Abstract
BackgroundLittle attention has been paid to asthma in ‘under-fives’ in Sub-Saharan Africa. In ‘under-fives’, acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. The mortality associated with acute respiratory diseases in Uganda is high but improving, dropping from 24% in 2004 to 11.9% in 2012. We describe the immediate clinical outcomes of children with acute asthma and pneumonia and document the factors associated with prolonged hospitalization and mortality.MethodsWe enrolled 614 children aged 2 to 59 months with acute respiratory symptoms presenting at the emergency paediatric unit of Mulago hospital. Clinical histories, physical examination, blood and radiological tests were done. Children with asthma and bronchiolitis were collectively referred to as ‘Asthma syndrome’. Hospitalized children were monitored every 12 hours for a maximum of 7 days. Survival analysis was done to compare outcome of children with asthma and pneumonia. Cox regression analysis was done to determine factors associated with prolonged hospitalization and mortality.ResultsOverall mortality was 3.6%. The highest case fatality was due to pneumocystis jirovecii pneumonia (2/4) and pulmonary tuberculosis (2/7). None of the children with asthma syndrome died. Children with ‘asthma syndrome’ had a significantly shorter hospital stay compared to those with pneumonia (p<0.001). Factors independently associated with mortality included hypoxemia (HR = 10.7, 95% CI 1.4- 81.1) and severe malnutrition (HR = 5.7, 95% CI 2.1- 15.8). Factors independently associated with prolonged hospitalization among children with asthma syndrome included age less than 12 months (RR = 1.2, 95% CI 1.0-1.4), hypoxemia (RR = 1.4, 95% CI 1.2-1.7), and severe malnutrition (RR = 1.5 95% CI 1.3-1.8). Similar factors were associated with long duration of hospital stay among children with pneumonia.ConclusionThis study identified a sharp decline in acute respiratory mortality compared to the previous studies in Mulago hospital. This may be related to focus on and treatment of asthma in this study, and will be analysed in a later study. Bacterial pneumonia is still associated with high case fatality. Hypoxemia, severe malnutrition, and being an infant were associated with poor prognosis among children with acute asthma and pneumonia and need to be addressed in the management protocols.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-014-0285-4) contains supplementary material, which is available to authorized users.
Highlights
IntroductionIn ‘under-fives’, acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria
Little attention has been paid to asthma in ‘under-fives’ in Sub-Saharan Africa
In this study, we describe the immediate clinical outcomes of children aged 2–59 months who were admitted with acute respiratory symptoms in Mulago hospital Uganda
Summary
In ‘under-fives’, acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. We describe the immediate clinical outcomes of children with acute asthma and pneumonia and document the factors associated with prolonged hospitalization and mortality. Pneumonia and acute asthma are different disease entities with similar clinical presentation among young children [1]. The diagnostic gold standards for pneumonia and acute asthma in young children are quite sensitive but very unspecific and may be difficult to apply in lowincome settings like Uganda [2,3]. 95% had prescriptions for antibiotics only 19.8% had combined asthma and bacterial pneumonia [6] In such circumstances, the outcomes of children with acute asthma are attributed to pneumonia. This may impact on management protocols for children with asthma, such as referral for chronic care, health education on prevention of exacerbations and home management of asthma attacks
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