Sex difference in outcome of pneumonia among children admitted in hospitals in Bangladesh

Introduction: Incidence of community acquired pneumonia is high in Bangladesh. A few studies have reported higher incidence of hospital admission among boy children than girls. We explored if outcome of pneumonia varied by sex among children who require admission in hospitals in Bangladesh. Method: Children 2-59 months of age who were admitted in selected hospitals and met WHO case definition of pneumonia, severe pneumonia, or very severe pneumonia , and had a culture were recruited following parental written consent. We observed children in hospital till discharge following improvement or death. Results: We recruited 7,552 children including 2,679 girls (36%). The average duration between illness onset and admission was 6 (±5) days. Severity of illness was similar across sex, but girl children were older in age (11 (±10.6) vs. 10 (±9.8) months; p<0.001), had a less educated father (36% vs. 38%; p=0.03) and were less frequently treated with an antibiotic before admission compared to boys (51% vs. 54; P= 0.04). We did not document sex difference with duration of admission and type of treatment provided in hospital, but more girls than boys died of pneumonia following treatment in hospital (4% vs.3%; p= 0.04). Conclusion: Compared to boys, girl children were less likely treated with an antibiotic at home for pneumonia and had a higher risk of death despite being treated in hospitals. Further research would be required to explore if son preference among parents for treating pneumonia at home attributes to higher case fatality among girl children in hospitals.