title: Co-morbidity: exploring the clinical overlap between pneumonia and diarrhoea in a hospital in Dhaka, Bangladesh.
abstract: BACKGROUND
  There is limited information on risk factors for pneumonia and pneumonia-related deaths in children who also have diarrhoea.
  
  
  OBJECTIVE
  To identify risk factors for the above in order to improve strategies for case management and to develop  appropriate public health messages.
  
  
  METHODS
  All children under 5 years of age admitted to the Special Care Ward, Dhaka Hospital of the International Centre for Diarrhoeal Disease Research (ICDDR,B) from 1 September to 31 December 2007 were considered for enrollment if they also  had diarrhoea. Of the 258 children with diarrhoea enrolled, those with (n=198) or without (n=60) WHO-defined pneumonia constituted the pneumonia and comparison groups, respectively. Among the 198 children with pneumonia, children who survived (n=174)  were compared with those who died in hospital (n=24).
  
  
  RESULTS
  After adjusting for socio-demographic factors, including low levels of literacy of either parent, low household income, not having a window or exhaust fan in the kitchen, household smoking and over-crowding,  children with pneumonia were more likely to sleep on a bare wooden-slatted or bamboo bed (OR 2·7, 95% CI 1·40-5·21, p = 0·003) than on other bedding, and were also more likely to have a parent/care-giver with poor knowledge of pneumonia (OR  1·94, 95% CI 1·02-3·70, p=0·043). Independent risk factors for death include severe underweight (OR 5·2, 95% CI 1·2-22·0, p=0·03), hypoxaemia (OR 17·5, 95% CI I 1·9-160·0,  p=0·01), severe sepsis (OR 8·7, 95% CI I 1·8-41·5, p=0·007) and lobar consolidation (OR 11·9, 95% CI 2·3-61·6, p=0·003).
  
  
  CONCLUSIONS
  Increased public  awareness of signs of pneumonia and severe sepsis in children under 5 is important to mitigate the risks of pneumonia and pneumonia-related deaths, and the importance of appropriate bedding for young children in reducing the risk of pneumonia needs to be addressed.
authors: Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. chisti@icddrb.org
authors: M J
authors: MJ
authors: Chisti
authors: T
authors: T
authors: Duke
authors: C F
authors: CF
authors: Robertson
authors: T
authors: T
authors: Ahmed
authors: A S G
authors: AS
authors: Faruque
authors: P K
authors: PK
authors: Bardhan
authors: S
authors: S
authors: La Vincente
authors: M A
authors: MA
authors: Salam
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003967:Diarrhea / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies