Study of risk factors for severe pneumonia among children between 2 months to 5 years of age


  • Vijay B. Shah Department of Pediatric, Government Medical College and New Civil Hospital, Surat, Gujarat, India
  • Kirti Mehta Department of Pediatric, Government Medical College and New Civil Hospital, Surat, Gujarat, India



Indoor air pollution, Mortality under 5 years, Severe and very severe pneumonia in children, Risk factors


Background: Acute respiratory illness is responsible for 19% of all deaths in children in below five years of age and 8.2% of all disability as measured by DALY. Recent studies have added other risk factors to the list including large family size, poor socioeconomic status, family history of bronchitis, advanced birth order, crowding, young age, air pollution, and the use of non-allopathic treatment in early stages of illness. Also, indoor air pollution is one of the major risk factors for acute lower respiratory tract infection in children in developing countries. The objectives of this study were to identify and compare the risk factors associated with severe and very severe pneumonia.

Methods: A prospective observational study. Children between 2 months to 5 years with clinical features of severe pneumonia were included in the study. Socioeconomic history like the type of house, family size, sanitary facilities and fuel-based cooking was recorded. Detailed history about immunization, feeding practice and degree of malnutrition was recorded. Chi Square test was used to determine significant differences between two groups.

Results: Total 150 patients could be included in the study. Immunization status shows that 74% were completely immunized, 9% were unimmunized and 17% were partially immunized. Most of the children were breast fed 95.33% and only 4.67% were bottle fed. 30% of the cases were grade 3 and 4 PEM and anemic. The socioeconomic status showed 84% were belonged to grade 3,4 and 5 and 16% belonged to grade 1 and 2. 96.67% were living in ill ventilated kutcha house with poor sanitation facilities and nearly 94% were living in house with fuel other than LPG.

Conclusions: Factors like previous history of similar illness, inappropriate immunization for age, anemia, PEM grade 3 and 4, poor housing condition, and indoor air pollution were significantly associated with severity of pneumonia. While severity of illness, PEM grade 3 and 4 and associated illness were the important risk factors for mortality.


Park K. Acute respiratory infections. In: Park’s textbook of preventive and social medicine, 20th ed. Jabalpur: M/s Banarasidas Bhanot Publishers; 2009: 151-159.

World Health Organization programme for the control of acute respiratory infections. Acute Respiratory Infections in children: Case Management in small hospitals and developing countries. A manual for doctors and other senior health workers, Geneva: WHO, 2004. Available at: Accessed 15 May 2019.

World Health Organization. Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities. Geneva: World Health Organization, 1991. Available at: maternal_child_adolescent/documents/ari_91_20/en/. Accessed 15 May 2019.

Behrman S. Epidemiology of acute respiratory infection in children of developing countries. Rev Infect Dis. 1991;6: S454-62.

Rudan I, Pinto BC, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86(5):408-16.

Dherani M, Pope D, Mascarenhas M, Smith KR, Weber M, Bruce N. Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis. Bull World Health Organization. 2008;86:390-8C.

Broor S, Panday RM, Ghosh M, Maitreyi RS, Lodha R, Singhal T, et al. Risk factors for severe acute lower respiratory tract infection in under five children. Indian Pediatr. 2001;38:1361-9.

Hassan NK, Al-Sadoon I. Risk factors for severe pneumonia in children in basrah. Trop Doct. 2001;31:139-41.

Shah N. Kutty RV, Premila PG, Sathy N. Risk factors for severe pneumonia in children in south Kerala: a hospital-based case-control study. Trop Pediatric. 1994;40:201-6.

Sehgal V, Sethi GR, Sachdev HPS, Satyanarayana V. Predictors of mortality on subjects hospitalized with acute lower respiratory tract infections. Indian Pediatrics. 1997;34:213-9.

Reddaiah VP, Kapoor SK. Acute respiratory infections in under five: Experience at comprehensive rural health services project hospital Ballabgarh. Indian J Comm Med. 1995;20:1-4.

Mishra S, Kumar H, Anand VK, Patwari AK, Sharma D. ARI control programme: result in hospitalized children. J Trop Pediatr. 1993;39:288-92.

Duke T, Poka H, Dale F, Michael A, Mgone J, Wal T. Chloramphenicol versus benzyl penicillin and gentamicin for the treatment of severe pneumonia in children in Papua New Guinea: a randomized trial. Lancet. 2002;359:474-80.






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