RISK-FACTORS FOR CHILDHOOD PNEUMONIA AMONG THE URBAN-POOR IN FORTALEZA, BRAZIL - A CASE-CONTROL STUDY

Reported are the results of a case-control study carried out between J uly 1989 and June 1990 in Fortaleza city, Ceara State, Brazil, to dete rmine the factors that place young children living in urban slum condi tions at increased risk of contracting pneumonia. Cases were 650 under -2-year-olds with a radiological diagnosis of pneumonia who were recru ited at the main paediatric hospital in the city over a full calendar year. Age-matched controls were recruited from the neighbourhood where the cases lived. Cases and controls were compared with respect to a v ariety of sociodemographic, environmental, reproductive, nutritional, and morbidity factors, and a risk factor questionnaire was administere d to the mother of each child or to the child's normal guardian. Cases and controls were also weighed and measured. Malnutrition was the mos t important risk factor for childhood pneumonia in the study populatio n, with weight-for-age, height-for-age, and weight-for-height also bei ng important risk factors. in view of the high prevalence of stunting in the study population, there is an urgent need to reduce the level o f malnutrition as a priority Attendance at a day care centre was also associated with a high odds ratio. In view of the growing numbers of c hildren attending day care centres in both developing and developed co untries, it is essential that ways be identified to improve the design and management of such centres in order to minimize the risk of pneum onia. Increased risks of childhood pneumonia were also associated with low birth weight, non-breast-feeding, crowding, high parity, and inco mplete vaccination status, but not with socioeconomic status or enviro nmental variables. Finally, children who had suffered from previous ep isodes of wheezing or been hospitalized for pneumonia had a greater th an threefold increased risk of contracting the disease.