Risk factors and clinical outcomes for pneumonia among under-five children in Afghanistan

Background: Pneumonia is a leading cause of death among under-5 children in Afghanistan, yet data to guide interventions are scarce. Aim: To assess the risk factors and outcomes of pneumonia among under-5 children in Kabul, Afghanistan. Methods: Between January 2022 and December 2023 we collected data from hospital paper-based medical records on 252 paediatric patients aged <5 years, in Kabul, Afghanistan, primarily diagnosed with a respiratory condition. We analysed the data using R version 4.3.2. We used the Shapiro-Wilk test to assess the normality of continuous data, and Levene test to evaluate homogeneity of variances. Group comparisons were performed using the Student’s t-test or one-way ANOVA for normally distributed data, and Mann–Whitney U test for abnormally distributed variables. P < 0.05 was regarded as statistical significance. Results: Of the children, 89% (95% CI: 84.5–92.5%) had severe or very severe pneumonia. The key risk factors for severity were previous respiratory illness (OR 2.33, 95% CI: 1.12–4.85, P = 0.02) and self-medication (OR 4.88, 95% CI: 0.98–24.4, P = 0.05), while adequate nutrition was protective (OR 0.32, 95% CI: 0.11–0.89, P = 0.03). Self-medication with antibiotic significantly increased complication risk (OR 9.27, 95% CI: 3.18–32.15, P = 0.0003). Cox regression showed faster recovery was associated with higher weight (HR 1.10, 95% CI: 1.03–1.18, P = 0.004), better economic status (HR 1.21, 95% CI: 1.03–1.43, P = 0.021) and full immunisation (HR 1.74, 95% CI: 1.23–2.46, P = 0.002). A history of syndromes delayed recovery (HR 0.51, 95% CI: 0.31–0.83, P = 0.007). Conclusion: The incidence of paediatric pneumonia in Kabul is overwhelmingly high, due mainly to malnutrition, unsafe medication, delayed care, and socioeconomic disadvantage. To improve paediatric health outcomes, there is an urgent need for pneumonia prevention and management strategies, including nutrition support, community education on responsible medication use and vaccination adherence, timely health care access, and socioeconomic support.