CLINICO–Demographic Profile and Outcomes of Hospitalised Children With Diphtheria in A Tertiary Care Hospital of Peshawar

AIM: To determine the clinico-demographic profile and predictors of mortality in hospitalised children with diphtheria. METHODS: This retrospective cohort study included 202 children aged 5-16 years diagnosed with diphtheria per WHO criteria at Lady Reading Hospital, Peshawar, from January 2023 to December 2024. Data on demographics, vaccination status, clinical features, complications, antibiotic use and outcomes were collected from HMIS records and treatment charts. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. RESULTS: Mean age was 8.44 ± 2.69 years; 52.5% were male and 64.9% unvaccinated. Fever (96.0%), cough (93.1%) and throat pain (85.2%) were the most common presentations. Complications included airway obstruction (15.8%), respiratory failure (14.9%) and carditis (14.4%). Linezolid, alone or in combination, was the most frequently used antibiotic (59.4%). The case fatality rate was 15.8%. In multivariable analysis, carditis was the only independent predictor of mortality (adjusted OR 18.50; 95% CI 4.72-88.92; p < 0.001); antibiotic choice and vaccination status were not significantly associated with death. CONCLUSION: Mortality in children hospitalised with diphtheria remains substantial, with carditis as the strongest independent predictor of death. The high case fatality rate, predominantly among unvaccinated children, highlights the need for early cardiac evaluation and strengthened vaccination programmes.