Risk Factors and Nutritional Determinants of Pneumonia in Children Under 5 years

Author(s): Dr. Jesmeen Morshed, Dr. Shamsun Nahar, Dr. Sanjida Khondakar Setu, Dr. Muhammad Shariful Hasan, Prof. Dr. Md. Atiar Rahman

Background: Pneumonia remains a leading cause of morbidity and mortality among children under five years, particularly in low- and middle-income countries. Understanding the associated risk factors and nutritional determinants is essential to guide preventive strategies. This study aimed to identify key determinants of pneumonia among under-five children in a tertiary care setting in Bangladesh.

Methods: This case-control study was conducted in the Department of Paediatrics and Paediatric Pulmonology Division of Bangladesh Medical University (BMU), Dhaka, from July 2024 to June 2025. A total of 60 children under five years were enrolled, comprising 30 clinically and radiologically confirmed pneumonia cases and 30 age- and sex-matched healthy controls attending the outpatient department or EPI centre. Data were analyzed using SPSS version 25.0. Categorical variables were compared using the chi-square test and continuous variables using the independent t-test, with a p-value <0.05 considered statistically significant.

Results: Children aged 2–3 years were more frequently affected (76.7% vs. 23.3%, p < 0.001). Malnutrition was significantly higher among cases compared to controls (50.0% vs. 23.3%, p = 0.031). Limited sun exposure (<30 minutes/week) and a history of recurrent respiratory infections were also notably more prevalent among cases (60.0% vs. 23.3%, p = 0.006; 63.3% vs. 26.7%, p = 0.004, respectively). Cases experienced more severe symptoms, including respiratory distress (93.3%) and hypoxia (60.0%).

Conclusion: Malnutrition, inadequate sun exposure and recurrent respiratory infections emerged as significant determinants of pneumonia in under-five children. Addressing these modifiable risk factors may reduce pneumonia burden and improve child health outcomes.