Predictors of Length of Hospital Stay Among Under-Five Children with Clinical Pneumonia at a Rural Tertiary Hospital Setting in South Africa

Abstract

Background: Pneumonia of viral and polymicrobial origin predominates the pathological profile of clinical childhood pneumonia, with high admissions rates in recent times. Identifying factors associated with prolonged hospital stay may aid in developing risk reduction strategies for improved admission outcomes. Methods: A facility-based historical cross-sectional study was conducted with a random selection of 186 medical records from January 2020 to December 2024 of children aged 0 to 5 with clinical pneumonia at a tertiary Hospital in Mthatha. Results: Over the five-year study period, clinical pneumonia accounted for 10.4% (95% CI: 9.8–11.1%, n = 950/9098) of the total under-five admissions. The median age was 108.5 (interquartile range (IQR) = 48.0–345.5) days, mainly comprising males (51.1%) and infants (65.2%), with viral (91.6%) and mild (88.0%) forms of pneumonia. The median length of hospital stay was 5 (IQR = 3.3–8) days, and 91 (49.5%) of the children had a prolonged hospital stay. In modified Poisson regression, infants [(relative risk (RR) = 2.7, 95% confidence interval (CI): 1.6–4.3), p < 0.001]; neonates (RR = 2.3, 95% CI: 1.2–4.6, p = 0.013); bacterial pneumonia (RR = 1.7, 95% CI: 1.2–2.6, p = 0.007); being hypoxic (RR = 2.2, 95% CI: 1.3–3.6, p = 0.003); absence of other respiratory tract infections (RR = 1.6, 95% CI: 1.2–2.1, p = 0.003), incomplete vaccination (RR = 1.5, 95% CI: 1.0–2.2, p = 0.038), non-usage of herbal medications (RR = 1.7, 95% CI: 1.3–2.2, p < 0.001), difficult breathing (RR = 1.7, 95% CI: 1.1–2.6, p = 0.028), current breastfeeding (RR = 0.6, 95% CI: 0.4–1.0, p = 0.048), other morbidities (RR = 0.7, 95% CI: 0.5–0.9, p = 0.002) were associated with prolonged length of hospital stay. Conclusion: Stratification of under-five children at admission according to age, type of pneumonia, vaccination status, and presence of other morbidities are needed to enhance monitoring and timely medical interventions.