Reported incidence and risk factors of childhood pneumonia in India: a community-based cross-sectional study

Prevalence of persistent pneumonia among severe pneumonia and nutritional status as its associated risk factor: A prospective observational study among under-five children

Background

Malnourishment is a risk factor for persistent pneumonia among under-five children with severe pneumonia. This study aims to determine the prevalence of persistent pneumonia and the association between nutritional status and pneumonia severity in children under 5 years of age.

Methodology

A prospective observational hospital-based study was conducted in the Department of Paediatrics, King George's Medical University (KGMU) from May 2019 to April 2020 among children aged 1 month to 5 years admitted with a diagnosis of severe pneumonia. An anthropometric assessment along with general and systemic examination was conducted. Weight for age, height for age and weight for height were calculated to assess the nutritional status. Children with severe pneumonia were followed for 4-6 weeks to assess the prevalence of persistent pneumonia.

Results

The prevalence of persistent pneumonia was 6.8%, while 32 (31.1%) and 64 (62.1%) patients had recurrent and severe pneumonia, respectively. No statistically significant distribution was observed in age, sex, residential area, parent's education or occupation of the child. The statistically significant distribution was seen on assessing nutritional status based on weight for age, height for age and weight for height (P value- 0.001, 0.001, 0.0001). Those with weight for age ≤ 3SD were anaemics and up to 1 year of age had 5.21, 3.52 and 2.83 times more odds of having persistent pneumonia, respectively.

Conclusion

The prevalence of persistent pneumonia among children less than 5 years of age was 6.8%. Malnutrition can be considered a major determinant of persistent pneumonia among children under 5 years of age.

Implementing Community-Based Strategies for Improved Pneumonia Care in Children: Insights From a Pilot Study

INTRODUCTION

Respiratory ailments, encompassing a spectrum of disorders, are a leading cause of mortality and morbidity in children, with pneumonia being particularly significant, accounting for 16% of child mortality. To ensure timely engagement with healthcare services, it is imperative to instill awareness through Information, Education, and Communication (IEC) initiatives targeting mothers of children under five. The primary objective of this pilot study is to assess the feasibility of a community-based intervention on health-seeking behaviour, knowledge, and practice measures concerning the management and prevention of pneumonia in children.

METHODOLOGY

The pilot study mirrored the main study's procedures in two villages, Bhuvanahalli and Gavanahalli, each randomly assigned as either an experimental or a control group. We selected 12 mothers with children under the age of five who had community-acquired pneumonia, employing a straightforward random technique, with six mothers from each group. These mothers were interviewed using a structured questionnaire focusing on health-seeking behaviour, knowledge, and practices related to the management and prevention of pneumonia. Mothers in the experimental group received a community-based intervention, specifically an educational set focusing on health-seeking behaviour, knowledge, and practice measures concerning the management and prevention of pneumonia in children, while those in the control group continued with their routine practices. We collected post-test data from the mothers in both groups at the 2nd, 4th, and 6th months of the intervention. The data analysis was conducted using the IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York) software. The Mann-Whitney test and Kruskal-Wallis analyses indicated a notable and statistically significant shift in health-seeking behaviour, knowledge, and practices pertaining to the management and prevention of pneumonia in children as a result of the community-based educational intervention implemented in the experimental group (P<0.05).

CONCLUSION

Community-based intervention is crucial to preventing mortality and morbidity in children. The findings of the pilot study affirm its feasibility and lay a strong foundation for further investigation and implementation.

Childhood Pneumonia in Low- and Middle-Income Countries: A Systematic Review of Prevalence, Risk Factors, and Healthcare-Seeking Behaviors

