Aetiology and severity of childhood pneumonia in primary care in Malawi.pdf (411.22 kB)
Download file

Aetiology and severity of childhood pneumonia in primary care in Malawi: a cohort study

Download (411.22 kB)
journal contribution
posted on 09.06.2022, 15:59 by Joe Gallagher, Master Chisale, Sudipto DasSudipto Das, Richard J Drew, Nadezhda Gleseva, Dermot M Wildes, Cillian De Gascun, Tsung-Shu Joseph Wu, Mark T Ledwidge, Chris Watson, BIOTOPE team

Objective: To determine the aetiology of community acquired pneumonia in children presenting to primary care in Northern Malawi, and to ascertain predictors for identification of children requiring hospitalisation.

Design: The BIOmarkers TO diagnose PnEumonia study was a prospective cohort study conducted from March to June 2016.

Setting: Primary care in Northern Malawi.

Patients: 494 children aged 2 -59 months with WHO defined pneumonia.

Main outcomes and measures: Number of children with bacterial infection identified and the sensitivity/specificity of WHO markers of severity for need for hospitalisation.

Results: 13 (2.6%) children had a bacterium consistent with pneumonia identified. A virus consistent with pneumonia was identified in in 448 (90.7%) of children. 56 children were admitted to hospital and two children died within 30 days. 442 (89.5%) received antibiotic therapy. Eleven children (2.6%) had HIV. WHO severity markers at baseline demonstrated poor sensitivity for the need for hospitalisation with a sensitivity of 0.303 (95% CI 0.188 to 0.441) and a specificity 0.9 (95% CI 0.868 to 0.926). A prediction rule to indicate the need for hospitalisation was developed.

Conclusions and relevance: The low rate of bacterial infection and high use of antibiotics in the setting of high immunisation rates highlights the changing profile of childhood pneumonia. Similarly, the markers of need for hospitalisation may have changed in the setting of extended immunisation. Further studies are required to examine this.


Bill & Melinda Gates Foundation – Investment ID: OPP1139557



The original article is available at

Published Citation

Gallagher J. et al. Aetiology and severity of childhood pneumonia in primary care in Malawi: a cohort study. BMJ Open. 2021;11(7):e046633

Publication Date

29 July 2021

PubMed ID



  • School of Pharmacy and Biomolecular Sciences

Research Area

  • Immunity, Infection and Inflammation
  • Cancer




  • Published Version (Version of Record)