Saha Shampa, Hasan Md, Kim Lindsay, Farrar Jennifer L, Hossain Belal, Islam Maksuda, Ahmed Asm Nawshad Uddin, Amin M Ruhul, Hanif Mohammed, Hussain Manzoor, El-Arifeen Shams, Whitney Cynthia G, Saha Samir K
Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
, 1600 Clifton Road, NE, MS A34, Atlanta, GA, 30329, USA.
BMC Public Health. 2016 Dec 7;16(1):1233. doi: 10.1186/s12889-016-3897-9.
Pneumonia is the leading infectious cause of morbidity and mortality in young children in Bangladesh. We present the epidemiology of pneumonia in Bangladeshi children <5 years before 10-valent pneumococcal conjugate vaccine introduction and investigate factors associated with disease severity and mortality.
Children aged 2-59 months admitted to three Bangladeshi hospitals with pneumonia (i.e., cough or difficulty breathing and age-specific tachypnea without danger signs) or severe pneumonia (i.e., cough or difficulty breathing and ≥1 danger signs) were included. Demographic, clinical, laboratory, and vaccine history data were collected. We assessed associations between characteristics and pneumonia severity and mortality using multivariable logistic regression.
Among 3639 Bangladeshi children with pneumonia, 61% had severe disease, and 2% died. Factors independently associated with severe pneumonia included ages 2-5 months (adjusted odds ratio [aOR] 1.60 [95% CI: 1.26-2.01]) and 6-11 months (aOR 1.31 [1.10-1.56]) relative to 12-59 months, low weight for age (aOR 1.22 [1.04-1.42]), unsafe drinking water source (aOR 2.00 [1.50-2.69]), higher paternal education (aOR 1.34 [1.15-1.57]), higher maternal education (aOR 0.74 [0.64-0.87]), and being fully vaccinated for age with pentavalent vaccination (aOR 0.64 [0.51-0.82]). Increased risk of pneumonia mortality was associated with age <12 months, low weight for age, unsafe drinking water source, lower paternal education, disease severity, and having ≥1 co-morbid condition.
Modifiable factors for severe pneumonia and mortality included low weight for age and access to safe drinking water. Improving vaccination status could decrease disease severity.
肺炎是孟加拉国幼儿发病和死亡的主要感染原因。我们介绍了在引入10价肺炎球菌结合疫苗之前，孟加拉国5岁以下儿童肺炎的流行病学情况，并调查了与疾病严重程度和死亡率相关的因素。
纳入孟加拉国三家医院收治的2至59个月大患有肺炎（即咳嗽或呼吸困难且有年龄特异性呼吸急促但无危险体征）或重症肺炎（即咳嗽或呼吸困难且有≥1项危险体征）的儿童。收集人口统计学、临床、实验室和疫苗接种史数据。我们使用多变量逻辑回归评估特征与肺炎严重程度和死亡率之间的关联。
在3639名患有肺炎的孟加拉国儿童中，61%患有重症疾病，2%死亡。与重症肺炎独立相关的因素包括：相对于12至59个月的儿童，2至5个月（调整后的优势比[aOR]为1.60[95%置信区间：1.26 - 2.01]）和6至11个月（aOR为1.31[1.10 - 1.56]）的儿童，年龄别体重低（aOR为1.22[1.04 - 1.42]），不安全饮用水源（aOR为2.00[1.50 - 2.69]），父亲受教育程度较高（aOR为1.34[1.15 - 1.57]），母亲受教育程度较高（aOR为0.74[0.64 - 0.87]），以及按年龄完成五价疫苗全程接种（aOR为0.64[0.51 - 0.82]）。肺炎死亡率增加与年龄<12个月、年龄别体重低、不安全饮用水源、父亲受教育程度较低、疾病严重程度以及有≥1种合并症有关。
重症肺炎和死亡率的可改变因素包括年龄别体重低和获得安全饮用水。提高疫苗接种率可降低疾病严重程度。
