Mortality and predictors among children aged 2 to 59 months admitted with severe pneumonia at the Regional Referral Hospital of Banfora, Burkina Faso

Abstract Introduction The burden of morbidity and mortality from severe pneumonia remains high among children under five, particularly in resource-limited countries such as Burkina Faso. Targeted hospital-based interventions are essential to achieve Sustainable Development Goal 3.2, which aims to reduce under-five mortality to 25 deaths per 1,000 live births by 2030. Methods A prospective cohort study was conducted in the pediatrics department of Regional Referral Hospital of Banfora, including 1,406 children aged 2–59 months hospitalized for severe pneumonia between August 2021 and January 2024. Predictors of mortality were identified using the Fine and Gray competing risk model. Results A total of 1,406 children were included in the analysis. The median age was 18 months (interquartile range: 9–32 months), and 53% were male. During hospitalization, 8.96% (126/1,406; 95% CI: 7.58–10.57) died, corresponding to a mortality rate of 1.93 per 100 person-days. Age < 12 months doubled the instantaneous risk of death. Additionally, hypoxemia (SaO₂ < 90%) (adjusted subdistribution hazard ratio [aSHR]: 1.54; 95% CI: 1.02–2.32), hospitalization during the rainy season (aSHR: 1.73; 95% CI: 1.18–2.54), convulsions (aSHR: 2.93; 95% CI: 1.92–4.47), the presence of stridor (aSHR: 2.17; 95% CI: 1.46–3.22), and hypoglycemia (aSHR: 2.37; 95% CI: 1.45–3.88) increased the risk of death. However, the risk of death was significantly lower in children with moderate or severe anaemia (respectively aSHR = 0.45; 95% CI: 0.24 - 0.84 and aSHR = 0.26; 95% CI: 0.13 - 0.52) and having received antibiotic therapy (ceftriaxone alone [SHRa = 0.52; 95% CI: 0.30 - 0.90] or combined with gentamicin (SHRa = 0.45; 95% CI: 0.30-0.69); ampicillin [aSHR = 0,35; IC95%: 0,13-0,97] and ampicillin combined with gentamicin (SHRa = 0.43; CI: 0.20 - 0.95). Conclusion The incidence and in-hospital mortality of severe pneumonia are a cause for concern at the Regional Referral Hospital of Banfora and in Burkina Faso. Targeted interventions in hospital settings are necessary and can help achieve Sustainable Development Goal 3.2 on reducing under-five mortality to 25 deaths per 1,000 live births by 2030.