Risk Factors and Predictors of Pneumonia Among Under-Five Children in Sana’a City, Yemen: A Multicenter Case-Control Study

Abstract

Background Pneumonia is a major cause of preventable morbidity and mortality among under-five children, particularly in low-resource and conflict-affected countries. However, evidence from Yemen remains scarce. This study examined child-related, maternal, and environmental factors possibly associated with pneumonia among under-five children in Sana’a City, Yemen. Methods An unmatched multicenter case-control study was conducted among 302 children aged 2–59 months at five tertiary hospitals from August to December 2023. The study included 151 children admitted to pediatric wards with pneumonia and 151 controls attending outpatient clinics for non-respiratory conditions and without clinical evidence of pneumonia. Data on potential factors associated with pneumonia were collected using a structured interviewer-administered questionnaire. Univariable binary logistic regression was used to assess associations, and variables with p < 0.20 were entered into a multivariable binary logistic regression model to identify independent predictors. Results In univariable analysis, low birthweight, prematurity, acute malnutrition, recent upper respiratory tract infection (URTI), having a household contact with respiratory infection, and poor ventilation in the cooking area were significantly associated with pneumonia. In multivariable analysis, acute malnutrition (adjusted odds ratio [AOR] = 1.9, 95% CI: 1.12–3.36; p = 0.020), recent URTI within the preceding week (AOR = 4.4, 95% CI: 2.49–7.80; p < 0.001), and having a household contact with respiratory infection (AOR = 1.9, 95% CI: 1.08–3.34; p = 0.027) remained independent predictors. Conclusion Acute malnutrition, recent URTI, and household contact with respiratory infection show independent associations with pneumonia among under-five children attending tertiary hospitals in Sana’a. These findings highlight child nutrition, early recognition and management of URTI, and household infection-prevention practices as priorities in this resource-limited, conflict-affected setting. However, these hospital-based case-control findings require confirmation in longitudinal, population-based studies before they can inform context-specific prevention strategies.