High Rates of Pneumonia in Children under Two Years of Age in a South East Asian Refugee Population
Open Access
- 8 January 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (1), e54026
- https://doi.org/10.1371/journal.pone.0054026
Abstract
There are an estimated 150 million episodes of childhood pneumonia per year, with 11–20 million hospital admissions and 1.575 million deaths. Refugee children are particularly vulnerable, with poorly defined pneumonia epidemiology. We followed a birth cohort of 955 refugee infants, born over a one-year period, until two years of age. Clinical and radiographic pneumonia were diagnosed according to WHO criteria. Detailed characteristics were collected to determine risk factors for clinical, radiological and multiple episodes of pneumonia. Investigations were taken during a pneumonia episode to help determine or to infer an aetiological diagnosis. The incidence of clinical pneumonia was 0.73 (95% CI 0.70–0.75) episodes per child year (/CY) and of radiological primary endpoint pneumonia (PEP) was 0.22/CY (95% CI 0.20–0.24). The incidence of pneumonia without severe signs was 0.50/CY (95% CI 0.48–0.53), severe pneumonia 0.15/CY (95% CI 0.13–0.17) and very severe pneumonia 0.06/CY (0.05–0.07). Virus was detected, from a nasopharyngeal aspirate, in 61.3% of episodes. A reduced volume of living space per person (IRR 0.99, 95% CI 0.99–1.0, p = 0.003) and young maternal age (IRR 1.59, 95% CI 1.12–2.27, p = 0.01) were risk factors for developing pneumonia. The risk of a child having >1 episode of pneumonia was increased by having a shorter distance to the next house (IRR 0.86, 95% CI 0.74–1.00, p = 0.04). Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (IRR 0.89, 95% CI 0.80–0.99, p = 0.03). Raised CRP and neutrophil values were associated with PEP. There was a high incidence of pneumonia in young children in this SE Asian refugee population. Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.Keywords
This publication has 22 references indexed in Scilit:
- Pneumonia and poverty: a prospective population-based study among children in BrazilBMC Infectious Diseases, 2011
- Viral pneumoniaThe Lancet, 2011
- Influenza in Refugees on the Thailand–Myanmar Border, May–October 2009Emerging Infectious Diseases, 2010
- Radiographic findings among children hospitalized with severe community‐acquired pneumoniaPediatric Pulmonology, 2010
- Global, regional, and national causes of child mortality in 2008: a systematic analysisThe Lancet, 2010
- Pneumonia: the leading killer of childrenThe Lancet, 2006
- Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies.2005
- The etiology of pneumonia in malnourished and well-nourished Gambian childrenThe Pediatric Infectious Disease Journal, 1994
- A Community-Based Study of Acute Respiratory Tract Infections in Chlldren in UruguayClinical Infectious Diseases, 1990
- Epidemiology of Acute Respiratory Tract Infections Among Guatemalan Ambulatory Preschool CbildrenClinical Infectious Diseases, 1990