Childhood pneumonia is a major contributor to illness and death in children under the age of five globally. Despite advancements in medical science, the burden of pediatric community-acquired pneumonia (CAP) remains high, particularly in low- and middle-income countries. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and healthcare-seeking behaviors associated with pediatric CAP to inform the development of targeted community-based interventions. An extensive search of various databases such as Medline, EMBASE, Web of Science, Cochrane, PubMed, PubMed Central, Helinet, SpringerLink, Google Scholar, and Biomed Central was performed, resulting in 65 potentially relevant studies. After a thorough evaluation process, 25 studies were selected for the final analysis. These selected studies offered valuable information on the epidemiology, risk factors, and healthcare-seeking behaviors associated with childhood pneumonia. The review revealed that environmental factors such as indoor air pollution, overcrowding, and exposure to tobacco smoke are significant risk factors for pediatric pneumonia. Additionally, socioeconomic factors, including poverty and a lack of access to clean water and sanitation, contribute to the vulnerability of children to this disease. Poor healthcare-seeking behaviors, driven by limited knowledge and awareness of pneumonia symptoms and treatment, further exacerbate the situation. The review also highlighted the critical role of vaccination, particularly against Haemophilus influenzae type b (Hib) and pneumococcus, in preventing pneumonia. However, gaps in vaccination coverage and challenges in accessing healthcare services remain barriers to effective pneumonia control. In light of these findings, the review recommends the implementation of community-based interventions that address the multifaceted determinants of pediatric pneumonia. These interventions should focus on improving environmental conditions, enhancing access to preventive measures such as vaccination, and promoting better healthcare-seeking behaviors through education and awareness campaigns. It is essential for healthcare providers, policymakers, and community members to collaborate in developing and implementing culturally appropriate and sustainable interventions. This cooperation aims to lessen the impact of pneumonia on children and their families.

Dyselectrolytemia in Children With Severe Pneumonia: A Prospective Study

Background Pneumonia is a condition characterized by inflammation of the lung parenchyma. It is one of the leading causes of mortality in children below five years of age. While predominantly prevalent in developing countries, it is also associated with significant healthcare-associated costs in developed countries. Among the many risk factors for childhood pneumonia, incomplete immunization, nonexclusive breastfeeding for less than six months, delayed weaning, poor household air quality, malnutrition, and low birth weight are the most commonly found. Electrolyte disturbances, also known as dyselectrolytemia, have been associated with a broad spectrum of acute infections, including pneumonia, particularly hyponatremia. It occurs in the majority of community-acquired pneumonia. Hyper- and hypokalemia are less frequently occurring electrolyte disturbances. Electrolyte disturbances are due to impairment of the intrarenal mechanism of urine dilution due to extracellular fluid volume depletion and inappropriate secretion of antidiuretic hormone. The central nervous system is imminently affected by acute hyponatremia. This condition frequently culminates in cerebral edema, a result of the rapid fluid shift, and causes sudden fatality. Aim of the study This study aims to study dyselectrolytemia in children with severe pneumonia. Objectives The study objectives are to assess dyselectrolytemia in children with severe pneumonia and to correlate dyselectrolytemia with morbidity and hospital stay. Methodology  This prospective study was conducted on 80 children in the age group of two months up to five years who visited our tertiary care center and had severe pneumonia. We evaluated the extent of dyselectrolytemia in our study population by analyzing the frequency correlation of different kinds of electrolyte imbalances. We also analyzed the correlation between morbidity and hospital stay. Results Out of 80 children in this study with severe pneumonia, 47 (59%) had electrolyte imbalance. Among the patients with electrolyte imbalance, 31 (39%) patients had hyponatremia followed by hypokalemia in 12 (15%) patients, hypernatremia in 3 (4%) patients, and hyperkalemia in 1 (1%) patient. Among the 17 (21%) children with pneumonia requiring ICU admission, 16 (94%) had dyselectrolytemia and 4 (24%) experienced fatal outcomes. Conclusions The majority of the children who were admitted to the ICU had severe pneumonia along with electrolyte imbalance. This necessitates the monitoring of the electrolyte and nutritional status of the patients with pneumonia. Providing proper nutrition advice for children with pneumonia may reduce morbidity and mortality. Early detection and treatment of electrolyte imbalances in pneumonia cases can decrease prolonged hospital stays, ICU admissions, and the need for mechanical ventilation, ultimately contributing to a reduction in morbidity and mortality.

