Magnitude and Predictors of Pneumonia among Under-Five Children in Ethiopia: A Systematic Review and Meta-Analysis

Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens

PURPOSE OF REVIEW

Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa.

RECENT FINDINGS

African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent.

SUMMARY

Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.

Determinants of pneumococcal vaccination dropout among children aged 12-23 months in Ethiopia: a secondary analysis from the 2019 mini demographic and health survey

Background

Vaccination is a cost-effective public health program that helps reduce significant morbidity and mortality in children under the age of five. Worldwide, the number of vaccine-preventable causes of child death has significantly decreased since the Expanded Program of Immunization (EPI) was introduced. However, for a variety of reasons, 23 million children did not have adequate access to vaccines in 2020. Therefore, this study aimed to evaluate the determinants of pneumonia conjugate vaccine (PCV) dropout among children aged 12-23 months in Ethiopia.

Methods

The study analyzed cross-sectional data obtained from the 2019 mini Ethiopian demographic and health survey. Multilevel binary logistic regression analysis was utilized, and the best fit model was chosen using the Akaike Information Criteria. The study comprised a weighted sample of 989 children aged 12 to 23 months. The study presented the Adjusted Odds Ratio (AOR) along with a 95% Confidence Interval (CI) to identify the significant factors influencing PCV dropout.

Results

The PCV dropout rate was reported at 20.2% in this study. In the multilevel analysis, possession of a health card (AOR = 0.076, 95% CI: 0.019, 0.04), vaccination for PCV 2 (AOR =0.002, 95% CI: 0.023, 0.263), and region 7 (AOR = 6.98, 95% CI: 10.1, 48.31) were significantly associated with children's PCV dropout.

Conclusion

Having a health card, having received the PCV 2 vaccinations, and region were significant predictors of PCV dropout. Consequently, health education on immunization for all mothers and region-specific, customized public health interventions are needed to reduce the vaccination dropout rate.

Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review

BACKGROUND

COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition.

METHODS

This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria.

RESULTS

Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D.

CONCLUSION

This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.

Recovery Time From Severe Community Acquired Pneumonia and Risk Factors Among Pediatrics, Ethiopia: A Retrospective Follow-Up Study

Introduction. Severe community acquired pneumonia (CAP) is a life-threatening condition, with high rates of morbidity and mortality. This study aimed to determine the recovery time from severe CAP and risk factors among pediatric patients. Methods. A retrospective follow-up study was conducted among 412 pediatric medical charts with severe CAP enrolled at Asella Referral and Teaching Hospital between January 01, 2021 and December 31, 2022. EpiData version 4.6.0.6 and STATA version 14.2 were used for data entry and statistical analysis, respectively. Bivariable and multivariable Cox proportional hazards regression analyzes were performed. Result. The median recovery time from severe CAP among pediatric patients was 5 days (IQR = 3-8 days). IDR of recovery from severe CAP was 13.089 per 100 [95%CI: 11.82, 14.49] pediatric days observations. The cumulative incidence of recovery from severe CAP was 89.56% [n = 369, 95%CI: 86.20, 92.18]. Age [AHR = 1.55, 95%CI: 1.12, 2.13, P = .007], vaccination status [AHR = 1.29, 95%CI: 1.03, 1.63, P = .027], presence of danger signs [AHR = 1.61, 95%CI: 1.26, 2.05, P = .000], presence of comorbidity [AHR = 1.67, 95%CI: 1.33, 2.10, P = .000], duration of seeking care [AHR = 1.71, 95%CI: 1.18, 2.47, P = .004], and oxygen therapy [AHR = 1.45, 95%CI:1.12, 1.87, P = .004] were statistically significant risk factors for recovery time from severe CAP. Conclusions. The median recovery time of patients with severe CAP is relatively high. Age, vaccination status, presence of danger signs, presence of comorbidities, duration of seeking care, and oxygen therapy were statistically significant risk factors of recovery time from severe CAP.

Effectiveness of bubble continuous positive airway pressure for treatment of children aged 1-59 months with severe pneumonia and hypoxaemia in Ethiopia: a pragmatic cluster-randomised controlled trial

BACKGROUND

The safety and efficacy of bubble continuous positive airway pressure (bCPAP) for treatment of childhood severe pneumonia outside tertiary care hospitals is uncertain. We did a cluster-randomised effectiveness trial of locally made bCPAP compared with WHO-recommended low-flow oxygen therapy in children with severe pneumonia and hypoxaemia in general hospitals in Ethiopia.

