Evaluation of Risk Factors for Morbidity and Mortality in Children Aged 1 Month to 6 Years Presenting with Lower Respiratory Tract Infection at a Tertiary Care Referral Hospital

Abstract

Background: Lower respiratory tract infections (LRTI) remain a leading cause of morbidity and mortality in children under six years of age, particularly in resource-limited settings. Identifying modifiable risk factors is essential for targeted prevention and risk stratification. Methods: This hospital-based observational study enrolled 100 children aged 1 month to 6 years admitted with LRTI at a tertiary care referral hospital. Demographic, socioeconomic, maternal, nutritional, clinical, laboratory, and environmental variables were recorded. Chi-square and Fisher exact tests, correlation analysis, and multivariable logistic regression were performed using SPSS version 25.0; p<0.05 was considered statistically significant. Results: The mean age was 20.88±17.93 months and 69% were male. Severe pneumonia was the most common diagnosis (38%). Malnutrition was frequent (72% underweight or severely underweight) and case fatality rose from 3.57% in normal children to 27.50% in severely underweight children. Unimmunized children had the highest mortality (32.56%). Non-survivors had lower hemoglobin (9.50±1.35 g/dL) than survivors (11.03±1.41 g/dL). Elevated total leukocyte count and C-reactive protein, need for CPAP or ventilation (OR 4.40), ICU admission (OR 4.49), and overcrowding (OR 3.23) predicted poor outcome, whereas exclusive breastfeeding was protective (OR 0.23). The logistic model showed excellent discrimination (AUC-ROC 0.924). Conclusion: Malnutrition, incomplete immunization, anemia, hypoxemia, and adverse environmental exposures strongly influence outcomes in pediatric LRTI. Early identification and correction of these factors, together with immunization and breastfeeding promotion, may reduce mortality.

Keywords: Lower respiratory tract infection; children; risk factors; malnutrition; immunization; mortality; odds ratio; logistic regression