Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan: a nested case–control analysis

Abstract

ObjectivesStudies in low-income and middle-income countries have shown an adverse association between environmental exposures including poverty. There is little literature from South Asia. We aimed to test the associations between housing, indoor air pollution and children’s respiratory health and recurrent fast breathing pneumonia in a poor urban setting in Pakistan.SettingPrimary health centres in a periurban slum in Karachi, Pakistan.MethodsNested matched case–control study within a non-inferiority randomised controlled trial of fast breathing pneumonia (Randomised Trial of Amoxicillin vs Placebo for Pneumonia (RETAPP)) in periurban slums of Karachi, Pakistan. Cases were children aged 2–60 months enrolled in RETAPP with fast breathing pneumonia who presented again with fast breathing between 8 weeks and 12 months after full recovery. Controls, selected in a 2:1 ratio, were age-matched participants who did not represent. Multivariable conditional logistic regression analysis was undertaken to explore associations with potentially modifiable environmental predictors including housing type, indoor air quality, exposure to tobacco smoke, outdoor pollution, household crowding, water and sanitation quality, nutritional status, immunisation completeness, breast feeding and airways hyperactivity.ResultsFast breathing recurred in 151 (3.7%) of children out of the total (4003) enrolled in the trial. Poor-quality housing of either katcha or mixed type strongly predicted recurrence with adjusted matched ORs 2.43 (95% CI 1.02 to 5.80) and 2.44 (1.11 to 5.38), respectively. Poor air quality, cooking fuel, inadequate ventilation, nutritional status, water, sanitation and hygiene (WASH) index, wheeze at first presentation and group of initial trial assignment were not independently predictive of recurrence.ConclusionPoor-quality housing independently predicted recurrence of fast breathing pneumonia.Trial registration numberNCT02372461

Housing quality and its impact on Acute Respiratory Infection (ARI) symptoms among children in Punjab, Pakistan

“…In context to the quality of housing construction, one of the studies conducted in northern areas of Pakistan concluded that the installation of fuel-efficient "smoke-free" cookstoves with chimneys, wall and floor insulations, and roof hatch windows have reduced in-house smoke and other air pollutants by over 80%, reduction in average household fuelwood expenditure of 50% and also the incidence of acute respiratory infections (ARIs), pneumonia and other illness has decreased by 50% in people [12]. Others have found that poor housing conditions and indoor air pollution were associated with the infection diseases like malaria, influenza, typhoid fever, diarrhoea and cholera among children [13,14].…”