Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan: a nested case-control analysis
Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan: a nested case-control analysis
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世界卫生组织定义的巴基斯坦婴儿呼吸急促性肺炎的复发、发生率和预测因素：巢式病例对照分析
DOI：
10.1136/bmjopen-2019-035277
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发表时间：
2020
期刊：
影响因子：
2.9
通讯作者：
Brown N
中科院分区：
文献类型：
--
作者：
Brown N
在低收入和中等收入国家的研究表明，包括贫困在内的环境暴露之间存在不良关联。南亚的文学作品很少。我们的目的是在卡拉奇的一个贫困城市环境中测试住房、室内空气污染和儿童呼吸系统健康与复发性快速呼吸性肺炎之间的关系。巴基斯坦。方法在一项快速呼吸性肺炎的非劣效性随机对照试验中进行巢式配对病例对照研究（阿莫西林与肺炎安慰剂（RETAPP）的随机试验），在巴基斯坦卡拉奇的城郊贫民窟。病例为2-60个月的儿童，入组RETAPP，患有快呼吸肺炎，在完全恢复后8周至12个月再次出现快呼吸。对照组以2：1的比例选择，年龄匹配的参与者不代表。进行多变量条件logistic回归分析，以探索与潜在可修改的环境预测因子的关联，包括住房类型，室内空气质量，暴露于烟草烟雾，室外污染，家庭拥挤，水和卫生质量，营养状况，免疫接种完整性，母乳喂养和气道过度活跃。结果在试验中登记的总人数（4003）中，151名（3.7%）儿童呼吸急促复发。无论是katcha或混合型的住房质量差强烈预测复发，调整匹配OR分别为2.43（95%CI 1.02至5.80）和2.44（1.11至5.38）。空气质量差、烹饪燃料、通风不足、营养状况、水、卫生和个人卫生（WASH）指数、首次就诊时的喘息和初始试验分配组均不能独立预测复发。
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