Abstract
BackgroundPneumonia is the leading cause of death for children under 5 years of age globally, making research on modifiable risk factors for childhood pneumonia important for reducing this disease burden. Millions of children globally are exposed to elevated levels of arsenic in drinking water. However, there is limited data on the association between arsenic exposure and respiratory infections, particularly among pediatric populations.MethodsThis case control study of 153 pneumonia cases and 296 controls 28 days to 59 months of age in rural Bangladesh is the first to assess whether arsenic exposure is a risk factor for pneumonia in a pediatric population. Cases had physician diagnosed World Health Organization defined severe or very severe pneumonia. Urine collected during hospitalization (hospital admission time point) and 30 days later (convalescent time point) from cases and a single specimen from community controls was tested for urinary arsenic by graphite furnace atomic absorption.ResultsThe odds for pneumonia was nearly double for children with urinary arsenic concentrations higher than the first quartile (≥6 μg/L) at the hospital admission time point (Odd Ratio (OR):1.88 (95 % Confidence Interval (CI): 1.01, 3.53)), after adjustment for urinary creatinine, weight for height, breastfeeding, paternal education, age, and number of people in the household. This was consistent with findings at the convalescent time point where the adjusted OR for children with urinary arsenic concentrations greater than the first quartile (≥6 μg/L) was 2.32 (95 % CI: 1.33, 4.02).ConclusionWe observed a nearly two times higher odds of pneumonia for children with creatinine adjusted urinary arsenic concentrations greater than the first quartile (≥6 μg/L) at the hospital admission time point. This novel finding suggests that low to moderate arsenic exposure may be a risk factor for pneumonia in children under 5 years of age.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-015-0069-9) contains supplementary material, which is available to authorized users.
Highlights
Millions of people in countries around the world are exposed to elevated levels of arsenic in drinking water
A total of 205 cases and 306 controls were recruited for the Pneumonia Etiology Research for Child Health (PERCH) study at the Matlab, Bangladesh site between January 2012 and September 2013
Thirty four percent of the 153 cases enrolled were fully vaccinated for Haemophilus Influenzae Type b (Hib) (>3 doses or ≥1 if the child is 12 months of age or older), and 66 % of the 296 controls were fully vaccinated for Hib (p = 0.0009)
Summary
Millions of people in countries around the world are exposed to elevated levels of arsenic in drinking water. In Bangladesh alone, it has been estimated that more than 35 million people are exposed to naturally occurring arsenic in drinking water at levels exceeding the World Health Organization guideline of 10 μg/L [1]. This arsenic is believed to result from arsenic-rich iron oxides in sediments being dissolved and released into the groundwater aquifer [2, 3]. Millions of children globally are exposed to elevated levels of arsenic in drinking water. There is limited data on the association between arsenic exposure and respiratory infections, among pediatric populations
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