According to the World Health Organisation, community-acquired pneumonia is the main cause of paediatric death, accounting for 20 % of deaths in children younger than 5 years old, and 90 % of these deaths occur in non-industrialised countries. This study has as objective to evaluate the influence of socio-economic, environmental and breastfeeding factors on the occurrence of pneumonia. An unmatched case–control study was conducted in children aged 6 months to 13 years old at a children’s hospital in Brazil. Multivariate analysis by logistic regression was performed to determine the variables used to predict pneumonia. A total of 252 children were selected. In the adjusted (by age) multivariate analysis, the following variables were associated with community-acquired pneumonia: (a) protective factors: breastfeeding >3 months, absence of other unrelated comorbidities, non-smoking mother, being the only child, child’s age >5 years and mother’s age >19 years old; (b) risk factors: maternal education <8 years and child’s birth order [≥second]. In the multivariate analysis, considering only children from 6 months to 5 years old, the following variables were associated with community-acquired pneumonia: (a) protective factors: breastfeeding >3 months, non-smoking mother and no smokers in the child’s bedroom; (b) risk factors: maternal education <8 years and prenatal complications. Conclusion: These findings contribute favourably to effectively minimising the risk factors related to the disease process and natural history of community-acquired pneumonia.
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Adegbola RA, Obaro SK (2000) Diagnosis of childhood pneumonia in the tropics. Ann Trop Med Parasitol 94:197–207
Cadwell J (1979) Education as a factor in mortality decline: an examination of Nigerian data. Popul Stud (Camb) 33:395–413
César JA, Victora CG, Barros FC, Santos IS, Flores JA (1999) Impact of breastfeeding on admission for pneumonia during postneonatal period in Brazil: nested case–control study. Br Med J 318:1316–1320
César JA, Victora CG, Santos IS et al (1997) Hospitalização por pneumonia: influência de fatores socioeconômicos e gestacionais em uma coorte de crianças no Sul do Brasil. Rev Saude Publica 31(1):53–61
Fishman, SM. (2001) Childhood and maternal underweight. In: Ezzati M, Lopez A, Rodgers A, Murray C. (eds) Comparative qualification of health risks: the global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva. Available at http://www.who.int/publications/cra/chapters/vol1/ooooi.xxlv.pdf.
Fonseca W, Kirkwood BR, Victora CG, Fuchs SR, Flores JA, Misago C (1996) Risk factors for childhood pneumonia among the urban poor in Fortaleza, Brazil: a case–control study. Bull World Health Organ 74:199–208
Franca E, Souza JMD, Guimarães MDC et al (2001) Associação entre fatores socioeconômicos e morte infantil e devido a diarréia, pneumonia e má nutrição em uma área metropolitana do Sudeste do Brasil: um estudo caso-controle. Cad Saude Publica 17(6):1437–1447
Galvão A, Lorenzo D, Luciano B et al (2008) Aleitamento como fator de proteção na infância. Gaz Med 77(suppl 1):2–7
Heiskanen-Kosma T, Korppi M, Jokinen C, Heinonen K (1997) Risk factors for community-acquired pneumonia in children: a population-based case–control study. Scand J Infect Dis 29(3):281–285
Isacs D, Krou JS (1988) Pneumonia in childhood. Lancet 1:741–743
Iwane MK, Edwards KM, Szilagyi PG, Walker FJ, Griffin MR, Weinberg GA et al (2004) Population-based surveillance for hospitalizations associated with respiratory syncytial virus, and parainfluenza viruses among young children. Pediatrics 113(6):1758–1764
Koch A, Molbak K, Homoe P, Sorensen P, Hjuler T, Olesen ME et al (2003) Risk factors for acute respiratory tract infections in young Greenlandic children. Am J Epidemiol 158(4):374–384