METHODS

This open, cluster-randomised trial was done in 12 general (secondary) hospitals in Ethiopia. We randomly assigned six hospitals to bCPAP as first-line respiratory support for children aged 1-59 months who presented with severe pneumonia and hypoxaemia and six hospitals to standard low-flow oxygen therapy. Cluster (hospital) randomisation was stratified by availability of mechanical ventilation. All children received treatment in paediatric wards (in a dedicated corner in front of a nursing station) with a similar level of facilities (equipment for oxygen therapy and medications) and staffing (overall, one nurse per six patients and one general practitioner per 18 patients) in all hospitals. All children received additional care according to WHO guidelines, supervised by paediatricians and general practitioners. The primary outcome was treatment failure (defined as any of the following: peripheral oxygen saturation <85% at any time after at least 1 h of intervention plus signs of respiratory distress; indication for mechanical ventilation; death during hospital stay or within 72 h of leaving hospital against medical advice; or leaving hospital against medical advice during intervention). The analysis included all children enrolled in the trial. We performed both unadjusted and adjusted analyses of the primary outcome, with the latter adjusted for the stratification variable and for the design effect of cluster randomisation, as well as selected potentially confounding variables, including age. We calculated effectiveness as the relative risk (RR) of the outcomes in the bCPAP group versus low-flow oxygen group. This trial is registered with ClinicalTrial.gov, NCT03870243, and is completed.

FINDINGS

From June 8, 2021, to July 27, 2022, 1240 children were enrolled (620 in hospitals allocated to bCPAP and 620 in hospitals allocated to low-flow oxygen). Cluster sizes ranged from 103 to 104 children. Five (0·8%) of 620 children in the bCPAP group had treatment failure compared with 21 (3·4%) of 620 children in the low-flow oxygen group (unadjusted RR 0·24, 95% CI 0·09-0·63, p=0·0015; adjusted RR 0·24, 0·07-0·87, p=0·030). Six children died during hospital stay, all of whom were in the low-flow oxygen group (p=0·031). No serious adverse events were attributable to bCPAP.

INTERPRETATION

In Ethiopian general hospitals, introduction of locally made bCPAP, supervised by general practitioners and paediatricians, was associated with reduced risk of treatment failure and in-hospital mortality in children with severe pneumonia and hypoxaemia compared with use of standard low-flow oxygen therapy. Implementation research is required in higher mortality settings to consolidate our findings.

FUNDING

SIDA Sweden and Grand Challenges Ethiopia.

Empowering child health: Harnessing machine learning to predict acute respiratory infections in Ethiopian under-fives using demographic and health survey insights

BACKGROUND

A dearth of studies showed that infectious diseases cause the majority of deaths among under-five children. Worldwide, Acute Respiratory Infection (ARI) continues to be the second most frequent cause of illness and mortality among children under the age of five. The paramount disease burden in developing nations, including Ethiopia, is still ARI.

OBJECTIVE

This study aims to determine the magnitude and predictors of ARI among under-five children in Ethiopia using used state of the art machine learning algorithms.

METHODS

Data for this study were derived from the 2016 Ethiopian Demographic and Health Survey. To predict the determinants of acute respiratory infections, we performed several experiments on ten machine learning algorithms (random forests, decision trees, support vector machines, Naïve Bayes, and K-nearest neighbors, Lasso regression, GBoost, XGboost), including one classic logistic regression model and an ensemble of the best performing models. The prediction ability of each machine-learning model was assessed using receiver operating characteristic curves, precision-recall curves, and classification metrics.

RESULTS

The total ARI prevalence rate among 9501 under-five children in Ethiopia was 7.2%, according to the findings of the study. The overall performance of the ensemble model of SVM, GBoost, and XGBoost showed an improved performance in classifying ARI cases with an accuracy of 86%, a sensitivity of 84.6%, and an AUC-ROC of 0.87. The highest performing predictive model (the ensemble model) showed that the child's age, history of diarrhea, wealth index, type of toilet, mother's educational level, number of living children, mother's occupation, and type of fuel they used were an important predicting factor for acute respiratory infection among under-five children.