Awareness among mothers on acute respiratory tract infections in under five children at north Gujarat, India

Acute respiratory infections (ARI) account for 14.3% of new born mortality and 15.9% of death among children aged 1 to 5 in India, making them significant contributors to morbidity and mortality in children. However, the bulk of these fatalities would be avoided if mothers were aware of the symptoms and signs of infections so that prompt referrals could be made. The goal of the current study was to gauge mothers of children under the age of five's knowledge of ARI and examine how well an education programme did in raising that knowledge. The information was gathered from 60 mothers of young children under the age of five in different areas around Gujarat State in India. The pre-intervention-post-test methodology was used. The mean pre-test observation score was 8.51, the mean post-test score was 19.31, and the mean difference was 11. There were 60 samples; the pre-test and post-test scores had standard deviations of 4.59 and 2.54, respectively. The calculated "t" value was also 17.29, the DF was 59, and the table value of "t" was 1.67. These findings demonstrate that the educational programme on ARI was successful in increasing the mother's knowledge.

Parents' Caring Approach for Their Children Suffering from Pneumonia-A Study among Bhil Tribes of Maharashtra

Context

In India, pneumonia deaths in the past decade show a decreasing trend in the child mortality rate from 74.6 to 45.4. However, NFHS-5 records an increase in prevalence to 2.8% from 2.7% in NFHS-4. The childhood pneumonia control strategies focus on strengthening the health system, skill-building health workers, counseling, and creating awareness about promoting healthy behaviors regarding the management of sick children.

Aims

The study attempts to understand "caregivers" care-seeking behavior and the management of childhood pneumonia.

Setting and Design

The study was conducted in the Akkalkuwa block of Nandurbar district, Maharashtra, India. We used episodic interviews, asking caregivers to recollect specific events linked to the need for treatment.

Methods and Material

A total of 11 in-depth interviews of mothers were conducted whose under-five children had pneumonia in the past year. These interviews used vignettes from real pneumonia cases to discuss community priorities for health care and actions taken to improve child's health. In addition, the qualitative data from the in-depth interviews were thematically analyzed.

Result

Cough, breathlessness, and disturbance in the routine schedule of the child were the major symptoms to identify pneumonia (vavlya) among children. Branding on the stomach, oil massage, and jadi-buti were commonly observed phenomena to seek help. Low priority, the influence of traditional healers and herbal medicines, and the inaccessibility of quality healthcare services were the main factors that led to the child's treatment.

Conclusion

Culturally appropriate activities are to be imparted on recognition of symptoms and appropriate care seeking, and community health workers need capacity building.

Prevalence of acute respiratory infections among children in India: Regional inequalities and risk factors

Aim

The high incidence of acute respiratory infection (ARI)-related morbidity and mortality is a major public health concern in developing countries. This study aimed to quantify regional inequalities and the degree of association between childhood ARI and background factors.

Methods

This study utilised information of 238 945 children aged below five years extracted from the Fourth Indian National Family Health Survey conducted in 2015–16. Inter-state and regional inequality in the prevalence of ARI were quantified and presented using a map of India and forest plot. The association of background characteristics and ARI was quantified using bivariate and multivariable binary logistic regression models.

Results

Significant inequalities in the prevalence of childhood ARI were observed across the six regions of India. Considering the children from north-east region as a reference, those from north, central and east regions were 0.68, 1.02 and 0.57 times more likely to suffer from ARI. Comorbidity, sex, age and nutritional status of children were significantly associated with the prevalence of ARI.

Conclusions

ARI remains a significant public health concern among Indian children. The results of this study showed that significant regional disparities in the prevalence of ARI exist in India. This study adds value to the better understanding of inequality patterns and quantifies within- and intra-region inequalities in the prevalence of ARI in India.

Does secondhand smoke exposure increase the risk of acute respiratory infections among children aged 0-59 months in households that use clean cooking fuel? A cross-sectional study based on 601 509 households in India

This study examines whether exposure to secondhand smoke (SHS) increases the risk of acute respiratory infections (ARI) among children aged 0-59 months. Study utilized nationally representative data from National Family Health Survey (2015-2016), which adopted two-stage stratified random sampling. Four mutually exclusive groups based on the type of cooking fuel usage and SHS exposure were created. Descriptive statistics and multivariate logistics regression analysis were applied. At the national level, 10.5% prevalence of ARI was reported during 2015-2016. About 47.9% (95%CI 47.7-48.2) of households was exposed to SHS and used solid biomass fuel for cooking. Nearly, 20.7% of households with clean fuel usage was exposed to SHS. Regression analysis suggests that the likelihood of ARI among children who were living in households with solid biomass fuel usage and exposed to SHS was 11% (95%CI 1.06-1.17) greater than children living in households with clean fuel usage with no SHS exposure. Moreover, our results further revealed that the odds of ARI among children living in households with clean fuel but exposed to SHS were 19% (95%CI 1.13-1.25) higher than the children living in the household with no SHS exposure and clean fuel use. Children living in households exposed to SHS are at higher risk of ARI.