Lakhanpaul M, Atkinson M, Stephenson T (2004) Community acquired pneumonia in children: a clinical update. Arch Dis Child Educ Pract Ed 89: ep29–ep34. Available at http://ep.bmj.com/cgi/content/full/89/2/ep29
Lilienfeld DL, Stoley PD (1994) Foundations of epidemiology: case–control studies, 3rd edn. Oxford University Press, London
Lopes CRC, Berezin EM (2009) Fatores de risco e proteção à infecção respiratória aguda em lactantes. Rev Saude Publica 43(6):1030–1034
López IB, Sepúlveda HB, Valdés II (1996) Neumonía en lactantes en control periódico de salud. características y factores asociados. Rev Med Chile 124:1359–1364
Macedo SEC, Menezes AMB, Albernaz E, Post P, Knorst M (2007) Fatores de risco para internação por doença respiratória aguda em crianças até um ano de idade. Rev Saude Publica 41(3):351–358
Nascimento LFC, Marcitelli R, Agostinho FS, Gimenes CS (2004) Análise hierarquizada dos fatores de risco para pneumonia em crianças. J Bras Pneumol 30(5):445–451
Nascimento-Carvalho CM, Rocha H, Benguigui Y (2002) Effects of socioeconomic status on presentation with acute lower respiratory tract disease in children in Salvador, Northeast, Brazil. Pediatr Pulmonol 33:244–248
Paiva MAS, Reis FJC, Fisher BRT, Rozov T (1998) Pneumonias na criança. I Consenso Brasileiro sobre pneumonias. J Bras Pneumol 24(2):101–108
Pereira ED, Torres L, Macedo J, Medeiros MM (2000) Effects of environmental tobacco smoke on lower respiratory system of children under five years of age. Rev Saude Publica 34(1):39–43
Prietsch SOM, Fischer GB, César JA, Lempek BS, Barbosa LV Jr, Zogbi L, Cardoso OC, Santos AM (2008) Doença respiratória aguda baixa em menores de cinco anos em Rio Grande, Rio Grande do Sul, Brasil: prevalência e fatores de risco. Cad Saude Publica 24(6):1429–1438
Reichenheim M, Harpham T (1989) Child health in a Brazilian squatter settlement: acute infections and associated risk factors. J Trop Pediatr 35:315–320
Scott JAG, Brooks WA, Peiris JSM, Holtzman D, Mulhollands K (2008) Pneumonia research to reduce childhood mortality in the developing world. J Clin Invest 118(4): 1291–1300. Available at http://www.jci.org/articles/view/33947/pdf
Shah N, Ramankutty V, Phil M, Premila PG, Sathy N (1994) Risk factors for severe pneumonia in children in South Kerala: a hospital-based case–control study. J Trop Pediatr 40:201–206
The United Nations Children’s Fund (UNICEF)/World Health Organization (WHO). Pneumonia: The forgotten killer of children 2006. Available at http://whqlibdoc.who.int/publications/2006/9280640489_eng.pdf. Accessed 15 June 2012
Thorn LK, Minamisava R, Nouer SS, Ribeiro LH, Andrade AL (2011) Pneumonia and poverty: a prospective population-based study among children in Brazil. BMC Infect Dis 11: 180. Available at http://www.biomedcentral.com/1471-2334/11/180
Victora CG, Fuchs SC, Flores JAC, Fonseca W, Kirkwood B (1994) Risk factors for pneumonia among children in a Brazilian metropolitan area. Pediatrics 93(6):977–985
Victora CG, Smith PG, Barros FC, Vaughan JP, Fuchs SC (1989) Risks factors for death due to respiratory infections among Brazilian infants. Int J Epidemiol 18(4):918–925
WHO (1998) News and activities acute respiratory infections: the forgotten pandemic. Bull World Health Organs 76(1):105–107
World Health Organization (1990) Acute respiratory infections in children: case management in small hospitals in developing countries. A manual for doctors and other senior health workers. Document WHO/ARI/90.5 1990. Programme for the Control of Acute Respiratory Infections, WHO, Geneva
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Barsam, F.J.B.G., Borges, G.S.D., Severino, A.B.A. et al. Factors associated with community-acquired pneumonia in hospitalised children and adolescents aged 6 months to 13 years old. Eur J Pediatr 172, 493–499 (2013). https://doi.org/10.1007/s00431-012-1909-z
- Community-acquired pneumonia
- Case–control study