Background: Acute severe pneumonia is the leading cause of death in children below five years of age. India tops in the list amongst the 15 countries having a high incidence of childhood pneumonia with 43 million episodes of pneumonia annually. Identification of modifiable risk factors of acute severe pneumonia can help in reducing the burden of disease. Methods: A hospital-based case control study was undertaken to determine risk factors associated with acute severe pneumonia in under-five children. A case definition of acute severe pneumonia as given by world health organization (WHO) was used for cases. Healthy children attending Pediatrics outpatient Department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in predesigned proforma. 732 children including 366 cases and 366 controls were enrolled in the study. Results: On stepwise logistic regression analysis it was found that low literacy status of the mother (OR:9.46; 95%CI:7.31-19.0); inappropriate immunization for age (OR:38.04;;cooking fuel other than liquid petroleum gas (OR:3.79; 95%CI: 2.40-6.78); low socioeconomic status (OR: 6.12; 95%CI: 2.42-35.48); overcrowding (OR:1.21; 95%CI: 1.03-2.21) and upper respiratory infection in family (OR:5.08; 95%CI: 3.79-7.67) were the significant contributors to the occurrence of acute severe pneumonia in children under five years. Conclusions: Low literacy status of mother, incomplete immunization status, use of fuel other than LPG, low socioeconomic status, overcrowding, family history of URTI emerged as risk factors for occurrence of acute severe pneumonia in under five children.

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