Predictors of severe illness in children under age five with concomitant infection with pneumonia and diarrhea at a large hospital in Dhaka, Bangladesh.
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.
Chisti
Mohammod Jobayer
MJ
Clinical Sciences Division, International Center for Diarrheal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
Huq
Sayeeda
S
Das
Sumon Kumar
SK
Malek
Mohammed Abdul
MA
Ahmed
Tahmeed
T
Faruque
Abu Syed Golam
AS
Salam
Mohammed Abdus
MA
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