Risk factors associated with acute lower respiratory tract infection in a cohort of newborns from birth to 24 months of age in a rural community of Bangladesh

Little is known about incidence, risk factors, and etiology of acute lower respiratory tract infection (ALRI) and pneumonia among the very young children from the rural communities of the developing countries. This study examined incidence and risk factors for ALRI and etiology and risk factors for pneumonia in a group of infants in Bangladesh.; A cohort of 252 newborns was prospectively followed from birth to 24 months of age. Data on respiratory symptoms and feeding habits were collected routinely by household visit. Socioeconomic information was collected during census and during enrollment of the children. Laboratory tests for bacterial and viral etiology and chest x-ray were done on hospitalized children with pneumonia. Univariate and multiple logistic regression analyses were conducted to identify the risk factors associated with ALRI and pneumonia.; The incidence of ALRI and pneumonia were 60 and 15.5, respectively, per 100 child years. The incidence rate of ALRI per child year was significantly higher among children with low birth weight, those born preterm, and those living in one-room households. Male children whose fathers' schooling was ≤5 years and children not exclusively breastfed from 0–3 months of age were more likely to develop ALRI. Respiratory syncytial virus (RSV) was predominant among the viral etiologies. A few strains of bacteria were isolated and distributed across five unique species: Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruinosa, Staphylococcus epidermidis, and Barnhamella catarrhalis. Children living in a one-room house had a higher probability of viral infection [odds ratio (OR) = 3.7] compared with children living in a house with more than one room. Among the hospitalized children, about 73% were classified as having severe pneumonia. Children whose fathers had no steady income and who lived in a family with more than five people had a higher probability of developing of severe pneumonia (OR = 4.1 and OR = 3.8, respectively) when compared with children whose fathers had a steady income and who lived in a smaller family. The fatality rate of the children hospitalized with pneumonia was 6.5%.; This study has several policy implications for the development of community intervention programs that target risk factors and for general health planning with an objective to reduce morbidity and mortality from ALRI. ALRI and pneumonia are diseases of very young children. A program to promote exclusive breastfeeding should be considered a priority, as it would have an immediate effect on reduction in morbidity and mortality from ALRI. Long-term programs should include prevention of low birth weight, reduction in preterm delivery, and improvement in parental education. Health education programs targeting parents should be considered to bring awareness regarding signs and symptoms associated with severe ALRI to encourage parents to seek prompt medical attention. Treatment of pneumonia should depend on clinical judgement rather than etiological findings and chest x-ray. Further study is needed regarding health-seeking behaviors for ALRI cases, particularly pneumonia, in a rural community where medical facilities are very limited. This information will further strengthen the health program for a community.