Epidemiology, Management, and Outcomes of Children With Severe Pneumonia in Pakistan

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 17

Haania Rizwan, MBBS (she/her/hers)

PAK

Disclosure(s): No relevant financial relationship(s) to disclose.
AS

Ameera Shabbir, MBBS (she/her/hers)

Sindh, PAK

Disclosure(s): No relevant financial relationship(s) to disclose.
PB

Perah Bachal, MBBS

Research Associate, Paediatrics and Child Health
Aga Khan University

Disclosure information not submitted.
Muhammad Uzair, MBBS (he/him/his)

Sindh, Pakistan

Disclosure(s): No relevant financial relationship(s) to disclose.
NU

Noor Ul Ain, MBBS, FCPS

Senior Instructor, Emergency Medicine
Aga Khan University

Disclosure information not submitted.
ZQ

Zareen Qasmi, MBBS, FCPS

Senior Clinical Instructor
ChildLife Foundation, Karachi, Pakistan

Disclosure information not submitted.
IS

Ibrahim Shakoor, MBBS, FCPS

Professor and Head, Department of Pediatrics
Abbasi Shaheed Hospital, Karachi, Pakistan

Disclosure information not submitted.
FJ

Fyezah Jehan, MBBS, FCPS, MPH

Professor, Paediatrics and Child Health
Aga Khan University

Disclosure information not submitted.
EM

Eric D. McCollum, MD, MPH

Associate Professor
Johns Hopkins University School of Medicine

Disclosure information not submitted.
JD

J. Lucian Davis, MD, MAS

Associate Professor, Epidemiology of Microbial Diseases
Yale School of Public Health

Disclosure information not submitted.
Qalab Abbas, Physician (he/him/his)

Aga Khan University, PAK

Disclosure information not submitted.
NI

Nadir Ijaz, MD, MHS

Instructor, Department of Pediatrics (Critical Care Medicine)
Yale School of Medicine

Disclosure information not submitted.

Introduction: Worldwide and in Pakistan, pneumonia is the leading cause of child death, but little is known about the trajectory of children with severe pneumonia in Pakistan. We aimed to characterize the epidemiology, presentation, management, and outcomes of children with severe pneumonia at tertiary hospitals in Pakistan.

Methods: Prospective cohort study at the private Aga Khan University and the public Abbasi Shaheed Hospitals in February-April 2025. We enrolled children 1–59 months who met World Health Organization (WHO) clinical criteria for severe pneumonia within 24 hours of emergency department (ED) presentation. Participants were followed daily via chart review, caregiver survey, and physical exam through discharge, transfer, death, or day 30. We used descriptive statistics to report child characteristics, presenting symptoms, and diagnostic and therapeutic interventions performed. Outcomes included maximum level of respiratory support, length of hospital stay, final disposition, and in-hospital mortality.

Results: We enrolled 165 children with severe pneumonia. Median age was 10 months (IQR 6-23); 58 (35.2%) had a chronic medical condition; 37 (22.4%) had at least moderate malnutrition. Along with cough (157/165, 95.2%) or difficulty breathing (134/165, 81.2%), 149 children (90.3%) had at least one WHO danger sign and 62 (37.6%) had severe respiratory distress. Chest x-ray was performed for 154 (93.3%) children; only 65 (42.2%) of these were consistent with pneumonia. Almost all children received antibiotics (147/165, 89.1%) and bronchodilators (148/165, 89.7%); 75/165 (45.5%) received corticosteroids. Bubble continuous positive airway pressure (75/165, 45.5%), low-flow oxygen (37/165, 22.4%), and high-flow nasal cannula oxygen (21/165, 12.7%) were the most frequent maximum levels of respiratory support. Median length of stay was 2.6 days (IQR 1.0-4.5); 105/165 (63.6%) were discharged home, 23 (13.9%) transferred hospitals, 23 (13.9%) left against medical advice, 3 (1.8%) died, and 8 (4.8%) were lost to follow up.

Conclusions: Future efforts should focus on reducing unnecessary treatment for children meeting WHO criteria for severe pneumonia without radiographic pneumonia and addressing reasons for children leaving against medical advice.