High Rates of Pneumonia in Children under Two Years of Age in a South East Asian Refugee Population |
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Authors: | Claudia Turner Paul Turner Verena Carrara Kathy Burgoine Saw Tha Ler Htoo Wanitda Watthanaworawit Nicholas P. Day Nicholas J. White David Goldblatt Fran?ois Nosten |
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Affiliation: | 1. Shoklo Malaria Research Unit, Mae Sot, Thailand.; 2. Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand.; 3. Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom.; 4. Immunobiology Unit, Institute of Child Health, University College London, London, United Kingdom.; Universidade Federal do Acre (Federal University of Acre), Brazil, |
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Abstract: | BackgroundThere 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.MethodsWe 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.FindingsThe 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.ConclusionsThere 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. |
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