Social inequality and pneumonia hospitalization in children under five years of age in Maranhão, Brazil

Maria Augusta Ribeiro Gaspar,Andréa Suzana Vieira Costa,Pedro Henrique Silva Barros,Fabiana Alves Soares,Bruno Luciano Carneiro Alves De Oliveira

doi:10.1590/1806-93042020000100006

Maria Augusta Ribeiro Gaspar, Andréa Suzana Vieira Costa + Show 3 more

Open Access

https://doi.org/10.1590/1806-93042020000100006

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Abstract

Abstract Objectives: to describe the characteristics of pneumonia hospitalizations in children under five years of age across the State of Maranhão, Brazil, and explore patterns of spatial distribution of admissions. Methods: ecological study using data on occurrences (age, gender, skin color/race, month of occurrence, and municipality of residence) between 2012 and 2017 taken from the Unified Health System’s Hospital Information System and municipal level socioeconomic indicators for 2010. Each respiratory disease, including pneumonia, was presented as a percentage of overall admissions for respiratory tract diseases, together with the monthly distribution of admissions as a percentage of total annual cases, and annual rate of admissions by gender. The General G* statistic was calculated to identify significant clustering of municipalities with similar proportions of hospital admissions for pneumonia relative to overall hospital admissions. Results: pneumonia was the leading cause of admissions for respiratory disease, accounting for 57% of all cases and occurring with greater frequency in the rainy season (February to June) and in cities with lower socioeconomic indicator values. The rate of admissions decreased over the study period. Significant clusters (p<0.05) of municipalities with high proportions of hospital admissions for pneumonia relative to overall hospital admissions occurred predominantly in the south of the state, while clusters with low propor-tions were located mainly in and around the metropolitan region of the state capital São Luís. Conclusions: pneumonia was shown to be a key cause of hospitalization in children and its distribution was associated with contextual socioeconomic factors, reflecting the quality of life and health status of children in Maranhão.

Highlights

The proportion of hospital admissions for pneumonia relative to overall hospital admissions increased with increasing social vulnerability, from 29.1% in cities with medium Social Vulnerability Index (SVI) to 66% in cities with high SVI (Table 1)
The findings show that pneumonia remains the main cause of hospital admissions among children in Maranhão, accounting for over a half of all admissions for respiratory diseases over the study period
Children aged between one to four years, boys, and brown children accounted for the highest proportion of cases, with the frequency and rate of admissions showing a downward trend throughout the study period

Summary

Introduction

Pneumonia is the leading cause of hospital admissions in children under five years of age in middle and high-income countries,[1,2] with variations in magnitude by region, state, and city.[1,3,4] The occurrence of the disease is strongly associated with individual characteristics, physical and socioeconomic factors, and sanitation.Hospital admissions for pneumonia are a sensitive marker of health care weaknesses and inadequate material living conditions and sanitation.[3,4,5] This is because pneumonia is one of the most readily solvable public health problems in global health terms[3,6,7] and should not present such a large volume of cases and admissions.[3]. Pneumonia is the leading cause of hospital admissions in children under five years of age in middle and high-income countries,[1,2] with variations in magnitude by region, state, and city.[1,3,4] The occurrence of the disease is strongly associated with individual characteristics, physical and socioeconomic factors, and sanitation. Childhood pneumonia is largely related to poverty, inadequate vaccination coverage, outdoor air pollution from burning biomass, indoor pollution from burning firewood for cooking,[3,6,9] and street dust and dust from agricultural activities.[9] It can be related to malnutrition, poor care practices, lack of proper sanitation, low country education levels, lack of experience of caring for children, and active and passive smoking among family members.[1,5] These factors are aggravated by lack of social and health services and actions and climatic variations.[10]

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