Correlates of acute lower respiratory tract infections in children under 5 years of age in India

BACKGROUND: In developing countries, acute lower respiratory tract infections (ALRTI) cause considerable morbidity, hospitalisation and mortality in children aged <5 years.

METHODS: A prospective case-control study was conducted to identify potential socio-demographic, nutritional and environmental risk factors for ALRTI. The World Health Organization definition for ALRTI was used for cases. Healthy children attending child immunisation services were enrolled as controls.

RESULTS: A total of 214 children, 107 cases and 107 controls, were enrolled. Among the cases, pneumonia, severe pneumonia and very severe disease constituted respectively 23.3%, 47.7% and 29%. Among cases and controls, the male-to-female ratio (1.3:1 vs. 0.9:1) and the proportion of infants (64.5% vs. 70.1%) were identical. Parents' literacy level was negatively associated with ALRTI. On multivariate logistic regression analysis, low socio-economic status (OR 4.89, 95%CI 1.93–12.36), upper respiratory infections in family members (OR 5.32, 95%CI 2.11–13.45), inappropriate weaning period (OR 3.01, 95%CI 1.12–8.07), malnutrition (OR 1.75, 95%CI 1.84–3.67), pallor (OR 7.18, 95%CI 2.08–24.82) and cooking fuel other than liquid petroleum gas (OR 3.58, 95%CI 1.23–10.45) were found to be significant risk factors (P < 0.05).

CONCLUSIONS: The present study identified various risk factors for ALRTI, some of which are modifiable by effective community education and public health measures.