Prognosis of Clinical Pneumonia in Undernourished Children in Rural Gambia

Prognosis of Clinical Pneumonia in Undernourished Children in Rural Gambia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognosis of Clinical Pneumonia in Undernourished Children in Rural Gambia Yasir Shitu Isa, Megan Carelus, Isabelle Silber, Rasheed Salaudeen, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7190681/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Mar, 2026 Read the published version in Pneumonia → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Undernutrition significantly increases the risk of severe infections and mortality in children under five, particularly in low- and middle-income countries. Pneumonia, a leading cause of childhood death, is especially dangerous in undernourished children, yet predictive tools to identify those at highest risk are lacking. Objective: To assess the prognosis of clinical pneumonia in undernourished children in rural Gambia and to develop simple, implementable prognostic algorithms for early identification of children at risk for poor outcomes. Methods: This study analyzed a subset of children enrolled in a larger prospective cohort designed to identify biomarkers of bacterial pneumonia. Children aged 2–59 months with clinical pneumonia were recruited from two rural Gambian hospitals. Clinical and anthropometric data were collected at baseline, during hospitalization, and at 30-day follow-up. Undernutrition was defined using WHO weight-for-height and height-for-age z-scores. Prognostic outcomes included death, prolonged hospital stay (≥7 days), post-discharge care-seeking, and clinical decline. Logistic regression and classification tree models were used to identify predictors of poor prognosis. Results: Among the children analyzed, 91% were undernourished, and 45% had moderate to severe wasting or stunting. Moderate-severe undernutrition was associated with a threefold increased risk of poor prognosis (adjusted OR 2.59; 95% CI: 1.54–4.35), with wasting showing a stronger association with mortality than stunting (OR 10.6 vs. 3.0). Three predictive algorithms were developed using combinations of anthropometric, clinical, and laboratory parameters, with sensitivities ranging from 84% to 90%. Conclusion: Moderate to severe undernutrition, particularly wasting, is a strong predictor of poor outcomes in children with pneumonia. Simple clinical algorithms incorporating age, nutritional status, and key clinical signs can help prioritize care in resource-limited settings. Further validation is warranted to enable their broader implementation. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Mar, 2026 Read the published version in Pneumonia → Version 1 posted Editorial decision: Revision requested 29 Sep, 2025 Reviews received at journal 26 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviews received at journal 07 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers invited by journal 02 Aug, 2025 Editor assigned by journal 27 Jul, 2025 Submission checks completed at journal 27 Jul, 2025 First submitted to journal 22 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7190681","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497139771,"identity":"05aad4ae-5dbd-4068-b560-cb447be484f3","order_by":0,"name":"Yasir Shitu Isa","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yasir","middleName":"Shitu","lastName":"Isa","suffix":""},{"id":497139772,"identity":"ec5c0166-896f-402f-8f3a-1fccc0902bee","order_by":1,"name":"Megan Carelus","email":"","orcid":"","institution":"Boston University School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"","lastName":"Carelus","suffix":""},{"id":497139773,"identity":"c6618a32-9f25-477d-bf3f-3145bcd49fb1","order_by":2,"name":"Isabelle Silber","email":"","orcid":"","institution":"Boston University School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Isabelle","middleName":"","lastName":"Silber","suffix":""},{"id":497139774,"identity":"711cb880-e652-42e4-ad24-ebcd0fba8b82","order_by":3,"name":"Rasheed Salaudeen","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rasheed","middleName":"","lastName":"Salaudeen","suffix":""},{"id":497139775,"identity":"dc4ede2f-bc83-4788-9512-6603ec265a15","order_by":4,"name":"Golam Sarwar","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Golam","middleName":"","lastName":"Sarwar","suffix":""},{"id":497139776,"identity":"a9075371-0e14-413f-bdd5-5b211cb3f6ce","order_by":5,"name":"Yekini Ajao Olatunji","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yekini","middleName":"Ajao","lastName":"Olatunji","suffix":""},{"id":497139777,"identity":"49f6b5ea-a95c-42e3-ac70-b3a8a59c6e57","order_by":6,"name":"Ilias Hossain","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ilias","middleName":"","lastName":"Hossain","suffix":""},{"id":497139778,"identity":"05ff6dcf-2a58-4cfb-ad51-737dbb181c47","order_by":7,"name":"Isaac Osei","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Osei","suffix":""},{"id":497139779,"identity":"3d858830-2d3d-481d-b227-433199307424","order_by":8,"name":"Galega