ArticlesAetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya
Introduction
There are no community-based incidence data on acute adult pneumonia in sub-Saharan Africa, but this disease ranks consistently highly as a cause of admission in hospital-based series.1, 2 Management guidelines were established 15–20 years ago, since when demography, urbanisation, HIV seroprevalence, and access to pharmaceutical products have changed substantially.3, 4 The aim of this prospective study was to provide an accurate description of the aetiology and outcome of acute pneumonia in a rural and an urban population, and to analyse the risk factors for mortality.
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Study population
The study population comprised consecutive adults (≥15 years old) with acute pneumonia who had lived for longer than 3 months in the Coast Province of Kenya. The cases presented between March, 1994, and May, 1996, to Coast Province General Hospital (which serves an urban population in Mombasa), or Kilifi District Hospital (which serves a rural population 60 km away). A case was defined by an illness of 14 days' duration or less that consisted of at least two respiratory symptoms (cough, sputum,
Patients' characteristics
We examined 281 clinical episodes of acute pneumonia. Seven patients were admitted to the study twice and one patient three times; these episodes were analysed independently. 63% of patients were male, 40% were aged 25–34 years, and 52% were HIV-1 seropositive (table 1). Mean body-mass index was 18·6 kg/m2 and mean haemoglobin concentration was 12·4 g/dL in men and 9·0 g/dL in women.
Of the 233 patients who presented to the urban hospital, a significantly greater number were male, HIV positive,
Discussion
In studies of pneumonia, the proportion of patients in whom a cause is identified varies from 16·5% to 98%.9, 10, 11, 12 This variation is attributable more to diagnostic specificity than to the populations studied.10, 12 If each of the 14 assays undertaken here had a specificity of 0·95, more than half the patients would have had at least one false positive diagnosis and 15% would have had at least two. To keep this problem to a minimum, we selected assays of high specificity—ie, blood and
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2019, International Journal of Infectious DiseasesCitation Excerpt :The particularly high incidence of pulmonary tuberculosis (PTB) among CAP patients in developing countries is one of the important differences when compared to CAP in North America and Europe (Brown, 2009; Zar et al., 2013). In a study performed in Kenya, Mycobacterium tuberculosis was the second most commonly identified pathogen among adults with pneumonia (Scott et al., 2000). In studies from China and other Asian countries, M. pneumoniae was detected at high rates among adult pneumonia cases (Liu et al., 2009; Cao et al., 2010).