Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan: a nested case-control analysis

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Brown, NickUppsala universitet,Internationell barnhälsa och nutrition,Aga Khan Univ Hosp, Dept Child Hlth, Natl Stadium Rd, Karachi 74800, Sindh, Pakistan. (author)

Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan : a nested case-control analysis

Article/chapterEnglish2020

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2020-01-07
BMJ PUBLISHING GROUP,2020
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LIBRIS-ID:oai:DiVA.org:uu-410166
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-410166URI
https://doi.org/10.1136/bmjopen-2019-035277DOI

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Language:English
Summary in:English

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Objectives Studies in low-income and middle-income countries have shown an adverse association between environmental exposures including poverty. There is little literature from South Asia. We aimed to test the associations between housing, indoor air pollution and children's respiratory health and recurrent fast breathing pneumonia in a poor urban setting in Pakistan. Setting Primary health centres in a periurban slum in Karachi, Pakistan. Methods Nested matched case-control study within a non-inferiority randomised controlled trial of fast breathing pneumonia (Randomised Trial of Amoxicillin vs Placebo for Pneumonia (RETAPP)) in periurban slums of Karachi, Pakistan. Cases were children aged 2-60 months enrolled in RETAPP with fast breathing pneumonia who presented again with fast breathing between 8 weeks and 12 months after full recovery. Controls, selected in a 2:1 ratio, were age-matched participants who did not represent. Multivariable conditional logistic regression analysis was undertaken to explore associations with potentially modifiable environmental predictors including housing type, indoor air quality, exposure to tobacco smoke, outdoor pollution, household crowding, water and sanitation quality, nutritional status, immunisation completeness, breast feeding and airways hyperactivity. Results Fast breathing recurred in 151 (3.7%) of children out of the total (4003) enrolled in the trial. Poor-quality housing of either katcha or mixed type strongly predicted recurrence with adjusted matched ORs 2.43 (95% CI 1.02 to 5.80) and 2.44 (1.11 to 5.38), respectively. Poor air quality, cooking fuel, inadequate ventilation, nutritional status, water, sanitation and hygiene (WASH) index, wheeze at first presentation and group of initial trial assignment were not independently predictive of recurrence. Conclusion Poor-quality housing independently predicted recurrence of fast breathing pneumonia.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
epidemiology
paediatric infectious disease & immunisation
tropical medicine
paediatric A&E and ambulatory care
public health
infection control

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Rizvi, ArjumandAga Khan Univ Hosp, Dept Child Hlth, Natl Stadium Rd, Karachi 74800, Sindh, Pakistan. (author)
Kerai, SalimaUniv British Columbia, Vancouver, BC, Canada. (author)
Nisar, Muhammad ImranAga Khan Univ Hosp, Dept Child Hlth, Natl Stadium Rd, Karachi 74800, Sindh, Pakistan. (author)
Rahman, NajeebAga Khan Univ Hosp, Dept Child Hlth, Natl Stadium Rd, Karachi 74800, Sindh, Pakistan. (author)
Baloch, BenazirAga Khan Univ Hosp, Dept Child Hlth, Natl Stadium Rd, Karachi 74800, Sindh, Pakistan. (author)
Jehan, FyezahAga Khan Univ Hosp, Dept Child Hlth, Natl Stadium Rd, Karachi 74800, Sindh, Pakistan. (author)
Uppsala universitetInternationell barnhälsa och nutrition (creator_code:org_t)

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By the author/editor: Brown, Nick; Rizvi, Arjumand; Kerai, Salima; Nisar, Muhammad ...; Rahman, Najeeb; Baloch, Benazir; show more...; Jehan, Fyezah; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences; and Public Health Gl ...

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