Lobga","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Galega","middleName":"","lastName":"Lobga","suffix":""},{"id":497139780,"identity":"d6593f5c-2ad6-4dc3-a2fc-41aa2cdae61a","order_by":9,"name":"Banjo Adeshola","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Banjo","middleName":"","lastName":"Adeshola","suffix":""},{"id":497139781,"identity":"c3a3b666-f442-48d7-b410-b4c461c38edf","order_by":10,"name":"Ousman Barjo","email":"","orcid":"","institution":"Medical Research Council Unit, The Gambia at the London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ousman","middleName":"","lastName":"Barjo","suffix":""},{"id":497139782,"identity":"54b25582-870a-409d-a096-63c6a795068c","order_by":11,"name":"Momodou M. 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Pneumonia, a leading cause of childhood death, is especially dangerous in undernourished children, yet predictive tools to identify those at highest risk are lacking.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To assess the prognosis of clinical pneumonia in undernourished children in rural Gambia and to develop simple, implementable prognostic algorithms for early identification of children at risk for poor outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study analyzed a subset of children enrolled in a larger prospective cohort designed to identify biomarkers of bacterial pneumonia. Children aged 2–59 months with clinical pneumonia were recruited from two rural Gambian hospitals. Clinical and anthropometric data were collected at baseline, during hospitalization, and at 30-day follow-up. Undernutrition was defined using WHO weight-for-height and height-for-age z-scores. Prognostic outcomes included death, prolonged hospital stay (≥7 days), post-discharge care-seeking, and clinical decline. Logistic regression and classification tree models were used to identify predictors of poor prognosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among the children analyzed, 91% were undernourished, and 45% had moderate to severe wasting or stunting. Moderate-severe undernutrition was associated with a threefold increased risk of poor prognosis (adjusted OR 2.59; 95% CI: 1.54–4.35), with wasting showing a stronger association with mortality than stunting (OR 10.6 vs. 3.0). Three predictive algorithms were developed using combinations of anthropometric, clinical, and laboratory parameters, with sensitivities ranging from 84% to 90%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Moderate to severe undernutrition, particularly wasting, is a strong predictor of poor outcomes in children with pneumonia. Simple clinical algorithms incorporating age, nutritional status, and key clinical signs can help prioritize care in resource-limited settings. Further validation is warranted to enable their broader implementation.\u003c/p\u003e","manuscriptTitle":"Prognosis of Clinical Pneumonia in Undernourished Children in Rural Gambia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 21:12:38","doi":"10.21203/rs.3.rs-7190681/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T18:37:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-26T18:54:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252596077689412549018058311748945237928","date":"2025-09-15T12:27:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116387359251946932674428885100497051120","date":"2025-08-12T20:16:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-07T10:00:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64471608102546507864366135612655642276","date":"2025-08-04T06:51:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-02T19:31:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T01:22:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-28T01:20:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pneumonia","date":"2025-07-22T22:54:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pneumonia","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pneu","sideBox":"Learn more about [Pneumonia](http://pneumonia.biomedcentral.com)","snPcode":"41479","submissionUrl":"https://submission.nature.com/new-submission/41479/3","title":"Pneumonia","twitterHandle":"@pneumoniajourn","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"afb0fafe-1ac9-48ae-bb77-79d78c9d5406","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:23:48+00:00","versionOfRecord":{"articleIdentity":"rs-7190681","link":"https://doi.org/10.1186/s41479-025-00194-8","journal":{"identity":"pneumonia","isVorOnly":false,"title":"Pneumonia"},"publishedOn":"2026-03-25 16:08:27","publishedOnDateReadable":"March 25th, 2026"},"versionCreatedAt":"2025-08-08 21:12:38","video":"","vorDoi":"10.1186/s41479-025-00194-8","vorDoiUrl":"https://doi.org/10.1186/s41479-025-00194-8","workflowStages":[]},"version":"v1","identity":"rs-7190681","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7190681","identity":"rs-7190681","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}