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M S, Vaithilingan S. Childhood Pneumonia in Low- and Middle-Income Countries: A Systematic Review of Prevalence, Risk Factors, and Healthcare-Seeking Behaviors. Cureus 2024; 16:e57636. [PMID: 38586234 PMCID: PMC10998654 DOI: 10.7759/cureus.57636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Abstract
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.
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Affiliation(s)
- Selvi M
- Community Health Nursing Department, Vinayaka Mission's Research Foundation, Salem, IND
| | - Sasi Vaithilingan
- Community Health Nursing Department, Vinayaka Mission's College of Nursing, Puducherry, IND
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Wetzke M, Schütz K, Kopp MV, Seidenberg J, Vogelberg C, Ankermann T, Happle C, Voigt G, Köster H, Illig T, Lex C, Schuster A, Maier R, Panning M, Barten G, Rohde G, Welte T, Hansen G. Pathogen spectra in hospitalised and nonhospitalised children with community-acquired pneumonia. ERJ Open Res 2023; 9:00286-2022. [PMID: 36923566 PMCID: PMC10009707 DOI: 10.1183/23120541.00286-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Paediatric community-acquired pneumonia (CAP) is a leading cause of paediatric morbidity. However, particularly for outpatients with paediatric CAP, data on aetiology and management are scarce. Methods The prospective pedCAPNETZ study multicentrically enrols children and adolescents with outpatient-treated or hospitalised paediatric CAP in Germany. Blood and respiratory specimens were collected systematically, and comprehensive analyses of pathogen spectra were conducted. Follow-up evaluations were performed until day 90 after enrolment. Results Between December 2014 and August 2020, we enrolled 486 children with paediatric CAP at eight study sites, 437 (89.9%) of whom had radiographic evidence of paediatric CAP. Median (interquartile range) age was 4.5 (1.6-6.6) years, and 345 (78.9%) children were hospitalised. The most prevalent symptoms at enrolment were cough (91.8%), fever (89.2%) and tachypnoea (62.0%). Outpatients were significantly older, displayed significantly lower C-reactive protein levels and were significantly more likely to be symptom-free at follow-up days 14 and 90. Pathogens were detected in 90.3% of all patients (one or more viral pathogens in 68.1%; one or more bacterial strains in 18.7%; combined bacterial/viral pathogens in 4.1%). Parainfluenza virus and Mycoplasma pneumoniae were significantly more frequent in outpatients. The proportion of patients with antibiotic therapy was comparably high in both groups (92.4% of outpatients versus 86.2% of hospitalised patients). Conclusion We present first data on paediatric CAP with comprehensive analyses in outpatients and hospitalised cases and demonstrate high detection rates of viral pathogens in both groups. Particularly in young paediatric CAP patients with outpatient care, antibiotic therapy needs to be critically debated.
