Improvements in nutritional management as a determinant of reduced mortality from community-acquired lower respiratory tract infection in hospitalized children from rural central Africa

Pediatr Infect Dis J. 2004 Aug;23(8):739-47. doi: 10.1097/01.inf.0000135663.17018.51.


Background: In-hospital mortality from lower respiratory tract infections (LTRI) is unacceptably high in developing countries where LTRI are still a leading cause of death.

Objective: To identify new approaches to reduce in-hospital mortality of LRTI through the improvement of its management.

Methods: The prospectively collected database of children admitted during an 11-year period with LRTI in a pediatric rural hospital in Central Africa was reviewed to determine the predictors of death and to evaluate the impact on mortality of 4 different protocols for the management of malnutrition.

Results: During the study period, 859 children were admitted with a nonmeasles severe LRTI. In the 3-year period during which blood cultures were obtained, 29.0% of the children with LRTI were bacteremic, and multiresistant Enterobacteriaceae were recovered in 81.4% of positive blood cultures. Independent predictors of death in children without edema were age <24 months, dehydration and hepatomegaly with adjusted odds ratios (numbers in parentheses, 95% confidence interval) of 3.47 (1.70-7.08), 4.24 (2.11-8.50) and 2.90 (1.43-5.85), respectively. In those with edema, a significantly increased risk of death was noted for girls [4.31 (1.71-10.90)], in children with z-score of weight to height < or = -3 [5.45 (1.67-17.79)] and when the serum albumin was <16 g/l [2.58 (1.01-6.58)]. The improvement in the management of malnutrition was followed by a reduction of LRTI-related mortality in children with edema from 32.4 to 8.9% (P < 0.001). In children without edema, the LRTI-related mortality decreased from approximately 12% to 3.5% when their diet was supplemented with micronutrients.

Conclusion: This study indicates that the improvement of the management of underlying nutritional deficiencies is crucial for the reduction of the high in-hospital case fatality rate associated with severe nonmeasles LRTI. The empiric antibiotic regimen should be modified to cover for multiresistant Enterobacteriaceae.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Child
  • Child, Preschool
  • Congo / epidemiology
  • Databases, Factual
  • Dehydration
  • Edema / complications
  • Female
  • Hepatomegaly
  • Hospital Mortality / trends*
  • Hospitals, Rural / statistics & numerical data
  • Humans
  • Infant
  • Infant Mortality / trends*
  • Infant, Newborn
  • Male
  • Malnutrition / complications
  • Malnutrition / therapy*
  • Nutritional Status
  • Nutritional Support*
  • Prospective Studies
  • Respiratory Tract Infections / mortality*
  • Respiratory Tract Infections / prevention & control*
  • Risk Factors
  • Rural Population