Predictors of death from severe pneumonia among children 2-59 months old hospitalized in Bohol, Philippines: implications for referral criteria at a first-level health facility

Objective To determine predictors of death among children 2 - 59 months old admitted to hospital with severe pneumonia. methods Prospective observational study from April 1994 to May 2000 to investigate serious infections in children less than 5 years old admitted to a tertiary care government hospital in a rural province in central Philippines. The quality of clinical and laboratory work was monitored. The WHO classification for severe pneumonia was used for patient enrolment. Results There were 1249 children with severe pneumonia and no CNS infection. Thirty children died. Using univariate analysis, the following factors were significantly associated with death: age 2 - 5 months, dense infiltrates on chest radiography and presence of definite bacterial pathogens in the blood. Stepwise logistic regression analysis revealed the following independent predictors of death: age 2 - 5 months, weight for age z- score less than) 2 SD, dense infiltrates on chest radiography and definite pathogens isolated in the blood. When the results of chest radiographs and blood cultures were not included to mimic facilities available at first- level facilities, age 2 - 5 months and weight for age z- score less than) 2 SD remained independent predictors of death. Conclusion When resources are limited, children with lower chest wall indrawing ( severe pneumonia) who are 2 - 5 months old or moderately to severely malnourished should be referred for immediate higher- level care.