CONCLUSION

The intricate web of factors contributing to ARI among under-five children was identified using an advanced machine learning algorithm. The child's age, history of diarrhea, wealth index, and type of toilet were among the top factors identified using the ensemble model that registered a performance of 86% accuracy. This study stands as a testament to the potential of advanced data-driven methodologies in unraveling the complexities of ARI in low-income settings.

Analysis of risk factor for pneumonia in children less than five years in Makassar

BACKGROUND

Pneumonia is one of the main causes of mortality in children less than five years worldwide and in Makassar City. The aim of this study was to investigate the risk factors for pneumonia in children less than five years in Makassar City.

MATERIALS AND METHODS

A case-control study design was used in this research. A total of 210 children with consent from the parents were included in this study, which consisted of 70 children's cases, and the data of the control group were taken by the random sampling method. All related data such as immunization record, nutritional status, birth body weight, vitamin A intake in the last six-month record, and parents' education, occupation, and monthly income were registered as independent and control variables. Data analysis was performed by the Chi-square and logistic regression model with a P value of 0.005 and odds ratio (OR) with a 95% confidence interval (CI).

RESULTS

Incomplete diphtheria-pertussis-tetanus-hepatitis B and Haemophilus influenzae type B (DPT-HB-Hib) immunization at the age of 2 months, 3 months, and 4 months, which had adjusted OR (AOR = 9,680; P = 0,001) and malnutrition condition (weight for age) (AOR = 5,486; P < 0,005), were associated with the incidence of pneumonia in children less than five years, whereas incomplete measles-rubella (P = 0,770), low birth weight history (P = 0,403), lack of vitamin A intake (P = 0,720), parents' education (P = 0,163), and presence of smoker inside the household (P =) were not associated with the incidence of pneumonia in children less than five years (P > 0.005) in Makassar City.

CONCLUSIONS

Incomplete DPT-HB-Hib immunization for three doses at the age of 2 months, 3 months, and 4 months and malnutrition were associated with pneumonia and the highest risk factors for developing pneumonia in children less than five years in Makassar City, Indonesia.

Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study

OBJECTIVE

This analysis is to present the burden and trends of morbidity and mortality due to lower respiratory infections (LRIs), their contributing risk factors, and the disparity across administrative regions and cities from 1990 to 2019.

DESIGN

This analysis used Global Burden of Disease 2019 framework to estimate morbidity and mortality outcomes of LRI and its contributing risk factors. The Global Burden of Disease study uses all available data sources and Cause of Death Ensemble model to estimate deaths from LRI and a meta-regression disease modelling technique to estimate LRI non-fatal outcomes with 95% uncertainty intervals (UI).

STUDY SETTING

The study includes nine region states and two chartered cities of Ethiopia.

OUTCOME MEASURES

We calculated incidence, death and years of life lost (YLLs) due to LRIs and contributing risk factors using all accessible data sources. We calculated 95% UIs for the point estimates.

RESULTS

In 2019, LRIs incidence, death and YLLs among all age groups were 8313.7 (95% UI 7757.6-8918), 59.4 (95% UI 49.8-71.4) and 2404.5 (95% UI 2059.4-2833.3) per 100 000 people, respectively. From 1990, the corresponding decline rates were 39%, 61% and 76%, respectively. Children under the age of 5 years account for 20% of episodes, 42% of mortalities and 70% of the YLL of the total burden of LRIs in 2019. The mortality rate was significantly higher in predominantly pastoralist regions-Benishangul-Gumuz 101.8 (95% UI 84.0-121.7) and Afar 103.7 (95% UI 86.6-122.6). The Somali region showed the least decline in mortality rates. More than three-fourths of under-5 child deaths due to LRIs were attributed to malnutrition. Household air pollution from solid fuel attributed to nearly half of the risk factors for all age mortalities due to LRIs in the country.

CONCLUSION

In Ethiopia, LRIs have reduced significantly across the regions over the years (except in elders), however, are still the third-leading cause of mortality, disproportionately affecting children younger than 5 years old and predominantly pastoralist regions. Interventions need to consider leading risk factors, targeted age groups and pastoralist and cross-border communities.

