Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review

摘要: Objectives: to quantify the degree by which moderate and severe degrees of malnutrition increase mortality risk in pneumonia, identify potential differences aetiology pneumonia between children with without malnutrition, evaluate validity WHO-recommended clinical signs (age-specific fast breathing chest wall indrawing) for diagnosis severely malnourished children. Methods: systematic search existing literature using a variety databases (Medline, EMBASE, Web Science, Scopus CINAHL). Results: risk: sixteen relevant studies were identified, universally showed that or are at higher death. For reported relative risks ranged from 2.9 121.2; odds ratios 2.5 15.1. 1.2 36.5. Aetiology: eleven evaluated Commonly isolated bacterial pathogens Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus Escherichia coli, Haemophilus influenzae. The spectrum frequency organisms differed those malnutrition. There very few data on role respiratory viruses tuberculosis. Clinical signs: Four investigating less sensitive as predictors radiographic Conclusions: two biggest killers childhood. Guidelines care need take into account this strong often lethal association if they contribute UN Millennium Development Goal 4, aiming substantial reductions childhood mortality. Additional regarding optimal diagnostic approach management required regions where death these diseases is common