Peer-reviewed article

Prevalence, incidence and associated factors of pneumonia among severely malnourished children hospitalized in Mulago National Referral Hospital, Uganda.

Harriet Nambuya, Ezekiel Mupere, Nicolette Nabukeera-Barungi, Paul Mubiri, Jolly General Kamugisha et al. · 28 Sept 2025

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study examined pneumonia in 400 children aged 6-59 months hospitalized with severe acute malnutrition at Mulago Hospital in Uganda. Pneumonia was present in 28% of children at admission and developed in 36% of those who did not have it initially. The risk of pneumonia was higher in younger children, those with stunting, HIV infection, tuberculosis, and those requiring nasogastric feeding or longer hospital stays. The findings highlight that pneumonia is a significant problem among malnourished children and better monitoring and treatment guidelines are needed.

Key points

Prevalence of pneumonia at admission or within 48 hours was 28% (95% CI: 24-33)
Incidence of pneumonia during hospitalization was 356 per 1000 admissions (95% CI: 305-416) among those without pneumonia at entry
Stunting was associated with both prevalence (Adjusted PR: 1.60) and incidence (Adjusted RR: 1.59) of pneumonia
Children aged 6-12 months had highest risk of developing pneumonia (Adjusted RR: 1.89)
Prolonged hospitalization of 15+ days more than doubled risk of pneumonia (Adjusted RR: 2.16)

Limitations

This study uses secondary data from a trial focused on probiotics and diarrhea, so pneumonia was not the primary outcome. The cross-sectional design for prevalence and retrospective cohort design for incidence cannot establish causation, only associations.

Abstract

BACKGROUND: Pneumonia is still a burden in children hospitalized with severe acute malnutrition (SAM). However, there is limited published information on the magnitude and characteristics of those who present with or develop pneumonia during hospitalization. We determined the prevalence and incidence of pneumonia, and associated factors among children aged 6-59 months hospitalized with SAM. METHODS: This study employed 2 study designs; cross sectional for prevalence of pneumonia and single arm retrospective cohort design for incidence of pneumonia. We used secondary data collected as part of the ProbiSAM trial that assessed the effect of Probiotics on diarrhea in children with severe acute malnutrition conducted at Mwanamugimu Nutrition Unit Mulago Hospital. Children aged 6-59 months hospitalized with SAM were assessed for prevalence and incidence of pneumonia. Prevalence of pneumonia was the proportion of pneumonia cases at the time of enrolment or within the first 48 hours of admission. 2)Incidence of pneumonia was the proportion who developed clinical signs of pneumonia for the first time during hospitalization among those who did not have pneumonia at enrolment or within 48 hours after admission. RESULTS: 400 children were included in the study and of these, 58% were males. Most (87%) of the children were aged 24 months and below. The prevalence of pneumonia was 28% (95% CI: 24-33). In multivariable analysis, factors associated with prevalence of pneumonia include: female sex (Adjusted PR: 1.72, 95% CI: 1.20-2.45), stunting (Adjusted PR: 1.60, 95% CI: 1.12-2.30) and presumptive TB (Adjusted PR: 1.95, 95% CI: 1.34-2.82). Incident pneumonia was estimated at 356 (95% CI: 305-416) per 1000 hospital admissions of children with SAM. In multivariable analysis, children at risk of pneumonia were: young age 6 to 12 months (Adjusted RR: 1.89, 95% CI: 1.10-3.29), stunting (Adjusted RR: 1.59, 95% CI: 1.15-2.20), HIV infection (Adjusted RR: 1.59, 95% CI: 1.08-2.33), presumptive TB (Adjusted RR: 1.73, 95% CI: 1.23-2.43), used a nasogastric tube for feeding (RR: 1.38, 95% CI: 1.00-1.89) and prolonged hospitalization of 15 days or more (Adjusted RR: 2.16, 95% CI: 1.39-3.35). CONCLUSION AND SIGNIFICANCE: This study identified that prevalence of pneumonia among children hospitalized with SAM is still high and similar to previous studies done in different settings in Uganda. In addition, this study showed that the risk of incident pneumonia among children hospitalized with SAM is high. These findings point out the need to develop guidelines to monitor, detect and treat incident pneumonia among children hospitalized with SAM. Stunting as factor associated with both prevalence and incidence of pneumonia underscores the importance of further research to evaluate how stunting relates to pneumonia.