Risk Factors for Presumed Bacterial Pneumonia Among HIV-uninfected Children Hospitalized in Soweto, South Africa.
BACKGROUND
Pneumonia is a leading cause of child morbidity and death. Data on risk factors can guide prevention efforts. Within a study on pneumococcal conjugate vaccine effectiveness, we investigated risk factors for presumed bacterial pneumonia (PBP).


METHODS
PBP cases were human immunodeficiency virus (HIV) uninfected children with lower respiratory tract infection and consolidation on chest radiograph or nonconsolidated infiltrate with C-reactive protein ≥40 mg/L hospitalized at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto. Age-matched community controls were identified using CHBAH birth records ±1 week of case birth date. Data were analyzed using conditional logistic regression.


RESULTS
A total of 889 PBP cases (median age 9 months) were matched to 2628 controls. Crowding was a significant risk factor among well-nourished children (adjusted odds ratio [aOR]: 2.29, 95% confidence interval [CI]: 1.89-2.78), but not in those with low weight-for-age. Malnutrition was associated with PBP; strength of association was highest in the absence of crowding (aOR: 6.68, 95% CI: 4.74-9.42). Exclusive breastfeeding was protective only among HIV-unexposed children (aOR: 0.65, 95% CI: 0.54-0.78). Self-reported maternal HIV infection was a risk factor among children exclusively breastfeed up to 4 months (aOR: 2.33, 95% CI: 1.53-3.55). Having indoor tap water was protective (aOR: 0.65, 95% CI: 0.54-0.78), whereas a primary care giver who smoked was a risk factor (aOR: 5.15, 95% CI: 2.94-9.03).


CONCLUSIONS
Our findings confirm several known pneumonia risk factors and highlight complex interactions between factors, including HIV exposure, breastfeeding, malnutrition and crowding. Improved housing, reduced secondhand smoke exposure and HIV prevention among women of reproductive age could lessen the child pneumonia burden.
From the *Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; †Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; §Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; ¶MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa; ‖Department of Pediatrics, Ngwelezane Hospital, Empangeni, South Africa; and **National Institute for Communicable Diseases: Division of National Health Laboratory Services, Johannesburg, South Africa.
Jennifer R
JR
Verani
Michelle J
MJ
Groome
Heather J
HJ
Zar
Elizabeth R
ER
Zell
Constant N
CN
Kapongo
Susan A
SA
Nzenze
Christine
C
Mulligan
David P
DP
Moore
Cynthia G
CG
Whitney
Shabir A
SA
Madhi
D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology