CC BY-NC-ND 4.0 · J Pediatr Infect Dis 2023; 18(03): 153-162
DOI: 10.1055/s-0043-1767815
Original Article

Low Mortality among Under-5 Children with Severe Community-Acquired Pneumonia: A 5-Year Retrospective Analysis of 588 Admissions in Ibadan, Nigeria

1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
Adeyinka Adeyemi Labaeka
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
Kayode Raphael Fowobaje
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
Hamish Graham
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
2   Centre for International Child Health, The Royal Children's Hospital, Murdoch Children Research Institute, University of Melbourne, Parkville, Australia
Adegoke Gbadegesin Falade
1   Department of Pediatrics, University College Hospital, Ibadan, Nigeria
3   Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
› Author Affiliations


Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials.

Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression.

Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged ≤12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1–7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0–5.6]) were independently associated with antibiotics change. The CFR was 1.36%.

Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.

Supplementary Material

Publication History

Received: 20 July 2022

Accepted: 02 March 2023

Article published online:
04 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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