Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis
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Published on: February 23, 2014
Sabiha Nasrin1, Md Tariqujjaman1, Marufa Sultana1,2
1Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh.
Insights
Children with prolonged fever, severe stunting, and those who received prior medical care are more likely to develop severe pneumonia. Identifying these risk factors can help reduce childhood pneumonia deaths globally.
Area of Science:
- Pediatrics
- Public Health
- Infectious Diseases
Background:
- Pneumonia is a leading global cause of child mortality, particularly in resource-limited settings.
- Approximately 152 million children under five experience clinical pneumonia annually, with 8.7% progressing to severe cases.
- Limited data exists to predict which children with pneumonia are at highest risk for developing severe forms.
Purpose of the Study:
- To identify risk factors associated with the progression from pneumonia to severe pneumonia in children.
- To inform the development of targeted interventions to reduce childhood pneumonia morbidity and mortality.
Main Methods:
- Secondary data analysis from a prospective cluster randomized controlled trial in urban Dhaka.
- Included 2,597 children aged two months to five years diagnosed with pneumonia or severe pneumonia.
- Classified children into pneumonia (904) and severe pneumonia (1693) groups based on WHO criteria.
Main Results:
- Children with temperature ≥38°C, illness duration ≥3 days, male sex, prior medical care, and severe stunting had a significantly higher likelihood of severe pneumonia.
- Severe pneumonia was more common in older children, those from wealthier families, and those seeking care from private urban facilities.
Conclusions:
- Male sex, longer illness duration, fever, prior medical care, and severe stunting are significant predictors of WHO-defined severe childhood pneumonia.
- These findings can guide the development of targeted interventions to decrease severe pneumonia-related childhood morbidity and mortality.
Background:
Pneumonia is the leading cause of death in children globally with the majority of these deaths observed in resource-limited settings. Globally, the annual incidence of clinical pneumonia in under-five children is approximately 152 million, mostly in the low- and middle-income countries. Of these, 8.7% progressed to severe pneumonia requiring hospitalization. However, data to predict children at the greatest risk to develop severe pneumonia from pneumonia are limited.
Method:
Secondary data analysis was performed after extracting relevant data from a prospective cluster randomized controlled clinical trial; children of either sex, aged two months to five years with pneumonia or severe pneumonia acquired in the community were enrolled over a period of three years in 16 clusters in urban Dhaka city.
Results:
The analysis comprised of 2,597 children aged 2-59 months. Of these, 904 and 1693 were categorized as pneumonia (controls) and severe pneumonia (cases), respectively based on WHO criteria. The median age of children was 9.2 months (inter quartile range, 5.1-17.1) and 1,576 (60%) were male. After adjustment for covariates, children with temperature ≥38°C, duration of illness ≥3 days, male sex, received prior medical care and severe stunting showed a significantly increased likelihood of developing severe pneumonia compared to those with pneumonia. Severe pneumonia in children occurred more often in older children who presented commonly from wealthy quintile families, and who often sought care from private facilities in urban settings.
Conclusion And Recommendation:
Male sex, longer duration of illness, fever, received prior medical care, and severe stunting were significantly associated with development of WHO-defined severe childhood pneumonia in our population. The results of this study may help to develop interventions target to reduce childhood morbidity and mortality of children suffering from severe pneumonia.
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