Pneumonia among under - five children in Ethiopia: a retrospective analysis from an urban hospital

Background

Pneumonia is the leading cause of death in under-five children in low-income countries. However, the burden of pneumonia in hospital admission is not traced systematically. This study was conducted to determine the proportion of under-five pneumonia admissions among children admitted to a hospital in Addis Ababa, Ethiopia between 2017-2021.

Methods

A retrospective record of pediatric admissions to the Yekatit 12 referral hospital in Addis Ababa, Ethiopia was assessed for the period 2017- 2021. The date of admission and discharge, length of stay, and outcome at discharge were collected in accordance with the Ethiopian National Classification of Diseases (NCoD). Descriptive statistics were used to assess the proportion of under-five children with pneumonia. Survival analyses using Log rank test and cox regression analysis were done to assess time to recovery (recovering from illness). Multivariable logistic regression was used to assess the influence of selected factors on pneumonia associated hospital admission.

Results

Between 2017-2021, 2170 children age 1 to 59 months were admitted, 564 (25.99%; 95% confidence interval 24.18% to 27.87%) were diagnosed with pneumonia. Among the sixty children who died during their hospitalization, 15 had been diagnosed with pneumonia. The median time to recover from pneumonia and discharge was 6 days. The odds of pneumonia hospital admission were higher among younger children (4.36 times higher compared to elder children with 95% CI 2.77,6.87)and were increased between the months of September to November.

Conclusions

Pneumonia accounts for more than a quarter of hospital admissions in under-five children and for a quarter of deaths in this urban cohort. Hospital admission due to pneumonia was higher among older children (36-59 months of age) in the months following the heavy rain months (September to November) as compared to younger children. Our data strongly support increase of vaccination to prevent under 5 pneumonia.

The Impact of mNGS Technology in the Etiological Diagnosis of Severe Pneumonia in Children During the Epidemic of COVID-19

Purpose

Metagenomic next-generation sequencing (mNGS) is an emerging technique for pathogen detection. However, most literature on the clinical application of pediatrics generally comprises case reports or small-scale cohort studies.

Patients and Methods

A total of 101 children with community-acquired severe pneumonia admitted to Tianjin Children's Hospital from November 2021 to February 2022 were included. Pathogens in bronchoalveolar lavage fluid (BALF) specimens were detected using mNGS. The performances of mNGS and conventional tests on pulmonary infection diagnosis and pathogen identification were compared.

Results

According to our data, mNGS had a broader spectrum for pathogen detection. The mNGS results of BALF showed that the number of children with severe pneumonia hospitalized for mycoplasma pneumoniae infection was more than that for other bacterial infections during the COVID-19 epidemic. In addition, 43 cases (42.6%) had been identified with mixed infection, including 36 cases (35.6%) of Mycoplasma pneumoniae mixed with other pathogenic bacteria. Analytically, the mNGS exhibited significantly enhanced detection in the BALF as compared with the conventional laboratory pathogenic detection approaches (P < 0.05). The Pearson correlation analysis revealed positive correlation between the time of fever during hospitalization and the number of mycoplasma sequences (P < 0.05).

Conclusion

Compared with traditional methods, mNGS has a higher etiological detection rate and can comprehensively detect various pathogens of severe pneumonia. Therefore, mNGS of bronchoalveolar lavage fluid should be performed in children with severe pneumonia, which is of great significance for guiding treatment.

Nasopharyngeal Carriage Rate of Streptococcus pneumoniae, Related Risk Factors, and Antibiotic Susceptibility Among Inmates in Hawassa Central Prison Institute: Hawassa, Sidama National Region, Ethiopia

Background

The bacterium Streptococcus pneumoniae commonly causes severe bacterial illnesses in both children and adults. S. pneumoniae is the most fatal bacterial pathogen, causing 50% of the deaths from lower respiratory infections in people of all ages.

Objectives

This study was aimed to determine a nasopharyngeal carriage rate of S. pneumoniae, related risk factors, and antibiotic susceptibility among prisoners in Hawassa Central Prison Institute Hawassa, Ethiopia.

