Aim: To find incidence of clinical pneumonia viz a viz radiologically confirmed pneumonia in children with severe acute malnutrition.

Materials and Methods: It was a hospital based prospective analytical study carried out over a period of 12 months from January 2013 to December 2013. 184children with SAM admitted to paediatrics ward were evaluated for pneumonia as per WHO criteria. Besides the routine investigations, each patient was subjected to X-ray chest, pulse-oximetry and Montoux test and the results were correlated.

Results: Out of 184 patients with SAM, 52 (28.26%) had features of clinical pneumonia but 7 (3.8%) out of them had a normal X-ray chest. Similarly, 15 (8.15%) cases had definite radiological features of pneumonia however, they did not fit into the clinical diagnostic criteria. Moreover, 6 of these 15 cases (40%) had hypoxia (Spo2< 90% at room air) on pulse-oximetry at the time of admission.

Conclusion: WHO recommended clinical criteria; if used alone is inadequate for diagnosis of pneumonia in children with SAM as occult pneumonia was seen in about 25% cases. Traditionally used X-ray chest should be made a basic cornerstone for diagnosis of pneumonia. Moreover, on pulse-oximetry, 40% of occult pneumonia cases showed hypoxia; thereby making it a useful adjunct in diagnosing pneumonia cases.

Keywords: Pneumonia, SAM, Occult pneumonia, Pulse-oximetry, Chest X-ray.

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