The effect of anemia on mortality in children hospitalized with severe pneumonia in Uganda

OBJECTIVE

To examine the effect of anemia on mortality among children hospitalized with severe pneumonia in Uganda.

STUDY DESIGN

This prospective cohort study enrolled children aged 6 to 59 months admitted with severe pneumonia to 2 hospitals in western Uganda. Severe pneumonia was diagnosed based on World Health Organization criteria, and anemia was diagnosed by hemoglobin (Hb) measured at admission.

RESULTS

Among 212 children with severe pneumonia, with a median age of 13.3 months, 67.5% had at least mild anemia (Hb < 11 g/dL) and 9.0% had severe anemia (Hb < 7 g/dL). A lower mean Hb was observed among children who died during hospitalization (8.5 vs 10.2 g/dL; mean difference 1.7 g/dL [95% CI: 0.6, 2.7]). Adjusting for age and oxygen saturation, Hb concentration was inversely associated with mortality. For every 1 g/dL increase in Hb, we observed a 28% lower odds of death (OR: 0.72 [95% CI: 0.57, 0.89]). We also calculated the product of Hb and oxygen saturation (saturated Hb); no child with a saturated Hb > 12 g/dL died, compared with 28% of children with saturated Hb < 6 g/dL.

CONCLUSIONS

Among children hospitalized with severe pneumonia, a dose-dependent and independent association was observed between anemia and risk of mortality, with an even greater effect among children with hypoxemia. Public health and clinical interventions that target prevention, early detection, and prompt treatment of anemia may improve outcomes of children with pneumonia, particularly in low-income settings.