Prevalence of the Acute Respiratory Infections and Associated Factors in the Rural Areas and Urban Slum Areas of Western Maharashtra, India: A Community-Based Cross-Sectional Study

Acute respiratory infections (ARIs) continue to be the most important cause of morbidity and mortality among under-five children. Some demographic and environmental factors are associated with ARIs among under-five children. This study was conducted with the objective to estimate the prevalence of ARIs among under-five children in the rural areas and densely populated urban slum areas in Maharashtra, India and to assess the association of the selected sociodemographic and household environmental factors with ARI. This study was conducted in 16 selected clusters from the rural areas and densely populated urban slum areas of the two districts in Maharashtra, India. Structured and validated proforma was used for collecting the data on the sociodemographic and household environmental risk factors. A total of 3,671 under-five children were surveyed. The prevalence of ARIs for the preceding month was 50.4%. It was higher among the children living in the rural areas (54.2%) compared to the children living in the urban areas (46.7%) (p = 0.01). The prevalence of ARIs was reported to be 51.4 and 49.4% in boys and girls, respectively. In the multivariate analysis, the researchers found that living in rural areas (p = 0.01) and parental smoking (p = 0.04) were significantly associated with the ARIs. An intervention such as reducing parental smoking habits at the household level may reduce ARIs.

The Deep Learning LSTM and MTD Models Best Predict Acute Respiratory Infection among Under-Five-Year Old Children in Somaliland

The most effective techniques for predicting time series patterns include machine learning and classical time series methods. The aim of this study is to search for the best artificial intelligence and classical forecasting techniques that can predict the spread of acute respiratory infection (ARI) and pneumonia among under-five-year old children in Somaliland. The techniques used in the study include seasonal autoregressive integrated moving averages (SARIMA), mixture transitions distribution (MTD), and long short term memory (LSTM) deep learning. The data used in the study were monthly observations collected from five regions in Somaliland from 2011–2014. Prediction results from the three best competing models are compared by using root mean square error (RMSE) and absolute mean deviation (MAD) accuracy measures. Results have shown that the deep learning LSTM and MTD models slightly outperformed the classical SARIMA model in predicting ARI values.

Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study

BACKGROUND

Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India.

METHODS

A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas.

RESULTS

The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight.

CONCLUSIONS

Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community.

TRIAL REGISTRATION

Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.

Distribusi Pneumonia Menurut Kasus Gizi Buruk dan Cakupan Imunisasi Pada Balita Di Jombang

