Childhood pneumonia is a leading cause of morbidity and mortality among underfives particularly in the resource-constraint part of the world. A high proportion of these deaths are due to lack of oxygen, thereby making oxygen administration a life-saving adjunctive when indicated. However, many primary health centres that manage most of the cases often lack the adequate manpower and facilities to decide which patient should be on oxygen therapy. Therefore, this study aimed to determine factors that predict hypoxaemia at presentation in children with severe pneumonia. Four hundred and twenty children aged from 2 to 59 months (40% infants) with severe pneumonia admitted to a health centre in rural Gambia were assessed at presentation. Eighty-one of them (19.30%) had hypoxaemia (oxygen saturation < 90%). Children aged 2–11 months, with grunting respiration, cyanosis, and head nodding, and those with cardiomegaly on chest radiograph were at higher risk of hypoxaemia ( ). Grunting respiration ( , 95% CI 2.287–7.482) and cyanosis ( , 95% CI 5.248–355.111) were independent predictors of hypoxaemia in childhood pneumonia. We conclude that children that grunt and are centrally cyanosed should be preferentially commenced on oxygen therapy even when there is no facility to confirm hypoxaemia. 1. Introduction Pneumonia is the inflammation of the lung parenchyma mostly caused by infectious agents in children [1]. These infectious agents are mainly bacteria and viruses. The inflammatory changes in the lungs impair effective gas exchange leading to its various clinical manifestations [1]. Childhood pneumonia is a leading cause of morbidity and mortality in under-fives especially in developing countries [2, 3]. It is a major cause of hospital admission and death being responsible for approximately one out of every five deaths among under-fives globally [2, 3]. The World Health Organization (WHO) estimated that about 156 million new cases of pneumonia occur in under-five children each year worldwide, of which 151 million episodes (>90 percent) occur in the developing world [2]. This translates to an incidence in under-five children estimated to be 0.29 episodes per child-year (with an interquartile range 0.21–0.71) in developing countries and 0.05 episodes per child-year in developed countries [2]. Most cases of pneumonia occur in Asia and sub-Saharan Africa with India (43 million), China (21 million), Indonesia and Nigeria (6 million each), taking the lion’s share of the burden [2, 3]. A recent report from Gambia estimated that 13.4 episodes of severe pneumonia per 1000
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