Risk factors associated with disease severity among children hospitalised with community-acquired pneumonia in Angola

Background: Community-acquired pneumonia (CAP) is a major cause of paediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries. Yet, to date, no studies have examined the risk factors for severe CAP in Angolan children. We aimed to identify these risk factors to improve CAP-associated morbidity and mortality. Methods: We conducted a prospective, observational study enrolling a convenience sample of children aged two months to 13 years hospitalised with CAP in the Hospital Pediátrico David Bernardino in Luanda, Angola. We included healthy children and those with asthma, human immunodeficiency virus, or sickle cell disease. We used multivariable logistic regression to assess risk factors associated with mortality as the primary outcome and prolonged hospitalisation as the secondary outcome. Results: From September 2019 to May 2021, we enrolled 372 patients hospitalised with CAP, confirmed by chest x-ray. Multivariable analysis identified age <1 year (adjusted odds ratio (aOR) = 7.51; 95% confidence interval (CI) = 1.72-34.12), seizures (aOR = 10.62; 95% CI = 1.17-80.71), and C-reactive protein ≥150 mg/L (aOR = 27.77; 95% CI = 4.48-575.26) as risk factors for mortality, while cough prior to hospitalisation was a protective factor (aOR = 0.05; 95% CI = 0.01-0.2). Cooking at home with coal or wood (aOR = 2.05; 95% CI = 1.13-3.80), malnutrition (aOR = 2.15; 95% CI = 1.17-4.01), inability to drink on admission (aOR = 2.43; 95% CI = 1.22-5.00), diminished breath sounds on auscultation (aOR = 2.67; 95% CI = 1.49-4.82), and pleural effusion on chest x-ray (aOR = 3.99; 95% CI = 2.23-7.27) were risk factors for prolonged hospitalisation (>7 days). Conclusions: We identified various demographic, environmental, clinical, laboratory, and radiologic findings as key risk factors for severe CAP in Angolan children.