title: High rates of pneumonia in children under two years of age in a South East Asian refugee population.
abstract: BACKGROUND
  There are an estimated 150 million episodes of childhood pneumonia per year, with 11-20 million hospital admissions and 1.575 million deaths. Refugee children are particularly vulnerable, with poorly defined pneumonia epidemiology.
  
  
  METHODS
  We followed a birth cohort of 955 refugee infants, born over a one-year period, until two years of age. Clinical and radiographic pneumonia were diagnosed according to WHO criteria. Detailed characteristics were collected to determine risk factors for clinical, radiological and multiple episodes of pneumonia. Investigations were taken during a pneumonia episode to help determine or to infer an aetiological diagnosis.
  
  
  RESULTS
  The incidence of clinical pneumonia was 0.73 (95% CI 0.70-0.75) episodes per child year (/CY) and of radiological primary endpoint pneumonia (PEP) was 0.22/CY (95% CI 0.20-0.24). The incidence of pneumonia without severe signs was 0.50/CY (95% CI 0.48-0.53), severe pneumonia 0.15/CY (95% CI 0.13-0.17) and very severe pneumonia 0.06/CY (0.05-0.07). Virus was detected, from a nasopharyngeal aspirate, in 61.3% of episodes. A reduced volume of living space per person (IRR 0.99, 95% CI 0.99-1.0, p = 0.003) and young maternal age (IRR 1.59, 95% CI 1.12-2.27, p = 0.01) were risk factors for developing pneumonia. The risk of a child having >1 episode of pneumonia was increased by having a shorter distance to the next house (IRR 0.86, 95% CI 0.74-1.00, p = 0.04). Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (IRR 0.89, 95% CI 0.80-0.99, p = 0.03). Raised CRP and neutrophil values were associated with PEP.
  
  
  CONCLUSIONS
  There was a high incidence of pneumonia in young children in this SE Asian refugee population. Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.
authors: Shoklo Malaria Research Unit, Mae Sot, Thailand. claudia@tropmedres.ac
authors: Claudia
authors: C
authors: Turner
authors: Paul
authors: P
authors: Turner
authors: Verena
authors: V
authors: Carrara
authors: Kathy
authors: K
authors: Burgoine
authors: Saw
authors: S
authors: Tha Ler Htoo
authors: Wanitda
authors: W
authors: Watthanaworawit
authors: Nicholas P
authors: NP
authors: Day
authors: Nicholas J
authors: NJ
authors: White
authors: David
authors: D
authors: Goldblatt
authors: François
authors: F
authors: Nosten
mesh_terms: D001210:Asia, Southeastern / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D002052:Myanmar / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D011024:Pneumonia, Viral / Q000453:epidemiology; D012036:Refugees; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology