Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya

• Published in: The Lancet (British edition) Vol. 355; no. 9211; pp. 1225 - 1230
• Main Authors: Scott, JAG, Hall, AJ, Muyodi, C, Lowe, B, Ross, M, Chohan, B, Mandaliya, K, Getambu, E, Gleeson, F, Drobniewski, F, Marsh, K
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 08.04.2000; Lancet; Elsevier Limited
• Subjects: Acute Disease; Adolescent; Adult; Adults; Age Distribution; Aged; Aged, 80 and over; AIDS/HIV; Antigens; Antimicrobial agents; Benzylpenicillin; Biological and medical sciences; Convalescence; Drug therapy; Employment; Enzyme-Linked Immunosorbent Assay; Epidemiology; Etiology; Female; Health risks; Heart rate; Herpes labialis; HIV; HIV Infections - mortality; HIV-1 - isolation & purification; Hospitals; Human immunodeficiency virus; Humans; Illnesses; Incidence; Influenza; Kenya - epidemiology; Laboratories; Lungs; Male; Medical sciences; Middle Aged; Mortality; Mortality risk; Mycobacterium tuberculosis - isolation & purification; Mycoplasma pneumoniae; Patients; Pneumology; Pneumonia; Pneumonia - blood; Pneumonia - microbiology; Pneumonia - mortality; Pneumonia, Pneumococcal - mortality; Population; Public health; Respiratory system : syndromes and miscellaneous diseases; Risk analysis; Risk Factors; Rural areas; Serology; Sex Distribution; Sputum; Streptococcus infections; Streptococcus pneumoniae; Streptococcus pneumoniae - isolation & purification; Treatment Outcome; Trends; Tuberculosis; Tuberculosis, Pulmonary - mortality; Urine; Kenya; Africa; United Kingdom > UK; United States > US; Human; Lung disease; Pneumonia; Clinical management; Respiratory disease; Etiology; Public health organization; Acute; Mortality; Risk factor; Public health; Mortality Determinants; Eastern Africa; Laboratory Examinations And Diagnoses; Risk Factors; Africa; Biology; Infections; Kenya; Research Methodology; English Speaking Africa; Examinations And Diagnoses; Diseases; Tuberculosis; Clinical Research; Population; Research Report; Developing Countries; Africa South Of The Sahara; Respiratory Infections > etiology; Demographic Factors; Population Dynamics
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(00)02089-4

Despite a substantial disease burden, there is little descriptive epidemiology of acute pneumonia in sub-Saharan Africa. We did this study to define the aetiology of acute pneumonia, to estimate mortality at convalescence, and to analyse mortality risk-factors. We studied 281 Kenyan adults who presented to two public hospitals (one urban and one rural) with acute radiologically confirmed pneumonia during 1994–96. We did blood and lung-aspirate cultures, mycobacterial cultures, serotype-specific pneumococcal antigen detection, and serology for viral and atypical agents. Aetiology was defined in 182 (65%) patients. Streptococcus pneumoniae was the most common causative agent, being found in 129 (46%) cases; Mycobacterium tuberculosis was found in 26 (9%). Of 255 patients followed up for at least 3 weeks, 25 (10%) died at a median age of 33 years. In multivariate analyses, risk or protective factors for mortality were age (odds ratio 1·51 per decade [95% Cl 1·04–2·19]), unemployment (4·42 [1·21–16·1]), visiting a traditional healer (5·26 [1·67–16·5]), visiting a pharmacy (0·30 [0·10–0·91]), heart rate (1·64 per 10 beats [1·24–2·16]), and herpes labialis (15·4 [2·22–107]). HIV-1 seropositivity, found in 52%, was not associated with mortality. Death or failure to recover after 3 weeks was more common in patients with pneumococci of intermediate resistance to benzylpenicillin, which comprised 28% of pneumococcal isolates, than in those infected with susceptible pneumococci (5·60 [1·33–23·6]). We suggest that tuberculosis is a sufficiently common cause of acute pneumonia in Kenyan adults to justify routine sputum culture, and that treatment with benzylpenicillin remains appropriate for clinical failure due to M tuberculosis, intermediate-resistant pneumococci, and other bacterial pathogens. However, interventions restricted to hospital management will fail to decrease mortality associated with socioeconomic, educational, and behavioural factors.