Growth and Development Risk Factors for Pneumonia Among Children in Bangladesh

[摘要] BackgroundPneumonia is the leading cause of death among children under 5 years of age.It is a respiratory disease typically resulting from an infection, but many children are carriers of the pathogens that cause pneumonia, yet remain healthy.The aim of this analysis was to explore birth milestone and nutritional risk factors associated with childhood pneumonia in Bangladesh.MethodsThe Pneumonia Etiology Research for Child Health (PERCH) project is a seven-country, case-control study, evaluating the etiology of and risk factors for hospitalized WHO-defined severe or very severe pneumonia among children 28 days to 59 months of age.Age-frequency matched controls were selected randomly from the same catchment area as the cases.This analysis was restricted to the Bangladesh study sites in Dhaka (urban) and Matlab (rural).The proportion with preterm birth (<37 weeks), small birth size, breastfeeding, recent vitamin A supplementation, and moderate or severe wasting (weight-for-height z-score < -2 SD), underweight (weight-for-age z-score < -2 SD), stunting (height-for-age z-score < -2 SDs), and mid-upper arm circumference (MUAC) measurement (< 125 mm), were compared between cases and controls.Age-adjusted odds ratios were calculated.Multivariate analyses were performed for the birth milestone and nutritional status variables.ResultsA total of 1,297 children were enrolled in Bangladesh, consisting of 525 cases and 772 controls.An increased risk of pneumonia was associated with small birth size (p=0.03), preterm birth (p=0.02), wasting (p < 0.0001), and underweight (p < 0.0001).Moderate or severe MUAC was associated with an increased risk at Dhaka (p=0.002).Among children less than 12 months of age, lack of exclusive breastfeeding was associated with an increased risk at Dhaka (p=0.01), but a slight decreased risk at Matlab (p=0.04).Associations remained in multivariable models that adjusted for child’s sex, maternal education, and the other birth milestone and nutritional risk factors. ConclusionPreterm birth, small birth size, and impairments in nutritional status increase the risk of childhood pneumonia in Bangladesh, with qualitative differences in the association by setting.Subsequent analyses incorporating other risk factors may help explain relationships seen in the current analysis and identify additional key factors.

[发布机构] Johns Hopkins University

[效力级别] Growth

[关键词] Childhood pneumonia;Growth;Nutrition;Epidemiology