Prevalence, associated factors and treatment prescriptions for community-acquired pneumonia: a cross-sectional study at the largest children’s hospital in the Ashanti Region, Ghana

Viral respiratory agents have increasingly become a major cause of paediatric community-acquired pneumonia (vCAP) globally, with a reported prevalence of 25.7% in Ghana. Despite improved access to molecular diagnostics in Ghana, its limited use has led to underdiagnosis and inappropriate treatment prescriptions of viral respiratory agents in paediatric vCAP. We determined the prevalence of viral respiratory agents, their association with associated factors and vCAP, and assessed the treatment prescriptions for the management of vCAP at Asokwa Children’s Hospital, the largest children’s hospital in the Ashanti Region of Ghana. The study was conducted from July to August 2023 using a cross-sectional design and convenience sampling approach among children under 18 years who met WHO Integrated Management of Childhood Illness (IMCI) criteria for pneumonia such as cough with phlegm, difficulty breathing, and fever. Socio-demographic and clinical information was collected using case report forms. Oropharyngeal swabs from the participants were screened for common respiratory viruses, including influenza A and B, respiratory syncytial virus (RSV), SARS-CoV-2, human rhinovirus (HRV), and human metapneumovirus (HMPV), using real-time polymerase chain reaction. Viral CAP (vCAP) was defined as RT-PCR-confirmed detection of at least one respiratory virus. Logistic regression analysis compared the association between associated factors and vCAP cases using STATA SE version 14. Among 305 participants, viral respiratory agents were detected in 31 cases, representing a prevalence of 10.2%, with 28 (9.2%) single viral detections and 3 (1.0%) double viral detections. Influenza A was the most frequently detected virus, in 17 (5.57%) participants, with 6 (1.97%) testing positive for RSV, 2 (0.7%) for Influenza B and 3 (1.0%) for SARS-CoV-2. Being a female (AOR: 2.6, 95% CI:1.2–5.7) and having fever (AOR: 2.8, 95% CI:1.3–6.2) were significantly associated with vCAP. Furthermore, antibiotics were administered to 58.1% of viral positive detections, with penicillin being the most prescribed (35.3%). Influenza A was the most frequently detected virus among children with vCAP in this cohort. Fever (≥ 38 °C) and female sex were identified as associated factors. Although antibiotics were prescribed in 58% of viral-positive cases, this likely shows empiric management in a setting where bacterial co-infection cannot be reliably excluded.