ABSTRACT Background: The program for finding pneumonia cases as an effort to prevent and control infectious diseases in Jombang is getting better. Risk factors for pneumonia in infants include complete basic immunization (IDL) status and nutritional status in infants. Complete basic immunization coverage in Jombang has met the Ministry of Health Strategic Plan 2015-2019 target of 80%, however pneumonia cases continue to occur and have continued to increase for the past 3 years.Objectives: Observing the trend between complete basic immunization coverage and cases of malnutrition with the incidence of pneumonia in children under five in Jombang Regency during 2015, 2016, 2017 and describe the distribution of cases in the form of maps.Methods: This type of research is descriptive by describing in the form of a map. The population in this study were all children under five in Jombang. Data was taken from the Jombang health profile in 2015, 2016 and 2017. Data management uses the Health Mapper application version 4.3.0.0 with product version 4.03.Results: The trend of the incidence of pneumonia with IDL coverage in Jombang in 2015-2017 shows, an increase in pneumonia cases in infants accompanied by a decrease in IDL coverage. This incident occurred in 19.04% in Jombang, specifically in Mojoagung, Sumobito, Ploso and Plandaan. While the increase in pneumonia was accompanied by an increase in cases of malnutrition occurred in 23.8% of the districts namely Ngoro, Mojowarno, Bareng, Sumobito and Plandaan.Conclussions: During 2015, 2016 and 2017 the incidence of pneumonia tends to increase followed by a decrease in IDL coverage and an increase in cases of malnutrition.ABSTRAK Latar Belakang: Progam penemuan kasus pneumonia sebagai upaya pencegahan dan pengendalian penyakit menular di Jombang semakin membaik. Faktor risiko dari pneumonia pada balita diantaranya adalah status imunisasi dasar lengkap (IDL) dan status gizi pada balita. Cakupan IDL di Kabupaten Jombang telah memenuhi target Renstra Kementrian Kesehatan tahun 2015-2019 sebanyak 80%, namun demikian kasus pneumonia tetap terjadi serta terus mengalami peningkatan selama 3 tahun tersebut.Tujuan: Melihat kecenderungan antara cakupan IDL dan kasus gizi buruk dengan kejadian pneumonia pada balita di Kabupaten Jombang selama tahun 2015, 2016, 2017 serta menggambarkan persebarannya dalam bentuk peta.Metode: Jenis penelitian ini adalah peneltian deskriptif dengan menggambarkan dalam bentuk peta. Populasi dalam penelitian ini adalah seluruh balita di Kabupaten Jombang. Data diambil dari profil kesehatan Jombang pada 2015, 2016 dan 2017. Manajemen data menggunakan aplikasi Health Mapper versi 4.3.0.0 dengan versi produk 4.03.Hasil: Kecenderungan kejadian pneumonia dengan cakupan IDL di Jombang pada tahun 2015-2017 menunjukkan terjadi peningkatan kasus pneumonia pada balita disertai dengan penurunan cakupan IDL. Kejadian ini terjadi di 19,04% kecamatan di Jombang tepatnya kecamatan Mojoagung, Sumobito, Ploso dan Plandaan. Sedangkan peningkatan pneumonia disertai dengan peningkatan kasus gizi buruk terjadi di 23,8% kecamatan yaitu Kecamatan Ngoro, Mojowarno, Bareng, Sumobito dan Plandaan. Kesimpulan: Selama tahun 2015, 2016 dan 2017 kejadian pneumonia cenderung mengalami peningkatan yang diikuti dengan penurunan cakupan IDL serta peningkatan kasus gizi buruk.

Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia's demographic and health surveys (1996-2014)

Introduction

acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under the age of five years globally accounting for 16% of deaths. In Zambia, ARI accounts for 30-40% of children's outpatient attendance and 20-30% of hospital admissions. We assessed trends and factors associated with ARI among under-five children in Zambia from 1996 to 2014.

Methods

we analysed the Zambia demographic and health survey data for 1996, 2002, 2007 and 2014 of under five children and their mothers. We extracted data using a data extraction tool from the women's file. We analysed trends using chi square for trends. We conducted a complex survey multivariable logistic regression analysis, reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values.

Results

we included a total of 6,854 and 2,389 (8%) had symptoms consistent with ARI. A 2% upward trend was noted between the 1996 and 2002 surveys but a sharp decline of 10% occurred in 2007. The chi2 trend test was significant p < 0.001. Children whose mothers had secondary or higher education were less likely to have ARI (AOR 0.30 95% CI 0.15-0.58) compared to those with no education. Underweight children had 1.50 times increased odds of having ARI (AOR 1.50 95% CI 1.25 - 1.68) compared with children who were not. Use of biomass fuels such as charcoal (AOR 2.67 95% CI 2.09 - 3.42) and wood (2.79 95% CI 2.45 -3.19) were associated with high odds for ARI compared to electricity.

Conclusion

the prevalence of ARI has declined in Zambia from 1996 to 2014. Factors associated with occurrence of ARI included being a child under one year, underweight, use of biomass fuel such as charcoal and wood. Interventions to reduce the burden of ARI should be targeted at scaling up nutrition programs, as well as promoting use of cleaner fuels.

Pulse oximeter with integrated management of childhood illness for diagnosis of severe childhood pneumonia at rural health institutions in Southern Ethiopia: results from a cluster-randomised controlled trial

OBJECTIVE

To assess whether pulse oximetry improves health workers' performance in diagnosing severe childhood pneumonia at health centres in Southern Ethiopia.

