High incidence of childhood pneumonia at high altitudes in Pakistan: a longitudinal cohort study/Forte incidence de la pneumonie infantile dans les regions de haute altitude du Pakistan: etude longitudinale de cohorte/Alta incidencia de neumonia en la ninez a grandes altitudes en el Pakistan: estudio longitudinal

Objective To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan. Methods A longitudinal cohort study was conducted in which 99 female government health workers in Punial and Ishkoman valleys (Ghizer district, Northern Areas of Pakistan) enrolled children at home, conducted home visits every 2 weeks and actively referred sick children to 15 health centres. Health centre staff used Integrated Management of Childhood Illness criteria to screen all sick children aged 2-35 months and identify those with pneumonia or severe pneumonia. Findings Community health workers enrolled 5204 eligible children at home and followed them over a 14-month period, ending on 31 December 2002. Health centre staff identified 1397 cases of pneumonia and 377 of severe pneumonia in enrolled children aged 2-35 months. Among children reported with pneumonia, 28% had multiple episodes. Incidence rates per 100 child-years of observation were 29.9 for pneumonia and 8.1 for severe pneumonia. Factors associated with a high incidence of pneumonia were younger age, male gender and living at high altitude. Conclusion Pneumonia incidence rates in the Northern Areas of Pakistan are much higher than rates reported at lower altitudes in the country and are similar to those in high-altitude settings in other developing countries. More studies are needed to determine the causes of pneumonia in these high-mountain communities. However, early introduction of the vaccines that are known to prevent pneumonia should be considered. Objectif Determiner l'incidence de la pneumonie et de la pneumonie severe chez les enfants vivant a haute altitude au Pakistan. Methodes On a mene une etude longitudinale de cohorte dans laquelle 99 agents de sante feminins de l'Etat, exercant dans les vallees de Punial et d'lshkoman (District de Ghizer, zones septentrionales du Pakistan), ont recrute des enfants a domicile, effectue des visites domiciliaires toutes les 2 semaines et oriente activement les enfants malades vers 15 centres de sante. Le personnel des centres de sante a utilise les criteres de gestion integree des maladies infantiles pour depister l'ensemble des enfants malades de 2 a 35 mois et identifier ceux atteints de pneumonie ou de pneumonie severe. Resultats Les agents de sante communautaires ont recrute a teur domicile 5204 enfants susceptibles de participer a l'etude et les ont suivis sur une periode de 14 mois, qui s'est achevee le 31 decembre 20