All patients enrolled into the study had a chest radiograph at admission which was read in digital format following the WHO guidelines for the interpretation of chest radiographs [20]. Enlarged heart (Cardiomegaly) was defined as cardiothoracic ratio of >0.55 in a well taken chest radiograph [21]. Also oxygen saturation (Osat) of the patients was measured using pulse oximeter (Nellcor N-200, USA) with appropriately sized paediatric probe attached to the finger or toe nail bed. The reading of the oximeter was recorded after stabilization of the reading for one minute by a trained nurse who was not involved in clinical examination. Hypoxaemia was defined as Osat <90%. Other investigations like Rapid Diagnostic Test for malaria using Optimal kit, full blood count including haemoglobin concentration, were done.All the children were placed on intravenous antibiotics according to the unit’s standard protocol for childhood pneumonia, fluid and calorie balance was ensured, oxygen therapy was administered when indicated, and children with associated congestive heart failure, pleural effusion, and other complications were appropriately treated.Ethical clearance for the study was obtained from the Joint Gambian Government/MRC Ethical Committee. Informed consent was also obtained from parents/caregivers of each study participant.
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