BACKGROUND:  Pneumonia remains the leading cause of mortality and morbidity among pediatric age groups worldwide. Several risk factors contribute to the progression of pneumonia into severe and complicated forms. Parapneumonic effusion is one of the most common complications to consider when severe pneumonia advances to a more critical stage. This study evaluates the prevalence, risk factors, and disease progression of severe pneumonia in children, providing valuable insights for resource-limited settings.

METHODS: A hospital-based prospective cohort study was conducted at a tertiary center from July 2022 to December 2023 among children aged 2 months to 14 years with severe pneumonia. Data were collected on socio-demographic characteristics, clinical status, disease progression, microbiological findings, and patient outcomes, and were analyzed using Stata Version 14.

RESULTS: A total of 74.13% of severe pneumonia cases occurred in children under 5 years of age. Fever, cough, tachypnea, dyspnea, and chest indrawing were the most frequently observed clinical presentations. Overall, 31.46% of patients progressed to parapneumonic effusion. Absence of prior pneumonia (AOR = 0.25; 95% CI: 0.11–0.57), no prior hospitalization for the current diagnosis (AOR = 0.49; 95% CI: 0.28–0.86), no exposure to secondhand cigarette smoke (AOR = 0.24; 95% CI: 0.07–0.84), and no contact with a coughing patient (AOR = 0.53; 95% CI: 0.29–0.96) were each associated with lower odds of progression to parapneumonic effusion. In contrast, malnutrition was associated with higher odds of progression (AOR = 2.00; 95% CI: 1.18–3.54).

CONCLUSION: A higher prevalence of severe pneumonia was observed in children under 5 years of age. Disease progression to parapneumonic effusion occurred in 31.46% of cases, and the mortality rate was 4.54%.

KEYWORDS: Severe Pneumonia; Disease Progression; Parapneumonic Effusion; Children; Ethiopia