title: Risk factors for pneumonia in urban-dwelling HIV-infected women: a case-control study in Nairobi, Kenya.
abstract: In sub-Saharan Africa, respiratory tract infections (RTI) are the leading cause of serious morbidity and mortality in HIV-infected persons. This study sought to investigate demographic, socioeconomic, and environmental risk factors for pneumonia in a cohort of HIV-infected women. The authors performed a nested case-control study in a cohort of HIV-1-infected adults followed in Nairobi, Kenya. Thirty-nine women who developed pneumonia during the follow-up period were selected as cases, and 66 women who did not develop pneumonia were randomly chosen to serve as control subjects. A questionnaire was administered in subjects' homes that assessed demographics, home environment, and socioeconomic status. Women were followed in the cohort for a median of 36.8 months (range, 27.3-39.3). Adjusting for length of follow-up period, factors associated with lower socioeconomic status (lower monthly spending [OR = 3.2; 95% CI, 1.2-8.4 per 10,000 Kenyan shilling decrease], having no savings [OR = 4.1; 95% CI, 1.4-11.9], less sturdy home construction material such as mud or cement walls [OR = 2.6; 95% CI, 1.1-5.9] or dirt floors [OR = 2.8; 95% CI, 1.0-7.6], and lack of a window in the home [OR = 5.5; 95% CI, 0.9-32.2]) and being widowed (OR = 4.3; 95% CI, 1.2-15.1) or single (OR = 3.3; 95% CI, 1.0-11.2) were associated with an increased risk of pneumonia. In multivariate analysis, widowed (AOR = 5.9; 95% CI, 1.3-26.3), single (AOR = 7.7; 95% CI, 1.6-36.4), and divorced (AOR = 4.5; 95% CI, 1.0-20.1) women, those without savings (AOR = 3.7; 95% CI, 1.2-11.7), and those living in more crowded and contagious conditions (AOR = 1.5; 95% CI, 1.1-2.1) remained at increased risk of pneumonia. If confirmed by prospective investigation, these findings could help identify persons and subpopulations of HIV-infected women with the greatest risk of pneumonia.
authors.affiliation: McMaster University, Hamilton, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Penner
authors.forename: Amalia S
authors.initials: AS
authors.lastname: Meier
authors.forename: Christina
authors.initials: C
authors.lastname: Mwachari
authors.forename: Francis
authors.initials: F
authors.lastname: Ayuka
authors.forename: Belinda
authors.initials: B
authors.lastname: Muchina
authors.forename: Joseph
authors.initials: J
authors.lastname: Odhiambo
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006798:Housing; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D017533:Marital Status; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D011203:Poverty; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D014505:Urban Population