Time to Recovery and Its Predictors among Under-Five Children with Severe Pneumonia at Jimma Town Public Hospitals: A Retrospective Follow-Up Study

Abstract

Background: Severe pneumonia is a leading cause of morbidity and mortality in under-five children, accounting for 14% of global under-five deaths in 2019. In Ethiopia, it is a priority disease under routine surveillance. While recovery times have been studied in various regions, most studies were limited to specific settings. Evidence on recovery patterns and predictors in Jimma, where severe pneumonia remains highly prevalent, is scarce. Objective: To assess the time to recovery from severe pneumonia and its predictors among under-five children admitted to Jimma University Medical Center and Shenen Gibe General Hospital. Methods: A facility-based retrospective follow-up study was conducted among 272 under five children admitted with severe pneumonia between July 1, 2021, and July 30, 2024 at public hospitals in Jimma town. A simple random sampling technique was used to select eligible medical records. A structured tool was used to extract data from medical records. Data were double-entered in EpiData 3.1 and exported to Stata 15 for analysis. The Kaplan Meier was used to estimate the survival function, and group differences were assessed using the log-rank test. Variables with P < 0.25 in the bivariate analysis were entered into the multivariable Cox proportional hazards regression to identify independent predictors of recovery time, with significance set at p < 0.05. Results: A total of 272 medical records reviewed and were retained for analysis. The median age was 10 months and 152 (55.9%) resided in rural areas. Of the total, 219 (80.5%) achieved clinical recovery and the total accumulated person-days at risk was 1,913 days. The overall median recovery time from severe pneumonia was 5 days (IQR: 3–9). Children who were malnourished (AHR = 0.57, 95% CI: 0.39–0.84), not exclusively breastfed (AHR = 0.49, 95% CI: 0.31–0.80), or not fully vaccinated (AHR = 0.72, 95% CI: 0.53–0.98) had a lower hazard of recovery compared to children with no malnutrition, exclusively breastfed and fully vaccinated respectively. Conclusion: The overall median recovery time was 5 days. Recovery from severe pneumonia was delayed among under-five children who were malnourished, not exclusively breastfed or not fully vaccinated at admission. Strengthening child nutrition, promoting exclusive breastfeeding, and ensuring full vaccination coverage are essential to improve recovery time in under-five children with severe pneumonia.