DESIGN

Parallel cluster-randomised trial.

SETTING

Government primary health centres.

PARTICIPANTS

Twenty-four health centres that treat at least one pneumonia case per day in Southern Ethiopia. Children aged between 2 months and 59 months who present at health facilities with cough or difficulty breathing were recruited in the study from September 2018 to April 2019.

INTERVENTION ARM

Use of the Integrated Management of Childhood Illness (IMCI) algorithm and pulse oximeter.

CONTROL ARM

Use of the IMCI algorithm only.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the proportion of children diagnosed with severe pneumonia. Secondary outcomes included referred cases of severe pneumonia and treatment failure on day 14 after enrolment.

RESULT

Twenty-four health centres were randomised into intervention (928 children) and control arms (876 children). The proportion of children with severe pneumonia was 15.9% (148 of 928 children) in the intervention arm and 3.9% (34 of 876 children) in the control arm. After adjusting for differences in baseline variables children in the intervention arm were more likely to be diagnosed as severe pneumonia cases as compared with those in the control arm (adjusted OR: 5.4, 95% CI 2.0 to 14.3, p=0.001).

CONCLUSION

The combined use of IMCI and pulse oximetry in health centres increased the number of diagnosed severe childhood pneumonia.

TRIAL REGISTRATION NUMBER

PACTR201807164196402.

Prevalence of pneumonia and its associated factors among under-five children in East Africa: a systematic review and meta-analysis

Background

Pneumonia is defined as an acute inflammation of the Lungs’ parenchymal structure. It is a major public health problem and the leading cause of morbidity and mortality in under-five children especially in developing countries. In 2015, it was estimated that about 102 million cases of pneumonia occurred in under-five children, of which 0.7 million were end up with death. Different primary studies in Eastern Africa showed the burden of pneumonia. However, inconsistency among those studies was seen and no review has been conducted to report the amalgamated magnitude and associated factors. Therefore, this review aimed to estimate the national prevalence and associated factors of pneumonia in Eastern Africa

Methods

Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of pneumonia from PubMed, Cochrane library, and Google Scholar. Heterogeneity across the studies was evaluated using the Q and the I² test. A weighted inverse variance random-effects model was applied to estimate the national prevalence and the effect size of associated factors. The subgroup analysis was conducted by country, study design, and year of publication. A funnel plot and Egger’s regression test were used to see publication bias. Sensitivity analysis was also done to identify the impact of studies.

Result

A total of 34 studies with 87, 984 participants were used for analysis. The pooled prevalence of pneumonia in East Africa was 34% (95% CI; 23.80–44.21). Use of wood as fuel source (AOR = 1.53; 95% CI:1.30–1.77; I² = 0.0%;P = 0.465), cook food in living room (AOR = 1.47;95% CI:1.16–1.79; I² = 0.0%;P = 0.58), caring of a child on mother during cooking (AOR = 3.26; 95% CI:1.80–4.72; I² = 22.5%;P = 0.26), Being unvaccinated (AOR = 2.41; 95% CI:2.00–2.81; I² = 51.4%;P = 0.055), Child history of Acute Respiratory Tract Infection (ARTI) (AOR = 2.62; 95% CI:1.68–3.56; I² = 11.7%;P = 0.337) were identified factors of pneumonia.

Conclusion

The prevalence of pneumonia in Eastern Africa remains high. This review will help policy-makers and program officers to design pneumonia preventive interventions.

Pneumonia among Under-Five Children in Northwest Ethiopia: Prevalence and Predictors-A Community-Based Cross-Sectional Study

Background

Acute respiratory infections in particular pneumonia constitutes the leading cause of morbidity and mortality among children under five years of age throughout the world. In Ethiopia, pneumonia continues to be the major childhood problem and killer, particularly in the study area. However, evidence dealing with the problem is still unavailable. The current study is aimed at determining the magnitude and risk factors of childhood pneumonia in Gondar City.

Methods

A community-based cross-sectional study was employed in five randomly selected clusters/subcities of Gondar City. A total of 792 child-mother/caregiver pairs in the selected subcities/clusters were included. A pretested and validated questionnaire was used by trained supervisors through house-to-house visits to collect the data. Binary logistic regression (bivariable and multivariable) was employed. An adjusted odds ratio with 95% confidence interval was used to declare statistically significant variables on the basis of p < 0.05 in the multivariable logistic regression model.

