Co-morbidity: exploring the clinical overlap between pneumonia and diarrhoea in a hospital in Dhaka, Bangladesh

• Published in: Annals of tropical paediatrics Vol. 31; no. 4; pp. 311 - 319
• Main Authors: Chisti, M J, Duke, T, Robertson, C F, Ahmed, T, Faruque, A S G, Bardhan, P K, La Vincente, S, Salam, M A
• Format: Journal Article
• Language: English
• Published: Leeds Taylor & Francis 01-11-2011; Maney
• Subjects: Bangladesh - epidemiology; Bare bed; bedding; Biological and medical sciences; Child, Preschool; Children; Cohort Studies; Comorbidity; death; Diarrhea - epidemiology; Diarrhea - mortality; diarrhoea; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hospitals; Households; Humans; hypoxaemia; Infant; Male; Medical sciences; Morbidity; Mortality; Other diseases. Semiology; Pneumology; pneumonia; Pneumonia - epidemiology; Pneumonia - mortality; Prospective Studies; Public health; Respiratory system : syndromes and miscellaneous diseases; Risk factors; Risk reduction; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Asia; Bangladesh; Lung disease; Pediatrics; Pneumonia; Prognosis; Respiratory disease; Diarrhea; Digestive diseases; Intestinal disease; Tropical medicine; Hospital; Morbidity
• ISSN: 0272-4936; 1465-3281
• DOI: 10.1179/1465328111Y.0000000033

Background: There is limited information on risk factors for pneumonia and pneumonia-related deaths in children who also have diarrhoea.
Aim: To identify risk factors for the above in order to improve strategies for case management and to develop appropriate public health messages.
Methods: All children under 5 years of age admitted to the Special Care Ward, Dhaka Hospital of the International Centre for Diarrhoeal Disease Research (ICDDR,B) from 1 September to 31 December 2007 were considered for enrollment if they also had diarrhoea. Of the 258 children with diarrhoea enrolled, those with (n = 198) or without (n = 60) WHO-defined pneumonia constituted the pneumonia and comparison groups, respectively. Among the 198 children with pneumonia, children who survived (n = 174) were compared with those who died in hospital (n = 24).
Results: After adjusting for socio-demographic factors, including low levels of literacy of either parent, low household income, not having a window or exhaust fan in the kitchen, household smoking and over-crowding, children with pneumonia were more likely to sleep on a bare wooden-slatted or bamboo bed (OR 2·7, 95% CI 1·40-5·21, p = 0·003) than on other bedding, and were also more likely to have a parent/care-giver with poor knowledge of pneumonia (OR 1·94, 95% CI 1·02-3·70, p = 0·043). Independent risk factors for death include severe underweight (OR 5·2, 95% CI 1·2-22·0, p = 0·03), hypoxaemia (OR 17·5, 95% CI I 1·9-160·0, p = 0·01), severe sepsis (OR 8·7, 95% CI I 1·8-41·5, p = 0·007) and lobar consolidation (OR 11·9, 95% CI 2·3-61·6, p = 0·003).
Conclusions: Increased public awareness of signs of pneumonia and severe sepsis in children under 5 is important to mitigate the risks of pneumonia and pneumonia-related deaths, and the importance of appropriate bedding for young children in reducing the risk of pneumonia needs to be addressed.