Association of modifiable risk factors with severity of pneumonia in children aged 2 months to 5 years: a prospective cross-sectional study from a tertiary care hospital in Mumbai

Abstract Background Pneumonia is a leading cause of morbidity and mortality in children under five years, especially in developing countries. Although the risk factors for childhood pneumonia are well documented, the relative contribution of these factors to disease severity remains less explored in Indian settings. This study evaluates the association between known epidemiological and modifiable risk factors and the clinical severity of pneumonia among hospitalized children aged 2–59 months. Assessment of these risk factors may lead to appropriate interventions resulting in reduction of severe disease and deaths. Methods A prospective cross-sectional study was conducted over 18 months in the pediatric ward and ICU of a tertiary care hospital in Mumbai after obtaining Ethics committee approval & parental consent. A total of 120 children aged 2 months–5 years with WHO-defined pneumonia were enrolled. Children were grouped into those with non-severe, severe, and very severe pneumonia. Risk factors assessed included parental education, breastfeeding, immunization, malnutrition, delayed healthcare-seeking and prior antibiotic use. Results Of 120 cases, 41 (34.2%) had non-severe, 59 (49.2%) severe, and 20 (16.7%) very severe pneumonia. Significant associations with pneumonia severity were found for low paternal education ( p < 0.001), short duration of exclusive breastfeeding ( p < 0.001), incomplete immunization ( p < 0.001), delayed healthcare-seeking ( p = 0.008), malnutrition ( p = 0.004), and prior antibiotic use ( p = 0.002). Maternal education and family history of recent respiratory infection were not significantly associated with pneumonia severity. Conclusion The following modifiable risk factors are associated with severe pneumonia: poor nutrition, incomplete immunization, delayed healthcare-seeking and prior antibiotic use. Interventions addressing these risks factors can substantially reduce childhood pneumonia morbidity and mortality.