Results

The prevalence of pneumonia among under-five children in the current study was found to be 12% with 95% CI: 10% to 14.4%. The presence of unpaved road within 100 m of the house (AOR = 2.27, 95% CI: 1.41-3.66), living within 100 m of heavy traffic (AOR = 1.94, 95% CI: 1.19-3.16), the habit of not opening doors while cooking (AOR = 1.62, 95% CI: 1.01-2.62), the presence of cockroach infestation (AOR = 1.98, 95% CI: 1.25-3.14), and new carpet in the house (AOR = 1.75, 95% CI: 1.01-3.03) were statistically significant variables associated with childhood pneumonia.

Conclusions

This study indicated that the prevalence of childhood pneumonia is still high. As such, enhancing strategies that would address unpaved roads within 100 m of the house, living within 100 m of heavy traffic, the habit of not opening doors while cooking, cockroach infestation, and new carpet in the house to reduce the burden of childhood pneumonia needs to be advocated.

Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

Introduction

Pneumonia in children is a common disease yet determining its aetiology remains elusive.

Objectives

To determine the a) aetiology, b) factors associated with bacterial pneumonia and c) association between co-infections (bacteria + virus) and severity of disease, in children admitted with severe pneumonia.

Methods

A prospective cohort study involving children aged 1-month to 5-years admitted with very severe pneumonia, as per the WHO definition, over 2 years. Induced sputum and blood obtained within 24 hrs of admission were examined via PCR, immunofluorescence and culture to detect 17 bacteria/viruses. A designated radiologist read the chest radiographs.

Results

Three hundred patients with a mean (SD) age of 14 (±15) months old were recruited. Significant pathogens were detected in 62% of patients (n = 186). Viruses alone were detected in 23.7% (n = 71) with rhinovirus (31%), human metapneumovirus (HMP) [22.5%] and respiratory syncytial virus (RSV) [16.9%] being the commonest. Bacteria alone was detected in 25% (n = 75) with Haemophilus influenzae (29.3%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (22.7%) being the commonest. Co-infections were seen in 13.3% (n = 40) of patients. Male gender (AdjOR 1.84 [95% CI 1.10, 3.05]) and presence of crepitations (AdjOR 2.27 [95% CI 1.12, 4.60]) were associated with bacterial infection. C-reactive protein (CRP) [p = 0.007]) was significantly higher in patients with co-infections but duration of hospitalization (p = 0.77) and requirement for supplemental respiratory support (p = 0.26) were not associated with co-infection.

Conclusions

Bacteria remain an important cause of very severe pneumonia in developing countries with one in four children admitted isolating bacteria alone. Male gender and presence of crepitations were significantly associated with bacterial aetiology. Co-infection was associated with a higher CRP but no other parameters of severe clinical illness.

Breastfeeding and the Risk of Infant Illness in Asia: A Review

Infancy remains the most vulnerable period of human life for death, illness, and establishing a lifetime trajectory of growth and health. It is estimated that there are 5.3 million deaths under five years of age worldwide and approximately 800,000 lives could be saved by improving breastfeeding rates and duration. In Asia, an estimated 300,000-350,000 child deaths could be prevented with optimal breastfeeding and the majority would be under 12 months of age. We present a systematic review of studies of infection and breastfeeding in infants in Asia and further review interactions of selected infectious diseases and breastfeeding. Initially, 2459 records of possible interest were identified, 153 full text papers were reviewed in detail, and 13 papers describing diarrhoeal disease and/or acute respiratory tract infection were selected for inclusion in the review. Additional papers were selected to discuss specific diseases and their relationship to breastfeeding. The review found that a variety of methods were used with differing definitions of breastfeeding and diseases. Overall, breastfeeding when compared to the use of infant formula, is associated with significantly lower rates of diarrhoeal disease and lower respiratory tract infection, with a reduction of 50% or more to be expected, especially in infants under six months of age. The relationship between breastfeeding and specific diseases including measles and HTLV1 were reviewed. Breastfeeding reduces some disease rates, but there remain a few conditions where breastfeeding may be contra-indicated.