Predictors of prolonged hospitalization among children aged 2–59 months with severe community-acquired pneumonia in public hospitals of Benishangul-Gumuz Region, Ethiopia: a multicenter retrospective follow-up study

Abstract

BackgroundPneumonia is a leading cause of morbidity and mortality among children aged under 5 years in Ethiopia. Prolonged hospitalization of severe community-acquired pneumonia is a significant problem in resource-limited countries. This study seeks to provide insights that can help improve the management and outcomes of severe community-acquired pneumonia, which is particularly important in the context of the Benishangul-Gumuz Region, Ethiopia, where access to quality healthcare services is limited, and childhood pneumonia is a significant health challenge.ObjectiveThe aim of the study was to determine the predictors of prolonged hospitalization among children aged 2–59 months admitted with severe community-acquired pneumonia between 1 January 2016 and 30 December 2020 in the public hospitals in Benishangul-Gumuz Region, Ethiopia.MethodA retrospective follow-up study design was conducted among randomly selected samples of 526 children. Data were entered into EPI data version 4.6 and analyzed using STATA version 14.0. The Cox proportional hazard regression model was fitted to identify the independent predictors of prolonged hospitalization, and variables with a p-value <0.05 in the multivariable model were considered statistically significant.ResultsThe median hospital stay was 5 days (interquartile range 2–8 = 6). Approximately 149 (28.93%) children had prolonged hospitalization (>5 days) and the recovery rate from severe community-acquired pneumonia was 19.69 per 100 person-day observations. The significant predictors of prolonged hospitalization were as follows: having facility referral sources [0.79, 95% confidence interval (CI), 0.63–0.98]; a nutritional status of wasting (0.64, 95% CI, 0.44–0.94); anemia (0.65, 95% CI, 0.46–0.90); no identified hemoglobin level (0.53, 95% CI, 0.41–0.70); no identified blood film (0.65, 95% CI, 0.53–0.80); no chest x-ray investigation (0.81, 95% CI, 0.65–0.99); pulmonary effusion (0.31, 95% CI, 0.15–0.66); and late presenters to hospital (0.67, 95% CI, 0.53–0.84) at admission.ConclusionsThe median length of stay in hospital was delayed compared to other studies. Wasting, late presenting to hospital, pulmonary effusion, anemia, absence of investigations of hemoglobin level, chest x-ray, and blood film at admission time were factors that significantly prolonged the hospitalization time. Hence, attention should be given to the prevention of malnutrition and anemia in children, increasing early health-seeking behavior in the community. Attention should be given to complications such as pleural effusion, and investigations, such as chest x-ray, hemoglobin levels, and blood films, should be performed when the child is admitted.