Bacia Laura, Avaga Stanslas, Ndrusini Simon Ngbape, Nakate Caroline, Damale Abdu, Kyomya Julius, Mwandah Daniel Chans, Kyoyagala Stella, Yadesa Tadele Mekuriya
Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Plot 8-18 Kabale Road, Mbarara, Uganda.
Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Ther Adv Infect Dis. 2025 Apr 25;12:20499361251335395. doi: 10.1177/20499361251335395. eCollection 2025 Jan-Dec.
Pneumonia remains a significant global health concern, particularly for children in low- and middle-income countries. Despite advancements in medical care and the availability of effective medication, treatment failure still occurs.
This study evaluated the incidence, associated factors, and outcomes of treatment failure among children under 5 years with pneumonia.
A prospective observational study.
We conducted this study among children under 5 years hospitalized with pneumonia at the pediatric ward of Mbarara Regional Referral Hospital over a period of 3 months. We enrolled the participants in the study consecutively. Data was analyzed using SPSS software Version 27. Logistic regression was used to determine factors associated with treatment failure.
A total of 216 children aged between 0 and 59 months were included in the study. The incidence of treatment failure after 48 h was 53 (24.5%). A total of 32 (60.4%) cases of treatment failure occurred early (between 48 and 72 h), while 21 (39.6%) occurred late (after 72 h). Distance of >5 km from the nearest health facility (adjusted odds ratio (AOR) = 2.2, 95% CI: 1.1-4.4, -value = 0.029), severe acute malnutrition (AOR = 6.2, 95% CI: 2.4-16.1, -value < 0.001), and adverse drug reaction (AOR = 6.9, 95% CI: 2.6-18.4, -value < 0.001) were independent predictors of treatment failure. The outcomes of treatment failure included prolonged hospitalization, death, referral to a higher-level facility, and complications of pneumonia.
Our study identified a high incidence of treatment failure among children under 5 years in this setting. There is a need for early and accurate diagnosis, which includes culture and sensitivity tests, timely initiation of effective antibiotic therapy, active pharmacovigilance, and close monitoring of patients with acute malnutrition to reduce the likelihood of treatment failure.
肺炎仍然是一个重大的全球健康问题，尤其是对低收入和中等收入国家的儿童而言。尽管医疗护理有所进步且有有效的药物可用，但治疗失败的情况仍然存在。
本研究评估了5岁以下肺炎患儿治疗失败的发生率、相关因素及治疗结果。
一项前瞻性观察性研究。
我们在姆巴拉拉地区转诊医院儿科病房对3个月内因肺炎住院的5岁以下儿童进行了这项研究。我们连续招募研究参与者。使用SPSS 27版软件进行数据分析。采用逻辑回归确定与治疗失败相关的因素。
共有216名年龄在0至59个月之间的儿童纳入研究。48小时后治疗失败的发生率为53例（24.5%）。共有32例（60.4%）治疗失败发生在早期（48至72小时之间），而21例（39.6%）发生在晚期（72小时后）。距离最近的医疗机构超过5公里（调整后的优势比（AOR）=2.2，95%置信区间：1.1 - 4.4，P值=0.029）、重度急性营养不良（AOR = 6.2，95%置信区间：2.4 - 16.1，P值<0.001）和药物不良反应（AOR = 6.9，95%置信区间：2.6 - 18.4，P值<0.001）是治疗失败的独立预测因素。治疗失败的结果包括住院时间延长、死亡、转诊至更高水平的医疗机构以及肺炎并发症。
我们的研究发现该地区5岁以下儿童治疗失败的发生率很高。需要进行早期准确诊断，包括培养和药敏试验，及时开始有效的抗生素治疗，积极开展药物警戒，并密切监测急性营养不良患者，以降低治疗失败的可能性。
