Abstract
BackgroundThe present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012.ResultsPneumonia was the primary cause of death, accounting for 26.4% (n = 81) of all 307 deaths. Of the pneumonia deaths, 58% (n = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24.7% (n = 20) in older infants (aged 6–11 months). The median duration of illness before pneumonia death was 8 days (interquartile range [IQR] 3–20 days). Prior to death, 91.4% (n = 74) children with pneumonia sought treatment, and of those who sought treatment, 52.7% (n = 39) sought treatment ≥ 2 days after the onset of disease. Younger infants of 4 weeks to < 6 months old were at 5.5-time (95% confidence interval [CI] 2.5, 12.0) and older infants aged 6–11 months were at 3-time (1.2, 7.5) greater risk of dying from pneumonia than older children aged 12–59 months. Children with a prolonged duration of illness (2–10 days) prior to death were at more risk for death by pneumonia than those who died from other causes (5.8 [2.1, 16.1]). Children who died from pneumonia sought treatment 3.4-time more than children who died from other causes. Delayed treatment seeking (≥ 2 days) behavior was 4.9-time more common in children who died from pneumonia than those who died from other causes. Children who died from pneumonia more often had access to care from multiple sources (5.7-time) than children who died from other causes.ConclusionsDelay in seeking appropriate care and access to multiple sources for treatment are the underlying risk factors for pneumonia death in young children in Bangladesh. These results indicate the perplexity in guardians’ decisions to secure appropriate treatment for children with pneumonia. Therefore, it further underscores the importance of focusing on mass media coverage that can outline the benefits of seeking care early in the progression of pneumonia and the potential negative consequences of seeking care late.
Highlights
The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh
Risk factors for pneumonia deaths Children aged 4 weeks to < 6 months, and those aged 6 to months, when compared with older children to 59 months old, were at increased risk to die from pneumonia than children who died from other causes
Children who died from pneumonia sought treatment from multiple sources more often before death than children who died from other causes
Summary
The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. Pneumonia is the leading cause of childhood death, accounting for 16% of 5.6 million deaths of children aged less than 5 years globally, more than 95% of which occur in developing countries [1]. The respiratory syncytial virus, Streptococcus pneumoniae, and Haemophilus influenzae are the leading causes of childhood pneumonia, with the latter two being preventable through vaccination [3]. These vaccines are currently included in the immunization programs of numerous countries. Cyanosis [9], inability to feed, malnutrition [9, 10], prolonged duration of illness [11], altered mental state [10], and the presence of underlying chronic illness (such as heart disease) [12] are related with increased pneumonia-associated mortality in young children
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