Methods

From July to August 2021, a cross-sectional investigation was carried out in Hawassa prison. All randomly chosen adult volunteers were a part of the study. In this study, about 330 different people were included. Within 3 h of collection, the swab specimen was inoculated onto 5% sheep blood agar; the inoculated medium was then incubated for 18-24 h at 35-37 °C in a CO2-enriched environment. Following incubation, the S. pneumoniae colonies were suspected, but the usual colony shape, alpha-hemolysis, Gram staining, optochin susceptibility, and bile solubility test allowed for confirmation. Antimicrobial susceptibility testing was carried out in accordance with the Clinical and Laboratory Standards Institute's guidelines.

Results

Overall carriage rate of S. pneumoniae among adult individuals were 41 (12.7%). The carriage rate of S. pneumoniae was affected by age classes that 39-48 years (OR = 4.82, 95%CI = 1.49-15.56, p = .009), 49-58 years (OR = 5.27, 95%CI = 1.27-21.89, p = .022), and greater than 58 years (OR = 4.36, 95%CI = 1.13-16.90, p = .033); cigarette smoking (OR = 3.41, 95%CI = 1.16-10.01, p = .026); and sharing beds (OR = 3.91, 95%CI = 1.27-12.07, p = .018). The majority of the isolates are susceptible for clindamycin (87.8%) and resistant for chloramphenicol (56%). Multidrug resistance was observed in 36.7%.

Conclusions

The overall carriage rate of S. pneumoniae was 12.7%. Age, cigarette smoking, and sharing beds in the same prison room had a substantial impact on this nasopharyngeal carriage rate. Chloramphenicol (56%), erythromycin (41.5%), tetracycline (39%), and co-trimoxazole (34.1%) resistance were seen in the majority of S. pneumoniae isolates. Early detection, hygiene maintenance, and appropriate treatment are necessary.

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

Objective

Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021.

Methods

A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval.

Results

Of the total participants, 116 (16.74%, 95% confidence interval: 14.1-19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00-2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64-6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07-2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10-2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14-2.84) were associated with an initial inappropriate antimicrobial use.

Conclusion

Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.

Prevalence of pneumonia and its determinant factors among under-five children in Gamo Zone, southern Ethiopia, 2021

Background

Pneumonia, which is a form of acute lower respiratory tract infection, affects the lung parenchyma and destructs alveolar air space. Pneumonia is the leading cause of morbidity and mortality in under-five children. It was estimated that pneumonia kills 900,000 under-five children each year worldwide. Approximately 172 deaths per 1,000 live births occur in sub-Saharan African countries, with pneumonia being the major cause. This study aimed to assess the prevalence and determinant factors of pneumonia inunder-five children in southern Ethiopia.

Methodology

An institutional cross-sectional study was employed. A total of 239 child-caregiver pairs were included. Data were collected by trained nurses using a semi-structured questionnaire. The collected data were checked for completeness, coded and entered into EPI data version 4.6, and exported to SPSS version 25 for analysis. Results were reported as the mean, frequency, and percentile. Logistic regression was employed to assess statistically significant predictors of pneumonia. Variables with a p-value <0.05 were considered statistically significant factors of pneumonia.

Result

The prevalence of pneumonia in the study area was 30%. Among the factors assessed, place of food cooking-inside the living room [adjusted odd ratio (AOR) = 5.79, 95% confidence interval (CI): 2.47-13.58], nonexclusive breastfeeding (AOR = 3.26, 95% CI: 1.42-7.52), vitamin A supplementation status (AOR = 5.62, 95% CI: 2.65-11.94), and vaccination status (AOR = 3.59, 95% CI: 1.49-8.66) were significantly associated with the occurrence of pneumonia in under-five children.

Conclusion

This study showed that the prevalence of pneumonia was relatively higher in Arba Minch town than other parts of the country. Place of food cooking, nonexclusive breastfeeding, vitamin A supplementation status, and vaccination status of children were significant factors of pneumonia among under-five children. Enhancing caregivers'/mothers' awareness of predicted factors was needed to reduce the incidence of childhood pneumonia and to enhance children's quality of health.

