Risk Factors for Community-acquired Pneumonia in Malaysian Pilgrims Attending the Hajj, 2012

Abstract

Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality in Malaysian pilgrims attending the Hajj every year. This study aimed to determine risk factors associated with CAP in Malaysians attending the Hajj. We conducted an unmatched case-control study at a Malaysian hospital in Mecca from September 2012 to January 2013, during the Hajj season. Individuals who met the definition of CAP were selected as cases. Controls were randomly selected among Malaysian pilgrims staying in the same accommodation as the cases, and followed up two weeks after returning to Malaysia. Information on risk factors was gathered using a structured questionnaire, and the strength of association was assessed using adjusted odds ratios (AOR) and 95% confidence intervals (CI) through a multiple logistic regression model. The study identified 108 cases and 673 unmatched controls.  Among cases, 57.4% were males and 98.1% were aged more than 50 years. CAP was significantly associated with drinking over three liters of water daily (AOR = 0.2, 95% CI = 0.9-0.4), taking multivitamins (AOR = 0.2, 95% CI = 0.9-0.5), age 60 years or more (AOR = 20.2, 95% CI = 10.6-38.3), asthma/chronic obstructive airway disease (AOR = 5.9, 95% CI = 2.4-14.7) and congestive cardiac failure (AOR = 5.4, 95% CI = 2.0-14.7). Determining potentially preventable risk factors for CAP could help to inform public health programs for future Hajj pilgrims and might potentially reduce the associated morbidity and mortality.

Keywords: Hajj, pilgrims, community-acquired pneumonia, risk factors, multivitamin