Outcomes of inpatients hospitalized with community acquired pneumonia
Date of Award
Master of Medicine (MMed)
Prof. Rodney Adam
Dr. Jumaa Bwika
Dr. Felix Riunga
Internal Medicine (East Africa)
Background: The morbidity from lower respiratory tract infections has varied between age groups and from region to region. In sub-Saharan Africa, pneumonia remains the most frequent reason for adult hospitalization, with approximately 4 million episodes and about 200,000 deaths every year. Some of the attributable factors have been HIV pandemic, pulmonary tuberculosis, and poor socio-economic status.
Objective: The main objective was to determine the morbidity of community-acquired pneumonia in patients admitted to a tertiary hospital in Nairobi, Kenya, between May 2019, and March 2020. The results are anticipated to help in informing protocols for the evaluation and treatment of community-acquired pneumonia.
Methods: This cohort is part of a nested study titled "The etiology and outcome of lower respiratory tract infections at AKUHN." One hundred fifty-eight patients were analyzed. Seventy-eight patients were recruited prospectively with a diagnosis of community-onset pneumonia on admission, while 80 patients were recruited retrospectively. The retrospective arm comprised patients with a discharge diagnosis of community-acquired pneumonia from May 2019 to March 2020. PSI and CURB65 scores, which are validated for predicting the risk of mortality, were obtained. The duration of hospital stay, critical care admission and associated complications were collected from their in-hospital charts, and clinic follow up records.
Results: The overall 30-day mortality was 1.9%. Critical care admission was found to be at 24%. The readmission rate was found to be at 6.3%. Cardiovascular disease and diabetes were the most prevalent comorbid disorders. Vaccination for pneumococcal infection and/either influenza was 7% for patients above 65 years. The mean length of stay was 6.4 days (IQR 4-8 days). There was a small but significant correlation between PSI and CURB65 with length of stay. Acute kidney injury was the predominant complication at 19%. In the prospectively recruited arm, 48.6% of patients had a viral aetiology of which the most common were Influenza A and Rhinovirus.
Conclusion: We had an older population compared to other African studies but with a low mortality rate. The admission to critical care was similar to other cohorts and of which, viral aetiologies contributed a significant percentage.
Nambafu, J. (2020). Outcomes of inpatients hospitalized with community acquired pneumonia (Unpublished master's dissertation). Aga Khan University, East Africa.