Risk Factors of Recurrent Pneumonia in Under-five Children Hospitalized at Hasan Sadikin Hospital

Background: Pneumonia is the highest cause of deaths among underfive children particularly in developing countries. Among children with pneumonia, many suffer from recurrent pneumonia (RP). Several studies reported that increase risk of recurrent pneumonia is associated with underlying diseases. Surprisingly, to date there are few primary studies investigating the risk factors of recurrent pneumonia particularly in developing countries.

Objective: To determine the risk factors of recurrent pneumonia in under 5 years

Methods: We assessed possible risk factors of recurrent pneumonia in a case control study of underfive patients admitted to Hasan Sadikin General Hospital, Indonesia from January 2014 to December 2016. Databases of patients underfive who were admitted 2 times or more for pneumonia were documented Control subjects were children (age and year of admission matched) with pneumonia but not recurrent. Bivariate statistical analysis was conducted to analyze prominent risk factors.

Results: Pneumonia in underfive children was 740 (95.73%) of 773 pneumonia patients in children. Recurrent pneumonia was documented in 88/740 (11.89%) underfive children with pneumonia. Among the risk factors associated with recurrent pneumonia, several were found to be statistically significant (P<0.001) including underlying congenital heart disease (OR=3.46; 95% CI: 1.57−7.71), cerebral palsy (OR=5.56, 95% CI: 1.87−17.69), HIV state (OR=41.93; 95% CI: 5.85-848.83), malnutrition (OR=3.79, 95% CI: 1.86−7.80), and residing in an overcrowded area (OR=4.75, 95% CI:2.32−9.78). Other risk factors that were analyzed but was not found statistically significant included prematurity, weight at birth, history of immunization, exposure to smoke, house pet, and other conditions such as hypothyroid and Down syndrome.

Conclusion: As a preventable disease, recurrent pneumonia may be controlled by addressing personal and environmental risk factors. Measures such as improving child’s nutritional state; educating and providing additional support for parents of children with congenital heart disease, cerebral palsy, and HIV may be done to prevent recurrent pneumonia.

Keywords: Recurrent, pneumonia, children, indonesia