Pneumonia in Uganda: Causes, Symptoms, Treatment, Management, and Prevention

Pneumonia is an infection of the lungs that inflames the small air sacs (alveoli). It can affect one or both lungs, making it hard to breathe and sometimes causing severe illness. Pneumonia is a major cause of sickness and death in children under five, the elderly, and people with weakened immune systems in Uganda.

If you or your child shows signs of pneumonia, Hope Plus can connect you to a licensed healthcare provider within minutes. They can guide urgent care, prescribe the right antibiotics, and advise on hospitalisation if needed. Learn more here: Hope Plus.

Key Takeaways

• Pneumonia can be caused by bacteria, viruses, or parasites, and the type of pathogen depends on age and health status.
• Infants and young children are at higher risk of severe disease.
• Early recognition and prompt treatment save lives.
• Oxygen therapy, antibiotics, and supportive care are critical for severe pneumonia.
• Vaccination, good nutrition, and avoiding smoke or overcrowding help prevent pneumonia.

Causes of Pneumonia

• Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Klebsiella, Mycoplasma pneumoniae.
• Viral: Respiratory syncytial virus (RSV), influenza, measles virus.
• Parasitic: Pneumocystis jiroveci (common in HIV-infected patients).
• Risk factors include malnutrition, old age, immunosuppression (HIV, cancer), pre-existing lung or heart disease, and recent infections like measles or pertussis.

Symptoms of Pneumonia

In Infants (<2 months)

• Fast breathing (>60 breaths per minute)
• Severe chest in-drawing, grunting
• Difficulty breastfeeding
• Convulsions or drowsiness
• Stridor (high-pitched breathing) or wheezing
• Fever may or may not be present
• Bluish skin or low oxygen (SpO2 < 90%)

Children (2 months–5 years)

• Fever (may be absent in severe illness)
• Cough
• Fast breathing: 2–12 months: >50 breaths/min; 1–5 years: >40 breaths/min
• Mild chest in-drawing
• Severe pneumonia includes cyanosis, inability to feed, convulsions, lethargy, or severe respiratory distress

Children >5 years and Adults

• Moderate: Fever, chest pain, cough (with or without sputum), rapid breathing (>30 breaths/min), no chest in-drawing
• Severe: As above plus chest in-drawing, pulse >120/min, temperature >39.5°C, low blood pressure (<90/60 mmHg), oxygen saturation <90%
• Elderly or immunosuppressed patients may show confusion or disorientation as the main sign

How Pneumonia is Diagnosed

Healthcare providers may use:

• Physical examination and breathing assessment
• Chest X-ray to check lung involvement and complications (pneumothorax, empyema, pneumatoceles)
• Blood tests (complete blood count)
• Sputum tests for bacteria or tuberculosis if available

Treatment of Pneumonia

Infants (<2 months)

• Infants are considered severe; referral to hospital is critical
• Warmth is maintained, and breastfeeding or expressed breast milk is given
• Oxygen is given if SpO2 <94%
• Antibiotics: Ampicillin 50 mg/kg IV every 6 hours plus Gentamicin 7.5 mg/kg IV once daily
• Neonates <7 days: Gentamicin 5 mg/kg IV once daily
• In severely ill infants: Ceftriaxone 100 mg/kg IV once daily
• Alternative if unavailable: Chloramphenicol 25 mg/kg IV every 6 hours (contraindicated in neonates <7 days)
• Treatment continues for at least 5 days or longer if meningitis or septicemia is suspected

Children (2 months–5 years)

Non-severe pneumonia

• Oral Amoxicillin dispersible tablets 40 mg/kg every 12 hours for 5 days
• If wheezing is present: Salbutamol inhaler 1–2 puffs every 4–6 hours until wheezing stops
• Reassess progress after 3 days

Severe pneumonia

• Referral and hospital admission after first dose of antibiotic
• Oxygen therapy if SpO2 <90%
• Antibiotics: Ampicillin 50 mg/kg IV every 6 hours or Benzylpenicillin 50,000 IU/kg IM/IV every 6 hours plus Gentamicin 7.5 mg/kg IV or IM once daily
• If no improvement after 48 hours: Ceftriaxone 80 mg/kg IV once daily
• If Staphylococcus aureus suspected: Gentamicin 7.5 mg/kg once daily plus Cloxacillin 50 mg/kg IV/IM every 6 hours
• Once improved, switch to oral Amoxicillin to complete at least 5 days of treatment

Supportive care

• Paracetamol 10 mg/kg every 4–6 hours for fever
• Gentle suctioning of thick secretions
• Careful fluid management to avoid overload
• Diazepam 0.5 mg/kg rectally or 0.2 mg/kg IV for convulsions
• Phenobarbital 10–15 mg/kg IM for prolonged convulsions, followed by oral maintenance

Children >5 years and Adults

Moderate pneumonia (ambulatory)

• Oral Amoxicillin 500 mg–1 g every 8 hours for 5 days (children: 40 mg/kg every 12 hours)
• If penicillin allergy or poor response: Doxycycline 100 mg every 12 hours for 7–10 days (children >8 years: 2 mg/kg per dose)
• Alternative: Erythromycin 500 mg every 6 hours for 5 days

Severe pneumonia (hospitalised)

• Oxygen therapy with SpO2 monitoring
• Benzylpenicillin 2 MU IV/IM every 4–6 hours (children: 50,000–100,000 IU/kg)
• If no improvement in 48 hours: Ceftriaxone 1 g IV/IM daily (children: 50 mg/kg, max 1 g)
• If Staphylococcus aureus suspected: Cloxacillin 500 mg IV every 6 hours
• Alternative: Chloramphenicol 1 g IV every 6 hours (children: 25 mg/kg)

Pneumonia by specific organisms

• Staphylococcus aureus: Cloxacillin 1–2 g IV/IM every 6 hours for 10–14 days (children >5 years: 50 mg/kg)
• Mycoplasma pneumoniae: Doxycycline 100 mg every 12 hours for 7–10 days (children >8 years: 2 mg/kg) or Erythromycin 500 mg every 6 hours for 5 days (children: 10–15 mg/kg)
• Klebsiella pneumoniae: Gentamicin 5–7 mg/kg IV daily or Ciprofloxacin 500 mg every 12 hours; children: Chloramphenicol 25 mg/kg every 6 hours
• Pneumococcal pneumonia: Benzylpenicillin 50,000 IU/kg IV/IM every 6 hours for 2–3 days, then switch to oral Amoxicillin 500 mg–1 g every 8 hours for 5 days (children: 40 mg/kg every 12 hours)

Prevention of Pneumonia

• Ensure children receive all routine vaccinations including pneumococcal and Hib vaccines
• Avoid exposure to smoke and crowded areas
• Maintain good nutrition
• Prompt treatment of respiratory infections like measles, pertussis, and influenza

FAQ: Common Questions About Pneumonia

1. How does pneumonia spread?
Through inhalation of bacteria or viruses from coughs, sneezes, or contaminated surfaces.

2. Who is most at risk?
Infants, children under five, the elderly, people with HIV, malnutrition, or chronic diseases.

3. Can pneumonia be treated at home?
Mild cases may be treated at home with antibiotics and supportive care under supervision. Severe cases require hospital admission.

4. How soon should antibiotics be given?
Antibiotics are started as soon as pneumonia is suspected, especially in infants and severe cases.

5. Is oxygen therapy important?
Yes, oxygen is given to maintain safe oxygen levels, particularly in children and adults with severe pneumonia.

6. Can pneumonia be prevented?
Vaccination, avoiding smoke and crowded spaces, and treating other infections early can reduce the risk.

7. How long does recovery take?
Most mild cases recover in 5–10 days. Severe cases may take several weeks, especially in children and the elderly.