Open Access Highly Accessed Research article

Pneumonia and poverty: a prospective population-based study among children in Brazil

Lícia KAM Thörn1, Ruth Minamisava2, Simonne S Nouer3, Luiza H Ribeiro4 and Ana Lucia Andrade5*

Author Affiliations

1 Department of Epidemiology, Secretariat of Health of the Municipality of Goiânia, Brazil

2 School of Nursing, Federal University of Goiás, Brazil

3 Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

4 Samaritano Hospital of Goiânia, Goiânia, Brazil

5 Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Brazil

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BMC Infectious Diseases 2011, 11:180  doi:10.1186/1471-2334-11-180

Published: 22 June 2011



Children in developing country suffer the highest burden of pneumonia. However, few studies have evaluated associations between poverty and pneumonia.


A prospective population-based study on pneumonia was carried out as part of the Latin America Epidemiological Assessment of Pneumococcus (LEAP study). Chest x-rays were obtained for children one to 35 months old with suspected pneumonia presenting to emergency care centers and hospital emergency rooms in Goiania, Brazil. Chest radiographs were evaluated according to WHO guidelines. Clustering of radiologically-confirmed pneumonia were evaluated using a Poisson-based spatial scan statistic. Associations between census socioeconomic indicators and pneumonia incidence rates were analyzed using generalized linear models.


From May, 2007 to May, 2009, chest radiographs were obtained from 11 521 children with clinical pneumonia; 3955 episodes were classified as radiologically-confirmed. Incidence rates were significantly higher in very low income areas (4825.2 per 105) compared to high income areas (1637.3 per 105). Spatial analysis identified clustering of confirmed pneumonia in Western (RR 1.78; p = 0.001) and Southeast (RR 1.46; p = 0.001) regions of the city, and clustering of hospitalized pneumonia in the Western region (RR 1.69; p = 0.001). Lower income households and illiteracy were associated with pneumonia incidence.


In infants the risk of developing pneumonia is inversely associated with the head of household income and with the woman educational level. Areas with deprived socioeconomic conditions had higher incidence of pneumonia and should be targeted for high vaccination coverage.