Exclusive Breastfeeding and Childhood Morbidity: A Narrative Review

Globally, diarrheal diseases and acute respiratory infections are the leading causes of morbidity and mortality in children under 5 years old. The benefits of exclusive breastfeeding in reducing the risk of gastrointestinal and respiratory infections are well documented. Optimal breastfeeding may potentially save the lives of about 800,000 children in low-income settings. Despite the evidence, around 63% of infants from birth to 6 months are not exclusively breastfed worldwide. We searched the literature published between 2010 and 2022 in Medline, Embase, and Scopus on the association between exclusive breastfeeding and infectious diseases. We selected and reviewed 70 relevant studies. Our findings expand and confirm the positive association between exclusive breastfeeding and reduced risk of a number of gastrointestinal, respiratory, and other infections in 60 out of 70 studies observed in both low- and high-income settings. Several studies analyzing exclusive breastfeeding duration reported that a longer exclusive breastfeeding duration is protective against many infectious diseases. This review also reported a lack of standardized definition for measuring exclusive breastfeeding in many studies. Overall, the results highlight the benefits of exclusive breastfeeding in many studies and suggests reporting exclusive breastfeeding in future studies using a consistent definition to enable better monitoring of exclusive breastfeeding rates.

Perception and experience of clinicians and caregivers in treating childhood severe pneumonia and hypoxemia using bubble continuous positive airway pressure in Ethiopian tertiary and general hospitals

BACKGROUND

In low and middle-income countries (LMICs), severe pneumonia with hypoxemia is the leading cause of child deaths, even with the provision of WHO-recommended antibiotic therapy, oxygen therapy and other supportive care. Previous studies found positive outcomes from the use of bubble continuous positive airway pressure (bCPAP) for treating these children compared to the standard oxygen therapy. Due to lack of data on the perceptions and experiences of hospital health care workers and caregivers of children on the feasibility and acceptability of bCPAP in treating children with severe pneumonia and hypoxemia in real-life settings, we examined these issues in tertiary and general hospitals in Ethiopia.

METHODS

As part of a three-stages clinical trial, this qualitative study was conducted in two tertiary (stage I) and two general (stage II) hospitals from September 2019 to July 2020. During stages I and II, we have consecutively enrolled children with severe pneumonia and hypoxemia and put them on bCPAP to examine its feasibility and acceptability by clinicians and parents. A total of 89 children were enrolled (49 from two tertiary and 40 from two general hospitals). Then qualitative data were collected through 75 repeated in-depth interviews by social-science experts with purposively selected 30 hospital health workers and 15 parents of 12 children who received bCPAP oxygen therapy in the hospitals. Interview data were supplemented by 6 observations in the hospitals. Data were analyzed using a thematic approach.

RESULTS

Identified structural and functional challenges for the introduction of bCPAP in treating childhood severe pneumonia and hypoxemia in the study hospitals include: inadequate number of pulse oximeters; unavailability of nasal prongs with age-specific size; inadequate and non-functioning oxygen flow meters, concentrator, and cylinders; disruption in power-supply; and inadequate number of staff. The opportunities in introducing bCPAP oxygen therapy included the availability of a dedicated corner for the study patients situated in front of nurse's station, required medicines and satisfactory level of clinicians' knowledge and skills for treating severe pneumonia patients. Additionally, the identified operational challenges were occasional lack of bubbling in the water-filled plastic bottle, lack of stand for holding the water-filled plastic bottle, and delayed shifting of oxygen source from an oxygen concentrator to a cylinder, particularly during electricity disruption. Participants (clinicians and parents) expressed their satisfaction as bCPAP oxygen therapy was found to be simple to handle, children had ease of breathing and recovered fast without major ill effects.

CONCLUSION

Our study identified some important structural, functional, and operational challenges that need to be addressed before implementation of bCPAP oxygen therapy especially in frontline general hospitals with limited resources. In spite of these observed challenges, the clinicians and caregivers were highly satisfied with the overall performance of bCPAP oxygen therapy.

Prevalence and Multi-Drug Resistance of Streptococcus pneumoniae Infection Among Presumptive Tuberculosis Adult Cases at Dilla University Referral Hospital, Dilla, Ethiopia

Introduction

Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in Africa. The simultaneous occurrence of both infections leads to delayed diagnosis and inadequate treatment. The study aimed to determine the prevalence, antimicrobial susceptibility pattern and associated factors of Streptococcus pneumoniae infection among presumptive Tuberculosis adult cases at Dilla University Referral Hospital, Dilla, Ethiopia.

Methods

An institution-based cross-sectional study was conducted on 422 presumptive TB cases visiting TB clinic at Dilla University Referral Hospital from April to June 2021. Following the Bartlett’s criteria, the accepted sputum samples were cultured on Blood agar plate and chocolate agar plate. Streptococcus pneumoniae was identified and confirmed by typical colony morphology, alpha-hemolysis, gram staining, optochin susceptibility and bile solubility tests. Antimicrobial susceptibility test was done by using the Kirby-Bauer disc diffusion method. Semi-structured questionnaires were used to collect data. Bivariate and multivariate logistic regression analyses were done by using SPSS version 23.0, computer software.

Results

The overall prevalence of S. pneumoniae in presumptive tuberculosis adult cases was 21.4% (95% CI: 17.7–25.5). S. pneumoniae has a high level of resistance to penicillin (74.1%), tetracycline (78.7%) and Trimethoprim-sulfamethoxazole (46%). Multidrug resistance was observed in 46.1% of bacterial isolates. Being primary education, more than five family size and one or two rooms in the house had more likely to cause S. pneumoniae infection.

Conclusion

This study revealed a relatively high prevalence of multidrug resistance of Streptococcus pneumoniae infection. Primary educational status, living in a crowded family, below two rooms in the house, had a significant association with S. pneumoniae infection.

Effectiveness of Bubble Continuous Positive Airway Pressure (BCPAP) for Treatment of Children Aged 1–59 Months with Severe Pneumonia and Hypoxemia in Ethiopia: A Pragmatic Cluster Randomized Controlled Clinical Trial

Despite the beneficial effect of bubble continuous positive airway pressure (BCPAP) oxygen therapy for children with severe pneumonia under the supervision of physicians that has been shown in different studies, effectiveness trials in developing country settings where low-flow oxygen therapy is the standard of care are still needed. Thus, the aim of this study is to assess the effectiveness of bubble CPAP oxygen therapy compared to the WHO standard low-flow oxygen therapy among children hospitalized with severe pneumonia and hypoxemia in Ethiopia. This is a cluster randomized controlled trial where six district hospitals are randomized to BCPAP and six to standard WHO low-flow oxygen therapy. The total sample size is 620 per arm. Currently, recruitment of the patients is still ongoing where the management and follow-up of the enrolled patients are performed by general physicians and nurses under the supervision of pediatricians. The primary outcome is treatment failure and main secondary outcome is death. We anticipate to complete enrollment by September 2022 and data analysis followed by manuscript writing by December 2022. Findings will also be disseminated in December 2022. Our study will provide data on the effectiveness of BCPAP in treating childhood severe pneumonia and hypoxemia in a real-world setting.

Pneumonia Prevalence and Associated Risk Factors among under-Five Children in Goncha Siso Enesie District, Northwest Ethiopia

Background. Pneumonia is one of the leading causes of morbidity and mortality among under-five children in various localities of Ethiopia. This study was aimed to assess the prevalence of pneumonia and its associated factors among under-five children who were visiting Ginde Woyin health center, Goncha Siso Enesie District, Northwest Ethiopia. Methods. A health center-based cross-sectional study was conducted among 403 participants by a systematic random sampling technique. Data were collected using questionnaires and sputum diagnosis. Data were analyzed using Statistical Package for Social Science (SPSS) version 26.0. Binary and multivariable logistic regressions were used to analyze the risk variables, and $P$ values < 0.05 were considered statistically significant. Results. The overall prevalence of pneumonia among under-five children was 24.3% (95% CI: 20.1, 28.3). The significant predictors for under-five pneumonia identified were the use of wood as a source of fuel for cooking (AOR = 2.769; $P=0.049$ ), starting complementary food before six months of age (AOR = 2.080; P = 0.033), and mixed breastfeeding conditions (AOR = 5.229; $P=0.001$ ). The highest under-five pneumonia was observed among children of age below one year (33.6%), rural dwellers (30.4%), family sizes above five (31.8%), children from families with a monthly income of less than 1000 Ethiopian Birr (<19.03 USD) (27.8%), whose mothers were students (61.5%), houses where cooking took place in the living room (37.8%), homes that lacked windows in the kitchens (28.4%), homes that lacked windows (41.5%), and mixed breastfeeders (44.1%). Conclusion. The prevalence of under-five pneumonia in the present study was relatively high. The findings in the present study will help policy makers and program officers to design pneumonia-preventive interventions.