title: Epidemiology and risk factors for pneumonia severity and mortality in Bangladeshi children <5 years of age before 10-valent pneumococcal conjugate vaccine introduction.
abstract: Pneumonia is the leading infectious cause of morbidity and mortality in young children in Bangladesh. We present the epidemiology of pneumonia in Bangladeshi children <5 years before 10-valent pneumococcal conjugate vaccine introduction and investigate factors associated with disease severity and mortality.
  
  
  
  Children aged 2-59 months admitted to three Bangladeshi hospitals with pneumonia (i.e., cough or difficulty breathing and age-specific tachypnea without danger signs) or severe pneumonia (i.e., cough or difficulty breathing and ≥1 danger signs) were included. Demographic, clinical, laboratory, and vaccine history data were collected. We assessed associations between characteristics and pneumonia severity and mortality using multivariable logistic regression.
  
  
  
  Among 3639 Bangladeshi children with pneumonia, 61% had severe disease, and 2% died. Factors independently associated with severe pneumonia included ages 2-5 months (adjusted odds ratio [aOR] 1.60 [95% CI: 1.26-2.01]) and 6-11 months (aOR 1.31 [1.10-1.56]) relative to 12-59 months, low weight for age (aOR 1.22 [1.04-1.42]), unsafe drinking water source (aOR 2.00 [1.50-2.69]), higher paternal education (aOR 1.34 [1.15-1.57]), higher maternal education (aOR 0.74 [0.64-0.87]), and being fully vaccinated for age with pentavalent vaccination (aOR 0.64 [0.51-0.82]). Increased risk of pneumonia mortality was associated with age <12 months, low weight for age, unsafe drinking water source, lower paternal education, disease severity, and having ≥1 co-morbid condition.
  
  
  
  Modifiable factors for severe pneumonia and mortality included low weight for age and access to safe drinking water. Improving vaccination status could decrease disease severity.
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Shampa
authors.initials: S
authors.lastname: Saha
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Md
authors.initials: M
authors.lastname: Hasan
authors.affiliation: , 1600 Clifton Road, NE, MS A34, Atlanta, GA, 30329, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kim
authors.affiliation: , 1600 Clifton Road, NE, MS C25, Atlanta, GA, 30329, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Farrar
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Belal
authors.initials: B
authors.lastname: Hossain
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Maksuda
authors.initials: M
authors.lastname: Islam
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Asm Nawshad Uddin
authors.initials: AN
authors.lastname: Ahmed
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: M Ruhul
authors.initials: MR
authors.lastname: Amin
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hanif
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.
authors.forename: Manzoor
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.|International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, 1212, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El-Arifeen
authors.affiliation: , 1600 Clifton Road, NE, MS C25, Atlanta, GA, 30329, USA.
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.affiliation: Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh. samirk.sks@gmail.com.|Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, 1207, Bangladesh. samirk.sks@gmail.com.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
mesh_terms: D000367:Age Factors; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D060766:Drinking Water / Q000009:adverse effects; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011018:Pneumonia, Pneumococcal / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D012720:Severity of Illness Index; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; D060766:Drinking Water; D022242:Pneumococcal Vaccines
keywords: Epidemiology; Mortality; Pneumonia; Severity; Streptococcus pneumoniae