

Conclusions: 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

Full text not available from this repository.

More information

e-pub ahead of print date: 14 September 2009
Published date: October 2009
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 337637
URI: https://eprints.soton.ac.uk/id/eprint/337637
ISSN: 1360-2276
PURE UUID: bb95d8a3-1b34-4e65-b0c0-fc93389bab9c

Catalogue record

Date deposited: 02 May 2012 08:33
Last modified: 16 Jul 2019 22:06

Export record

Altmetrics

Contributors

Author: Mohammod Jobayer Chisti
Author: Marc Tebruegge
Author: Sophia La Vincente
Author: Stephen M. Graham
Author: Trevor Duke

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×