Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh.
Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia.
PLoS One. 2022 Mar 23;17(3):e0265871. doi: 10.1371/journal.pone.0265871. eCollection 2022.
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.
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.
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.
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.
肺炎是全球儿童死亡的主要原因，而这些死亡病例大多数发生在资源有限的环境中。在全球范围内，五岁以下儿童临床肺炎的年发病率约为 1.52 亿，主要集中在中低收入国家。其中，8.7%的儿童发展为需要住院治疗的重症肺炎。然而，用于预测儿童患重症肺炎风险的相关数据十分有限。
对一项前瞻性聚类随机对照临床试验中的相关数据进行二次数据分析；研究对象为在城市达卡市的 16 个社区中，年龄在 2 个月至 5 岁之间、患有社区获得性肺炎或重症肺炎的男童和女童。
分析纳入了 2597 名 2-59 月龄儿童。其中，904 名儿童被归类为肺炎（对照组），1693 名儿童被归类为重症肺炎（病例组），这两组的分类依据均为世界卫生组织的标准。儿童的中位年龄为 9.2 个月（四分位间距，5.1-17.1），1576 名（60%）为男性。在校正了混杂因素后，与患有肺炎的儿童相比，体温≥38°C、病程≥3 天、男性、曾接受过医疗护理和严重发育迟缓的儿童发展为重症肺炎的可能性显著增加。年龄较大的儿童更容易出现重症肺炎，他们通常来自富裕的五分位数家庭，经常在城市环境中寻求私立医疗机构的治疗。
在本研究人群中，男性、较长的病程、发热、曾接受过医疗护理和严重发育迟缓与世界卫生组织定义的重症儿童肺炎的发展显著相关。本研究的结果可能有助于制定干预措施，以降低患有重症肺炎的儿童的发病率和死亡率。
