Journal Article

Multihospital Surveillance of Pneumonia Burden among Children Aged <5 Years Hospitalized for Pneumonia in Bangladesh

Aliya Naheed, Samir K. Saha, Robert F. Breiman, Fatema Khatun, W. Abdullah Brooks, Shams El Arifeen, David Sack and Stephen P. Luby

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue Supplement_2, pages S82-S89
Published in print March 2009 | ISSN: 1058-4838
Published online March 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/596485
Multihospital Surveillance of Pneumonia Burden among Children Aged <5 Years Hospitalized for Pneumonia in Bangladesh

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Background. Pneumonia contributes substantially to childhood mortality in Bangladesh. We conducted a study to characterize the disease severity and risk factors for mortality among children hospitalized for pneumonia in Bangladesh.

Methods. We analyzed data on hospitalization, patient characteristics, and mortality collected by a multicenter hospital-based surveillance of pneumonia in Bangladesh.

Results. From May 2004 through April 2007, 4155 children aged 2–59 months who met a pneumonia case definition adopted by GAVI's Pneumococcal Vaccines Accelerated Development and Introduction Plan-sponsored surveillance networks were enrolled after blood culture specimens were obtained. The mean duration (±SD) from illness onset to hospital admission was 6±3 days; 1842 children (44%) received antimicrobial treatment before hospitalization, and an additional 924 (22%) received antimicrobial treatment after admission to the hospital. Bacteria were isolated from 161 (4%) of the 4155 specimens, including 10 (6%) Streptococcus pneumoniae isolates and 5 (3%) Haemophilus influenzae type b isolates. The case-fatality rate for pneumonia in the hospital was 4% (150 deaths), and the children who died did so after a median of 2 days of hospitalization (range, 0–24 days). Infancy was highly associated with death due to pneumonia (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3–3.2), as were very severe pneumonia (OR, 7.9; 95% CI, 5.6–11.2), a blood culture positive for bacteria (OR, 3.4; 95% CI, 2.0–5.8), severe malnutrition (OR, 4.6; 95% CI, 2.9–7.4), and delayed admission (mean [±SD] duration from illness onset to admission, 6±6 days, compared with 5±4 days for survivors; P<.04).

Conclusions. The prevalence of pneumonia among children aged <5 years in hospitals in Bangladesh is high. However, the isolation rate of bacteria is low, possibly because of the high (68%) background use of antibiotics. Multiple risk factors associated with pneumonia case fatality suggest multiple strategies, including vaccines, to reduce pneumonia-related and overall child mortality in Bangladesh.

Journal Article.  4739 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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