Determinants of severe pneumonia among 2-59 months old children in public hospitals of Central Ethiopia region: a case-control study

Background Severe pneumonia is a leading cause of hospitalization among children aged 2–59 months globally. Ethiopia ranks among the 15 countries with the highest prevalence of childhood pneumonia; however, data on the determinants of developing severe pneumonia are limited. Objective This study aims to identify the determinants of severe pneumonia among children aged 2–59 months in public hospitals in the Central Ethiopia Region. Methods and Materials A hospital-based unmatched case-control study was conducted from January 1 to March 30, 2025. The sample size consisted of 387 participants (129 cases and 258 controls), with two hospitals selected using a lottery method. Data on potential risk factors were collected through face-to-face interviews using structured questionnaires. The collected data were entered using EpiData version 3.1 and exported to SPSS version 25. A bivariate logistic regression model was employed to assess the correlation between each independent variable and the outcome variable. Variables with a p-value ≤ 0.25 were considered for multiple logistic regression analysis to identify predictors of severe pneumonia. Adjusted odds ratios (AORs) with 95% confidence intervals were used to report the strength of associations, with statistical significance set at p < 0.05. Results Nearly half of the cases and controls were female. The highest proportion of cases (65, 50.4%) and controls (158, 60.9%) was observed in the 24–59 month age group. Independent predictors of severe pneumonia included: child age under 12 months(AOR = 3.509, p < 0.001), maternal age below 25 years (AOR = 4.956, p < 0.002), overcrowding (AOR = 3.794, p < 0.001), poor ventilation (AOR = 2.545, p < 0.008), inadequate access to clean water (AOR = 2.520, p < 0.019), insufficient basic sanitation (AOR = 2.503, p < 0.025), delayed healthcare seeking (AOR = 4.888, p < 0.025), incomplete vaccination status (AOR = 5.787, p < 0.001), uvula cutting (AOR = 4.898, p < 0.001), non-exclusive breastfeeding (AOR = 2.581, p = 0.003), and co-morbidities such as malaria (AOR = 4.885, p = 0.001), diarrhea (AOR = 3.791, p = 0.004), and acute upper respiratory tract infections (AOR = 2.680, p = 0.037). There is an urgent need to develop strategic interventions to address these underlying risk factors.