MALNUTRITION AND COMORBIDITY AS DETERMINANTS OF PNEUMONIA SEVERITY IN HOSPITALIZED CHILDREN: A CROSS-SECTIONAL STUDY FROM TERTIARY CARE HOSPITAL IN PESHAWAR, PAKISTAN

Abstract

Background: Comorbid conditions are widely believed to worsen the clinical course of pediatric pneumonia, yet the magnitude of this relationship in South Asian tertiary care settings is not well quantified.

Objective: To determine the prevalence of comorbid conditions among hospitalized children with pneumonia and to quantify their association with pneumonia severity in tertiary care hospitals in Peshawar, Pakistan.

Methods: A cross-sectional, retrospective chart-review study was conducted on 180 pediatric patients (2 months–12 years) with a confirmed diagnosis of pneumonia, selected by non-probability convenience sampling from participating tertiary care hospitals. Comorbidity status and pneumonia severity (mild/moderate/severe) were extracted from structured medical records. Associations were tested using chi-square analysis, one-way ANOVA, and linear regression in SPSS.

Results: A comorbid condition was documented in 41.7% of patients, most commonly malnutrition (20.0%), followed by asthma (10.0%), congenital heart disease (8.9%), and prematurity (2.8%). Pneumonia was moderate in 38.9% of patients, mild in 35.6%, and severe in 25.6%. Mean severity score differed markedly by comorbidity group, from 1.20 in prematurity and 1.76 in children with no comorbidity to 2.06 in asthma and congenital heart disease and 2.25 in malnutrition — the only group whose mean severity exceeded the cohort average (1.90). Comorbidity was significantly associated with severity by ANOVA (F = 4.318, p = 0.002), chi-square (χ² = 20.36, df = 8, p = 0.009), and linear regression (B = −0.111, β = −0.205, p = 0.006; R² = 0.042), with malnourished children accounting for the largest share of severe cases (17/46, 37.0% of all severe cases) despite comprising only 20.0% of the cohort.

Conclusion: Comorbidity, and malnutrition in particular, is a significant and clinically meaningful determinant of pneumonia severity among hospitalized children in this tertiary care setting. Systematic nutritional and comorbidity screening at admission may help identify children at elevated risk of severe disease and support earlier, more intensive clinical management.