Time to Recovery and Predictors of Severe Pneumonia in Children Under Five Years of Age at Referral and General Hospitals in Sidama Region, Southern Ethiopia, multicenter prospective cohort study

Background A longer period of hospitalization is known to raise the risk of local and systemic infection, which can lead to complicated pneumonia. These negative impacts of inpatient management of severe pneumonia become more pronounced if the length of recovery time is prolonged. Therefore, the aim of this study was to assess the time to recovery from severe pneumonia and its predictors among under-five children. Methodology A multicenter prospective cohort study was conducted on 286 children under five years of age with severe pneumonia from March to July 2024 at referral and general hospitals in the Sidama Region, South Ethiopia. Data collectors received two-days training. Systematic sampling was employed to select participants. Data analysis was performed using STATA version 16, with Cox proportional regression. The Cox proportional hazard model assumption was validated using the Schoenfeld residual global test, which yielded a P-value of 0.505.

Among 286 under-five children with severe pneumonia, the median time to recovery was 5 days (interquartile range = 4-7). The incidence of recovery rate was 17.27 (95% CI, 15.3- 19.4) per 100 person-days. Severe acute malnutrition (adjusted hazard ratio; 0.567, 95% CI (0.357- 0.90)), presence of danger signs (adjusted hazard ratio; 0.497, 95% CI (0.314-0.787)) and presence of co-morbidities (adjusted hazard ratio; 0.618, 95% CI (0.477- 0.800)) were associated with time to recovery from severe pneumonia in children younger than five years.

and recommendations The median recovery time of pediatric patients admitted with severe pneumonia was relatively high. Malnutrition, presence of danger signs, and comorbidities were significant associated factors; therefore, to reduce time to recovery from severe pneumonia by enhancing nutritional status, early detection and treatment of the danger signs, and comorbidity diseases. Competing Interest Statement The authors have declared no competing interest. Clinical Trial no Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical clearance for this study was obtained from the Institutional Review Board of the College of Medicine and Health Science, School of Public Health, Hawassa University(Ref.NO:IRB/110/16, Date:16/03/2024 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability data avavailable at authors. Acronyms and Abbreviations - AHR - adjusted hazard ratio - BSC - bachelor science - CHR - crude hazard ratio - CI - confidence interval - HIV - human immune virus - HUCSH - Hawassa university comprehensive specialized hospital - IQR - interquartile range - NICU - neonate intensive care unit - SAM - severe acute malnutrition - SCAP - severe community acquired pneumonia - URTI - upper respiratory tract infection - WHO - world health organizations