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Affiliation(s)
- Martin Wetzke
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,These authors contributed equally
| | - Katharina Schütz
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Excellence Cluster RESIST (EXC 2155), Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Hannover, Hannover, Germany.,These authors contributed equally
| | - Matthias Volkmar Kopp
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Department of Paediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Lübeck, Germany.,Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Jürgen Seidenberg
- Department of Paediatric Pneumology and Allergology, Universitätsklinik für Kinder- und Jugendmedizin Oldenburg, Oldenburg, Germany
| | - Christian Vogelberg
- University Children's Hospital, Technical University Dresden, Dresden, Germany
| | - Tobias Ankermann
- Department of Paediatric Pulmonology, Clinic of Pediatrics UKSH, University of Kiel, Kiel, Germany
| | - Christine Happle
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Excellence Cluster RESIST (EXC 2155), Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Hannover, Hannover, Germany
| | - Gesche Voigt
- Department of Paediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Lübeck, Germany
| | - Holger Köster
- Department of Paediatric Pneumology and Allergology, Universitätsklinik für Kinder- und Jugendmedizin Oldenburg, Oldenburg, Germany
| | - Thomas Illig
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Christiane Lex
- Department of Paediatric Pulmonology, University of Göttingen, Göttingen, Germany
| | - Antje Schuster
- Department of Paediatrics, University of Düsseldorf, Düsseldorf, Germany
| | - Ralph Maier
- Private Practice for Children, Tuttlingen, Germany
| | - Marcus Panning
- Institute of Virology, University of Freiburg, Freiburg, Germany
| | - Grit Barten
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,CAPNETZ STIFTUNG, Hannover, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Welte
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Excellence Cluster RESIST (EXC 2155), Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Hannover, Hannover, Germany
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Voigt GM, Thiele D, Wetzke M, Weidemann J, Parpatt PM, Welte T, Seidenberg J, Vogelberg C, Koster H, Rohde GGU, Härtel C, Hansen G, Kopp MV. Interobserver agreement in interpretation of chest radiographs for pediatric community acquired pneumonia: Findings of the pedCAPNETZ-cohort. Pediatr Pulmonol 2021; 56:2676-2685. [PMID: 34076967 DOI: 10.1002/ppul.25528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 11/09/2022]
Abstract
Although chest radiograph (CXR) is commonly used in diagnosing pediatric community acquired pneumonia (pCAP), limited data on interobserver agreement among radiologists exist. PedCAPNETZ is a prospective, observational, and multicenter study on pCAP. N = 233 CXR from patients with clinical diagnosis of pCAP were retrieved and n = 12 CXR without pathological findings were added. All CXR were interpreted by a radiologist at the site of recruitment and by two external, blinded pediatric radiologists. To evaluate interobserver agreement, the reporting of presence or absence of pCAP in CXR was analyzed, and prevalence and bias-adjusted kappa (PABAK) statistical testing was applied. Overall, n = 190 (82%) of CXR were confirmed as pCAP by two external pediatric radiologists. Compared with patients with pCAP negative CXR, patients with CXR-confirmed pCAP displayed higher C-reactive protein levels and a longer duration of symptoms before enrollment (p < .007). Further parameters, that is, age, respiratory rate, and oxygen saturation showed no significant difference. The interobserver agreement between the onsite radiologists and each of the two independent pediatric radiologists for the presence of pCAP was poor to fair (69%; PABAK = 0.39% and 76%; PABAK = 0.53, respectively). The concordance between the external radiologists was fair (81%; PABAK = 0.62). With regard to typical CXR findings for pCAP, chance corrected interrater agreement was highest for pleural effusions, infiltrates, and consolidations and lowest for interstitial patterns and peribronchial thickening. Our data show a poor interobserver agreement in the CXR-based diagnosis of pCAP and emphasized the need for harmonized interpretation standards.
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Affiliation(s)
- Gesche M Voigt
- Department of Pediatric Pneumology and Allergology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany
| | - Dominik Thiele
- Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.,University Medical Center Schleswig-Holstein, Institute of Medica, Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Martin Wetzke
- Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.,Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Jürgen Weidemann
- Department of Pediatric Radiology and Imaging, Children's and Youth Hospital auf der Bult, Hannover, Germany
| | - Patricia-Maria Parpatt
- Department of Imaging and Interventional Radiology, University Hospital Oldenburg, Germany
| | - Tobias Welte
- Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.,Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany.,Deptartment of Pulmonay Medicine, Hannover Medical School, Hannover, Germany, Hannover, Germany
| | - Jürgen Seidenberg
- Department of Pediatric Pneumology and Allergology, University Hospital, Oldenburg, Germany
| | - Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital, Dresden, Germany
| | - Holger Koster
- Department of Pediatric Pneumology and Allergology, University Hospital, Oldenburg, Germany
| | - Gernot G U Rohde
- Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.,Department of Respiratory Medicine, University Hospital Frankfurt, Germany
| | - Christoph Härtel
- Department of Pediatric Pneumology and Allergology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Department of Pediatrics, University Hospital, Würzburg, Germany
| | - Gesine Hansen
- Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.,Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias V Kopp
- Department of Pediatric Pneumology and Allergology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.,Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
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