Risk Factors for the Development of Pneumonia and Severe Pneumonia in Children.

OBJECTIVE To identify the risk factors for pneumonia and severe pneumonia in children. DESIGN Prospective cohort study. SETTING Five tertiary-care teaching hospitals in India. PARTICIPANTS Children 2 to 59 months of age suffering from acute respiratory infection (ARI). MAIN OUTCOME MEASURES Risk factors for the development of WHO defined pneumonia and severe pneumonia. RESULT A total of 18159 children screened, and 7026 (39%) children with ARI were enrolled. According to the WHO criteria, 938 (13.4%) and 6088 (86.6%) of the enrolled children had pneumonia and no pneumonia, respectively. Out of 938 children with pneumonia, 347 (36.9%) had severe pneumonia. On univariate analysis, younger age, male gender and low weight for height, were significant risk factors for pneumonia. On multivariate analysis, one-unit increase in age in months (OR = 0.97; 95% CI: 0.97-0.98) and weight for height z-score (OR = 0.76; 95% CI: 0.72-0.79) had a protective effect. CONCLUSIONS Young age and undernutrition (low weight for height/length) in children are significant independent risk factors for pneumonia.