Risk Factors Associated with Pneumonia Co-infection in Children under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh, 1996 to 2007
Methods: We used prospectively collected data from the Diarrheal Disease Surveillance System of the Dhaka Hospital in Bangladesh to identify children under 60 months of age who presented with signs and symptoms of pneumonia, defined as a patient who satisfied all three criteria: 1) History of cough with diarrhea, 2) an abnormal lung exam on admission, and 3) tachypnea on admission. We compared the characteristics of those with pneumonia against a control group who did not satisfy any of the above criteria, matched for month and year of admission at a ratio of 1:3.
Results: For the years 1996-2007, out of total 14,628 diarrheal patients under age 5 surveyed, there were 607 (4%) patients who satisfied criteria for pneumonia. Of those with pneumonia, 26 (4%) died, compared with only 2 (0.1%) of those with diarrhea only. Cases with pneumonia also had a longer hospital stay (mean (SD), 84 (97) hrs vs. 25 (41) hrs in controls). A pathogen was detected in the stool of 4536 (31%) of all patients, including 353 (58%) of those with pneumonia. In a multivariable logistic regression model comparing cases (n=607) with controls (n=1808), including socio-demographic and behavioral factors, we found that concurrent pneumonia was associated with severe acute malnutrition, younger age, less maternal education, lower family income, and lack of current breastfeeding. Entry of individual pathogens into the model identified rotavirus as negatively associated with pneumonia.
Conclusion: We demonstrate that malnutrition, young age, lack of breastfeeding, poor education status, and lower family income are independent risk factors associated with concurrent pneumonia in young children presenting with diarrhea in Bangladesh.
M. A. Malek, None
A. S. G. Faruque, None
M. J. Chisti, None
E. T. Ryan, None