Risk factors associated with the severity of pneumonia in a cohort of hospitalized children in a rural setting

Abstract

Objectives: Pneumonia remains a leading cause of death in South African children under 5 years of age. Known risk factors for pneumonia have been the focus of public health strategies to mitigate disease. This study aimed to determine whether adverse household environmental factors were associated with severe compared to non-severe pneumonia in children admitted to Worcester Provincial Hospital (WPH), South Africa. Materials and Methods: We conducted a case–control study at WPH from January 1st to December 31st, 2019, including children aged 0–59 months admitted with pneumonia. Using the WHO definition, children were categorized as having severe or non-severe pneumonia. Structured interviews with consenting primary caregivers were conducted in both groups on weekdays throughout the year to collect demographic, social, maternal, infant, and household factors. We compared the odds of adverse household environmental factors including tobacco smoke exposure, indoor smoke exposure, and overcrowding in children with severe compared to non-severe pneumonia. Results: A total of 305 children were included, 134 (43.9%) cases with severe pneumonia and 171 (56.1%) controls with non-severe pneumonia. Baseline characteristics of children, including age (median 6.9 months; IQR 2.5–17.5), appropriate nutritional status (81.6%; n = 249), and HIV unexposed and uninfected status (81.3%; n = 248), were similar between groups. Caregiver characteristics, including age (median 28 years; IQR 23–33), secondary schooling (71.2%, n = 217), and HIV negative status (81%, n = 247), were also comparable between groups. There was no association in univariable or multivariable analysis between severe pneumonia and adverse household environmental factors including tobacco smoke exposure (aOR 0.73; 95% CI 0.44–1.21), overcrowding (aOR 0.65, 95% CI 0.39–1.08), and indoor smoke exposure (aOR 2.85; 95% CI 0.89–9.09). However, children with severe pneumonia had at least 5 times greater odds (aOR 5.42; 95% CI 1.10–26.65) of living in a household with a pit latrine toilet compared to any other toilet than children with non-severe pneumonia. Conclusion: Few factors were found to be associated with pneumonia severity, except for living in a household with a pit latrine toilet. This may represent socioeconomic vulnerability and the risk associated with developing severe pneumonia.