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RISK FACTORS FOR PNEUMONIA AMONG HIV-UNINFECTED YOUNG CHILDREN IN SOWETO, SOUTH AFRICA
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| Speaker: |
Jennifer Verani
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| Author: |
J.R. Verani1, M. Groome2, H.J. Zar3, E. Zell1, C. Kapongo4, G. Malete2, C. Mulligan3, D. Moore2, C. Whitney1, S. Madhi2,5
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| Affiliation: |
1Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Respiratory and Meningeal Pathogens Research Unit, Chris Hani Baragwanath Hospital, Johannesburg, 3Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital/ University of Cape Town, Cape Town, 4Department of Pediatrics, Ngwelezane Hospital, Richard’s Bay, 5National Institute for Communicable Diseases, Johannesburg, South
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Background: Pneumonia is a leading cause of child morbidity and death in South Africa and globally. Data on risk factors can guide prevention efforts. Within a study on pneumococcal conjugate vaccine effectiveness, we investigated risk factors for probable bacterial pneumonia (PBP).
Methods: PBP cases were HIV-uninfected children aged < 2 years with lower respiratory tract infection and consolidation on chest radiograph or non-consolidated infiltrate with C-reactive protein >40 mg/L hospitalized at Chris Hani Baragwanath Hospital (CHBH) in Soweto. HIV-uninfected age-matched community controls were identified using CHBH birth records ±1 week of case birth date. Data collected by interview were analyzed using multivariable conditional logistic regression.
Results: Among 450 cases and 1,242 controls, risk factors for PBP included: male sex (adjusted odds ratio [aOR] 1.32, 95%CI 1.04-1.68), preterm/low birth-weight (aOR 1.64, 95%CI 1.22-2.20), previous hospitalization (aOR 2.52, 95%CI 1.69-3.75), house of non-brick material (OR 1.37, 95%CI 1.04-1.80), and primary care-giver smoking (aOR 3.10, 95%CI 1.38-7.00). Exclusive breastfeeding at age < 4 months was included in the model, but was not significant (aOR 0.79; 95%CI 0.59-1.05). We found effect modification between maternal HIV and crowding (>2 people sleeping in room with child); an HIV-infected mother was a risk factor only when crowding was absent (aOR 1.75, 95%CI 1.21-2.53).
Conclusions: Our findings are consistent with known pneumonia risk factors including male sex, preterm/low birth-weight, low socioeconomic status, and passive smoke exposure. They also contribute to growing evidence of poor health outcomes in HIV-exposed uninfected infants, perhaps through increased exposure to respiratory pathogens.
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