Pneumonia and poverty: a prospective population-based study among children in Brazil
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2011
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Background: Children in developing country suffer the highest burden of pneumonia. However, few studies have
evaluated associations between poverty and pneumonia.
Methods: A prospective population-based study on pneumonia was carried out as part of the Latin America
Epidemiological Assessment of Pneumococcus (LEAP study). Chest x-rays were obtained for children one to 35
months old with suspected pneumonia presenting to emergency care centers and hospital emergency rooms in
Goiania, Brazil. Chest radiographs were evaluated according to WHO guidelines. Clustering of radiologicallyconfirmed
pneumonia were evaluated using a Poisson-based spatial scan statistic. Associations between census
socioeconomic indicators and pneumonia incidence rates were analyzed using generalized linear models.
Results: From May, 2007 to May, 2009, chest radiographs were obtained from 11 521 children with clinical
pneumonia; 3955 episodes were classified as radiologically-confirmed. Incidence rates were significantly higher in
very low income areas (4825.2 per 105) compared to high income areas (1637.3 per 105). Spatial analysis identified
clustering of confirmed pneumonia in Western (RR 1.78; p = 0.001) and Southeast (RR 1.46; p = 0.001) regions of
the city, and clustering of hospitalized pneumonia in the Western region (RR 1.69; p = 0.001). Lower income
households and illiteracy were associated with pneumonia incidence.
Conclusions: In infants the risk of developing pneumonia is inversely associated with the head of household
income and with the woman educational level. Areas with deprived socioeconomic conditions had higher
incidence of pneumonia and should be targeted for high vaccination coverage.
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THORN, Licia Kam et. al. Pneumonia and poverty: a prospective population-based study among children in Brazil. BMC Infectious Diseases, London, v. 11, n. 180, 2011.