Treatment failure among children under 5 years hospitalized with pneumonia at the pediatric ward of Mbarara Regional Referral Hospital in Southwestern Uganda: a prospective observational study

Abstract

Background: 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. Objective: This study evaluated the incidence, associated factors, and outcomes of treatment failure among children under 5years with pneumonia. Design: A prospective observational study. Method: We conducted this study among children under 5years hospitalized with pneumonia at the pediatric ward of Mbarara Regional Referral Hospital over a period of 3months. 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. Results: A total of 216 children aged between 0 and 59months were included in the study. The incidence of treatment failure after 48h was 53 (24.5%). A total of 32 (60.4%) cases of treatment failure occurred early (between 48 and 72h), while 21 (39.6%) occurred late (after 72h). Distance of >5km from the nearest health facility (adjusted odds ratio (AOR)=2.2, 95% CI: 1.1–4.4, p-value=0.029), severe acute malnutrition (AOR=6.2, 95% CI: 2.4–16.1, p value<0.001), and adverse drug reaction (AOR=6.9, 95% CI: 2.6–18.4, p-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. Conclusion: Our study identified a high incidence of treatment failure among children under 5years 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.