title: Multihospital surveillance of pneumonia burden among children aged <5 years hospitalized for pneumonia in Bangladesh.
abstract: 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+/- 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.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. anaheed@icddrb.org
authors.forename: Aliya
authors.initials: A
authors.lastname: Naheed
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Fatema
authors.initials: F
authors.lastname: Khatun
authors.forename: W Abdullah
authors.initials: WA
authors.lastname: Brooks
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: David
authors.initials: D
authors.lastname: Sack
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000367:Age Factors; D001459:Bangladesh / Q000453:epidemiology; D001769:Blood / Q000382:microbiology; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*