title: Childhood pneumonia and crowding, bed-sharing and nutrition: a case-control study from The Gambia.
abstract: Greater Banjul and Upper River Regions, The Gambia.
  
  
  
  To investigate tractable social, environmental and nutritional risk factors for childhood pneumonia.
  
  
  
  A case-control study examining the association of crowding, household air pollution (HAP) and nutritional factors with pneumonia was undertaken in children aged 2-59 months: 458 children with severe pneumonia, defined according to the modified WHO criteria, were compared with 322 children with non-severe pneumonia, and these groups were compared to 801 neighbourhood controls. Controls were matched by age, sex, area and season.
  
  
  
  Strong evidence was found of an association between bed-sharing with someone with a cough and severe pneumonia (adjusted OR [aOR] 5.1, 95%CI 3.2-8.2, P < 0.001) and non-severe pneumonia (aOR 7.3, 95%CI 4.1-13.1, P < 0.001), with 18% of severe cases estimated to be attributable to this risk factor. Malnutrition and pneumonia had clear evidence of association, which was strongest between severe malnutrition and severe pneumonia (aOR 8.7, 95%CI 4.2-17.8, P < 0.001). No association was found between pneumonia and individual carbon monoxide exposure as a measure of HAP.
  
  
  
  Bed-sharing with someone with a cough is an important risk factor for severe pneumonia, and potentially tractable to intervention, while malnutrition remains an important tractable determinant.
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia; Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: S R C
authors.initials: SR
authors.lastname: Howie
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Schellenberg
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: O
authors.initials: O
authors.lastname: Chimah
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia; Child Health Department, University of Benin, Teaching Hospital, Benin City, Nigeria.
authors.forename: R C
authors.initials: RC
authors.lastname: Ideh
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: B E
authors.initials: BE
authors.lastname: Ebruke
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: C
authors.initials: C
authors.lastname: Oluwalana
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: G
authors.initials: G
authors.lastname: Mackenzie
authors.affiliation: Ministry of Health and Social Welfare, Banjul, The Gambia.
authors.forename: M
authors.initials: M
authors.lastname: Jallow
authors.affiliation: Ministry of Health and Social Welfare, Banjul, The Gambia.
authors.forename: M
authors.initials: M
authors.lastname: Njie
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: S
authors.initials: S
authors.lastname: Donkor
authors.affiliation: Harvard School of Public Health, Department of Global Health and Population, Boston, and Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA; National Exposure Research Laboratory, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Dionisio
authors.affiliation: MRC-Public Health England Centre for Environment and Health, Imperial College London, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Goldberg
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Fornace
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: P C
authors.initials: PC
authors.lastname: Hill
authors.affiliation: Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand.
authors.forename: C C
authors.initials: CC
authors.lastname: Grant
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: T
authors.initials: T
authors.lastname: Corrah
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Prentice
authors.affiliation: Medical Research Council (MRC) Human Nutrition Research, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Greenwood
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Smith
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia, GlaxoSmithKline Vaccines, Wavre, Belgium.
authors.forename: R A
authors.initials: RA
authors.lastname: Adegbola
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK, Harvard School of Public Health, Department of Global Health and Population, Boston, and Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA.
authors.forename: K
authors.initials: K
authors.lastname: Mulholland
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects; D001513:Beds; D002248:Carbon Monoxide / Q000032:analysis; D016022:Case-Control Studies; D002675:Child, Preschool; D003371:Cough / Q000453:epidemiology*; D003441:Crowding; D004781:Environmental Exposure / Q000009:adverse effects; D005191:Family Characteristics; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009752:Nutritional Status; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002248:Carbon Monoxide