Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines--A Community-Based Study

PLoS One. 2015 May 4;10(5):e0125009. doi: 10.1371/journal.pone.0125009. eCollection 2015.


Pneumonia is a leading cause of deaths in infants and young children in developing countries, including the Philippines. However, data at the community level remains limited. Our study aimed to estimate incidence and mortality rates and to evaluate risk factors and health-seeking behavior for childhood pneumonia. A household level interview survey was conducted in Biliran Island, the Philippines. Caregivers were interviewed using a semi-structured questionnaire to check if children had symptoms suggesting pneumonia-like episodes from June 2011 to May 2012. Of 3,327 households visited in total, 3,302 (99.2%) agreed to participate, and 5,249 children less than 5 years of age were included in the study. Incidence rates of pneumonia-like episodes, severe pneumonia-like episodes, and pneumonia-associated mortality were 105, 61, and 0.9 per 1,000 person-years, respectively. History of asthma [hazard ratio (HR): 5.85, 95% confidence interval (CI): 4.83-7.08], low socioeconomic status (SES) (HR: 1.11, 95% CI: 1.02-1.20), and long travel time to the healthcare facility estimated by cost distance analysis (HR: 1.32, 95% CI: 1.09-1.61) were significantly associated with the occurrence of pneumonia-like episodes by the Cox proportional hazards model. For severe pneumonia-like episodes, a history of asthma (HR: 8.39, 95% CI: 6.54-10.77) and low SES (HR: 1.30, 95% CI: 1.17-1.45) were significant risk factors. Children who had a long travel time to the hospital were less likely to seek hospital care (Odds ratio: 0.32, 95% CI: 0.19-0.54) when they experienced severe pneumonia-like episodes. Incidence of pediatric pneumonia-like episodes was associated with a history of asthma, SES, and the travel time to healthcare facilities. Travel time was also identified as a strong indicator for health-seeking behavior. Improved access to healthcare facilities is important for early and effective management. Further studies are warranted to understand the causal relationship between asthma and pneumonia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Community-Based Participatory Research
  • Female
  • Geography
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Islands
  • Male
  • Odds Ratio
  • Philippines / epidemiology
  • Pneumonia / epidemiology*
  • Pneumonia / mortality
  • Proportional Hazards Models
  • Public Health Surveillance
  • Retrospective Studies
  • Risk Factors

Grants and funding

This work was supported by Japan Science and Technology Agency and Japan International Cooperation Agency, Science and Technology Research Partnership for Sustainable Development, research name Comprehensive Etiological and Epidemiological Study on Acute Respiratory Infections in Children: Providing Evidence for the Prevention and Control of Childhood Pneumonia in the Philippines, no grant number, URL HO received it. This work was also supported by Japan Society for the Promotion of Science, Grant-in-Aid for Young Scientists (B), Grant Number 21790570, URL RT received it. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.