Association of environmental arsenic exposure with Pnuemonia in children aged less than five years residing in Khairpur, District of sindh : a case-control study

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Pneumonia is considered to be one of the most important diseases that contribute for mortality among children less than five years of age globally, especially amongst developing countries like Pakistan. Environmental arsenic exposure, primarily through underground drinking water is believed to be an important risk factor for adverse respiratory health outcomes in adults and children residing in high risk areas. However, there is a dearth of clear scientific evidence regarding association of arsenic exposure with pneumonia among children. Objectives: To determine association between environmental arsenic exposure and risk of developing pneumonia among children aged less than five years in district Khairpur Sindh., Pakistan. Methods: A hospital-based, age group matched (2-11months, 12-59 months) case control study comprising of 138 cases and 152 controls was conducted from March 2016 to July 2016 at District Khairpur, Sindh. Cases comprised of newly diagnosed children with pneumonia according to the WHO criteria, presenting at the secondary care level facility (GIMS); while controls comprised of patients at Pediatrics outpatient or inpatient department of the same facility with complaints other than pneumonia. All the participants were interviewed(through a guardian) at the hospital through a structured and pre tested questionnaire, while 24 hour spot urine was collected at the time of recruitment and was frozen at 4°C and transferred to PCRWR laboratory in Karachi for future analysis. To determine association between the arsenic exposure and pneumonia in children, multiple logistic regression analysis was done and adjusted odds ratios were calculated after controlling for possible confounders. Results: Descriptive statistics suggest that there were 69(52%) children of age 2-11 months among cases and 106(67%) among controls. Around 83(63%) cases were exposed to arsenic above 10 μg/L and 97(61%) controls were exposed to > 10 ps/L concentration of arsenic. Arsenic concentration turned out to be insignificant (adjusted OR: 1.25, 95% CI 0.76-2.07). Breastfeeding was found to be significantly associated with pneumonia (adjusted OR: 0.376, 95% CI 0.23-0.61). Conclusion: After controlling for various confounders in multivariable model, Arsenic exposure remained an insignificant risk factor for pneumonia among•children in Pakistan. Our findings are contradictory to a previous case control study from Bangladesh and demonstrate that arsenic exposure is not a risk factor for pneumonia in low exposure areas. Keywords: Arsenic, pneumonia, children, Khairpur

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