Factores de riesgo de fallecer en domicilio por neumonía, de niños chilenos de estratos socioeconómicos bajos, Santiago de Chile (1990-1994)

Abstract

Pneumonia is the main cause of late infant mortality in Chile. Over 60% of these deaths occur at home. The lack of hospital beds and the inadequate outpatient management are contributing factors. To assess risk factors for home deaths due to pneumonia in Chilean children. The clinical and environmental histories of 53 (39 male) children that died due to pneumonia in their homes were analyzed. The cause of death was confirmed by necropsy with histopathological studies in all cases. These cases were compared with 88 control children of similar age, gender, socioeconomic status and living in the same geographical area of Metropolitan Santiago. Fifty four percent of deceased children were of less than 3 months of age and only 3 cases and their controls were above 1 year old. Identified risk factors for death were malnutrition with an odds ratio of 30.6 (CI 3.9-64.8, p < 0.001), low birth weight with an odds ratio of 5 (CI 1.8-14.1, p < 0.001), previous admissions to hospitals with an odds ratio of 5.79 (CI 2-17.1, p < 0.001), congenital malformations (mainly cardiac) with an odds ratio of 8.4 (CI 2-39.9, p = 0.001) and a history of bronchial obstruction with an odds ratio of 5.68 (p < 0.001). Identified maternal risk factors were smoking with an odds ratio of 4.13 (CI 1.6-10.7 p < 0.001) and being a teenager with an odds ratio of 4.3 (CI 1.7-11, p < 0.001). Malnutrition, low birth weight, history of previous hospital admissions and having a teenager or smoker mother were considered as independent risk factors using a stepwise analysis. Chilean low income children have identifiable risk factors for death at their homes due to pneumonia, that can be preventively managed.