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Abstract
Background Pneumonia is the leading infectious killer of children less than 5 years of age worldwide. In addition to vaccines that help prevent pneumonia, understanding the environmental and socioeconomic risk factors for child pneumonia is critical to further prevention.
Methods Data from children with fast breathing pneumonia enrolled in a non-inferiority clinical trial assessing the effectiveness of 3-day placebo versus antibiotic treatment in Lilongwe, Malawi were used to examine environmental and socioeconomic characteristics within the study population. Location of residence was collected for enrolled children, and spatial enrolment rates were compared across Lilongwe using a spatial scan statistic.
Results Data from 1101 children were analysed. Three urban subdistricts (locally known as ‘Areas’) (Areas 24, 36 and 38) out of 51 were identified with higher than expected enrolment. These three areas were associated with higher rates of poverty (37.8% vs 23.9%) as well as informal settlements and poorer sanitation (42.4% vs 7.4%) than other areas. Parents of enrolled children from these areas also had lower rates of secondary education compared with parents of children enrolled from other areas (55% vs 67% (p<0.01) among fathers; 47% vs 54% (p<0.01) among mothers).
Conclusion In Lilongwe, areas with higher rates of poverty, informal settlements and poor sanitation contributed higher than expected enrolment of children to our fast breathing child pneumonia clinical trial when compared with other areas. Additional research is needed to evaluate the impact of environmental and socioeconomic risk factors, along with vaccination status, on the incidence of fast breathing pneumonia in children living in this region.
- pneumonia
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Footnotes
Contributors EN: conceptualisation, project administration, supervision, methodology, data curation, formal analysis, writing (original draft, review and editing). RS: conceptualisation, methodology, data curation, formal analysis, writing (review and editing). TM: project administration, methodology, data curation, writing (review and editing). SM: conceptualisation, methodology, data curation, formal analysis, writing (review and editing). ASG: funding acquisition, conceptualisation, project administration, supervision, methodology, data curation, formal analysis, writing (review and editing).
Funding This research is supported by a grant from the Bill and Melinda Gates Foundation. The authors had full access to all the data in the study and had final responsibility for the decision to submit this manuscript for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was conducted in accordance with the International Conference on Harmonisation, Good Clinical Practice and the Declaration of Helsinki 2008, and was approved by the Western Institutional Review Board in the state of Washington, USA; the College of Medicine Research and Ethics Committee, Blantyre, Malawi; and the Malawi Pharmacy, Medicines and Poisons Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository.