Abstract:
Background: Pneumonia is the leading cause of childhood morbidity and mortality
globally and in Kenya. Clinical practice guidelines for pneumonia are one of the tools
advocated by WHO for reducing mortality. There are Kenyan national management
guidelines adapted from WHO. Adherence to the latest guidelines has not been
evaluated in Kenya.
Objective: To determine adherence to national guidelines for management of
pneumonia and describe hospital outcomes and associated factors among children 2-59
months discharged from Kitale County Hospital with an admission diagnosis of
pneumonia.
Methods: This was a retrospective chart review carried out in the Pediatric wards of
Kitale County hospital in Trans Nzoia County, Kenya. Data were collected from the
participant‟s inpatient records upon discharge or death. All files were included till a
sample size of 380 was achieved. Data on demographics, management and outcomes
was extracted from the pediatric admission form, daily ward round notes and treatment
sheet. Data were then compared with the national guidelines to assess adherence. The
outcomes of interest were duration of hospital stay and death.
Results: The median age at recruitment was 12 months (IQR7, 24). The gender was
male in 52% (198) of the participants. The diagnosis was severe pneumonia in 56%
(213) and pneumonia in 44% (167) of the participants. Adherence at admission was 32
%( 121). Appropriate diagnosis was made in 53.4 %( 202), correct drug chosen in 55.8
%( 212) and correct dosage prescribed in 71.1 %( 270) of the participants. The
proportion of the patients correctly managed in accordance with guidelines during the
inpatient stay was 0.6 %( 2). Complete adherence from admission to discharge was in
2.1% (8) of the cases. Median length of stay was 3 days (IQR2, 4). Length of stay was
not associated with age, gender, diagnosis classification, admitting clinician and
nutritional status. The case fatality rate was 8.2%. Severe pneumonia (P=0.001) and
overall adherence (P=<0.001) were significantly associated with mortality. On logistic
regression, severe pneumonia (OR 6.365; CI 95% 1.841-22.000 P=<0.003) increased
the odds of mortality.
Conclusion: The level of adherence to the guidelines was low, markedly decreasing
from admission to discharge. Case fatality rate was higher than global average.
Recommendations: A study to evaluate factors affecting adherence to national
pneumonia management guidelines and how to improve it should be carried out.
