title: Predictors of severe illness in children under age five with concomitant infection with pneumonia and diarrhea at a large hospital in Dhaka, Bangladesh.
abstract: We compared the socio-demographic and clinical outcomes as predictors in severely ill hospitalized under-five diarrheal children with and without pneumonia. We studied 496 under-five children with diarrhea admitted to the Special Care Ward (SCW) of Dhaka Hospital of International Center for Diarrheal Disease Research, Bangladesh from 1999 to 2004. Children with pneumonia, in addition to their diarrhea, constituted the study group (cases), and those who did not have pneumonia constituted the comparison (control) group. The individual predictors of pneumonia in children were a history of cough (OR 2.19, 95% CI 1.30-3.72, p=0.002), fever (OR 1.73, 95% CI 1.19-2.53, p=0.003), and rapid breathing (OR 2.45, 95% CI 1.49-4.03, p<0.001). Hypothermia (6% vs 2%; p=0.02), hyponatremia (41% vs 27%; p=0.003) and dehydrating diarrhea (81% vs 69%, p=0.003) were more frequent in control children. On logistic regression analyses, the case fatality among children with pneumonia was nearly two times (OR, 1.88 CI, 1.12-3.15, p= 0.02) than that of controls. Formulation of guidelines and implementation of a more comprehensive approach to managing pneumonia among severely ill diarrheal children is necessary to reduce childhood deaths in Bangladesh.
authors.affiliation: Clinical Sciences Division, International Center for Diarrheal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Mohammod Jobayer
authors.initials: MJ
authors.lastname: Chisti
authors.forename: Sayeeda
authors.initials: S
authors.lastname: Huq
authors.forename: Sumon Kumar
authors.initials: SK
authors.lastname: Das
authors.forename: Mohammed Abdul
authors.initials: MA
authors.lastname: Malek
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.forename: Abu Syed Golam
authors.initials: AS
authors.lastname: Faruque
authors.forename: Mohammed Abdus
authors.initials: MA
authors.lastname: Salam
mesh_terms: D000704:Analysis of Variance; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D002675:Child, Preschool; D015897:Comorbidity; D003967:Diarrhea / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000150:complications* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index