There are an estimated 150 million episodes of childhood
pneumonia per year, with 11-20 million hospital admissions and 1.575 million deaths. Refugee children are particularly vulnerable, with poorly defined
pneumonia epidemiology.
METHODS: We followed a birth cohort of 955 refugee infants, born over a one-year period, until two years of age. Clinical and radiographic
pneumonia were diagnosed according to WHO criteria. Detailed characteristics were collected to determine risk factors for clinical, radiological and multiple episodes of
pneumonia. Investigations were taken during a
pneumonia episode to help determine or to infer an aetiological diagnosis.
FINDINGS: The incidence of clinical
pneumonia was 0.73 (95% CI 0.70-0.75) episodes per child year (/CY) and of radiological primary endpoint
pneumonia (PEP) was 0.22/CY (95% CI 0.20-0.24). The incidence of
pneumonia without severe signs was 0.50/CY (95% CI 0.48-0.53), severe
pneumonia 0.15/CY (95% CI 0.13-0.17) and very severe
pneumonia 0.06/CY (0.05-0.07). Virus was detected, from a nasopharyngeal aspirate, in 61.3% of episodes. A reduced volume of living space per person (
IRR 0.99, 95% CI 0.99-1.0, p = 0.003) and young maternal age (
IRR 1.59, 95% CI 1.12-2.27, p = 0.01) were risk factors for developing
pneumonia. The risk of a child having >1 episode of
pneumonia was increased by having a shorter distance to the next house (
IRR 0.86, 95% CI 0.74-1.00, p = 0.04). Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (
IRR 0.89, 95% CI 0.80-0.99, p = 0.03). Raised CRP and neutrophil values were associated with PEP.
CONCLUSIONS: There was a high incidence of
pneumonia in young children in this SE Asian refugee population.
Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.