(1207) Epidemiology and Outcomes of Children With Respiratory Distress at a Referral Hospital in Cameroon

Introduction: Most childhood deaths from acute respiratory illnesses are now preventable thanks to advances such as non-invasive positive pressure ventilation. Children in low-and middle-income countries have a high risk of mortality from preventable diseases due to lack of resources, even in large, tertiary referral centers such as Laquintinie Hospital (LHD) in Douala, Cameroon. To triage limited equipment and promote additional research investigations, it is critical to characterize the current burden of illness of pediatric respiratory disease. We sought to analyze children under age 5 years presenting with respiratory illnesses at LHD to identify characteristics associated with in-hospital mortality.

Methods: This was a retrospective chart review completed on children under 5 years presenting from 1/22-12/23 to LHD emergency department with a respiratory illness. Children with known cardiac or lung disease, trauma, or prematurity were excluded. We utilized chi-square, Mann-Whitney U, and logistic regression analysis in Stata (College Station, TX). This study was approved by the CHOP (23-020901) and LHD IRBs.

Results: One hundred fifty-three patient records were analyzed. Median age was 6 months (IQR 3-13). The majority (95%, n=145) were previously healthy; 3% (n=5/143) of children were HIV positive while 7% (n=11) suffered from malnutrition. The most common admission diagnosis was pneumonia (54%, n= 82). Most children (78%, n=119) did not receive chest radiographs. Laboratory testing beyond glucose, malaria testing, and blood counts were uncommon. Ninety-five percent (n=145) of children received antibiotics. Low-flow oxygen was utilized in 94% (n=143). Mortality was 43% (n=66). Patients who died had higher median temperatures, white blood cell counts, and lower hemoglobin (p < 0.05). Among survivors, median discharge Pediatric Overall Performance Category score was 1 (IQR 1-2). Higher temperature (OR 2.78, CI 1.29-5.98, p< 0.01) and lower hemoglobin were associated with mortality (OR 0.80, CI 0.71-0.99, p< 0.05).

Conclusions: Mortality was high and occurred early in the admission, suggesting late presentation and the potential to improve pre-hospital care. Given the frequent use of oxygen, access to additional respiratory support could improve outcomes for children with respiratory illnesses in Douala.