ChildhoodAnemiaatHighAltitude:RiskFactorsforPoor Outcomes in Severe Pneumonia

Pneumonia is the leading cause of mortality in young children globally, and factors that affect tissue delivery of oxygen may affect outcomes of pneumonia. We studied whether altitude and ane- mia influence disease severity and outcomes in young children with World Health Organization-defined severe pneumonia. METHODS: We analyzed data from the SPEAR (Severe Pneumonia Eval- uationAntimicrobialResearch)study,aWorldHealthOrganization-and USAID-sponsored multinational randomized controlled trial of antibiotics for severe pneumonia among children aged 2 to 59 months in resource-poor settings. The trial enrolled 958 children in 8 sites at varying elevations, classified as high ($2000 m) or low (,2000 m) altitude. We compared illness severity and assessed the effect of anemia on treatment outcome at high and low altitudes, adjusting for potential confounders and study site. RESULTS: Children at high altitudes had significantly lower oxygen sat- uration on presentation, more cyanosis, lower systolic blood pressure, and higher hemoglobin. After adjusting for potential confounders, ane- mia predicted treatment failure in children living at high altitude (rel- ative risk: 4.07; 95% confidence interval: 2.60-6.38) but not at low altitude (relative risk: 1.12; 95% confidence interval: 0.96-1.30). Chil- dren at high altitude took longer to reach normoxemia than did children at lower altitudes (5.25 vs 0.75 days; P , .0001). CONCLUSIONS: Children at high altitude present with more severe dis- ease, and children with anemia at high altitude are at greater risk of poor outcome when being treated for severe pneumonia. Given the high global prevalence of anemia among young children, prevention and treatment of anemia should be a priority in children living at high altitude and could improve outcomes of pneumonia. Pediatrics