Attitude and health-seeking behaviour of caregivers in the management of pneumonia in children less than 5 years in Kaduna State, Nigeria

BackgroundChildhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.MethodsWe conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate.ResultsWe identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low– and–middle income countries (LMIC) and high–income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5–8.7), US$ 51.7 (95% CI 17.4–91.0) and US$ 242.7 (95% CI 153.6–341.4)–559.4 (95% CI 268.9–886.3) in community, out–patient facilities and different levels of hospital in–patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%–115.8% of patients’ monthly household income in LMIC. The mean direct non–medical cost and indirect cost for severe pneumonia management accounted for 0.5–31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3–6.4) and 7.7 (IQR 5.5–9.9) days in LMIC and HIC respectively for these children.ConclusionThis is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.

Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score <-3 of the WHO median, or presence of nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children from other studies, 64 (10%) and 29 (21%) isolates of M. tuberculosis were identified respectively. Children from South Africa were infected with HIV without specification of their nutritional status whereas children from other countries had SAM but without indication of their HIV status. Our review of the existing data suggests that pulmonary tuberculosis may be more common than it is generally suspected in children with acute pneumonia and SAM, or HIV infection. Because of the scarcity of data, there is an urgent need to investigate PTB as one of the potential aetiologies of acute pneumonia in these children in a carefully-conducted larger study, especially outside Africa.

Smog effects on pneumonia in under-five children in Pontianak CityPurposeThe purpose of this study was to discover the influence of smoke haze on the incidence of pneumonia in under-five children in Pontianak.MethodsAn ecological study was conducted using time trend analysis, with correlation and multiple linear regression analysis on data of under-five children diagnosed with pneumonia following primary health care diagnosis meeting WHO criteria in Integrated Management of Childhood Illness (MTBS) in Pontianak from January 2010 to January 2014. ResultsThe study found that smoke haze had no direct effects on the incidence of pneumonia in under-five children in Pontianak. Instead, pneumonia in under-five children is influenced by seasons, while smoke haze is also affected by the season, especially during the dry season.ConclusionPneumonia disease in under-five children was influenced by seasons. In the dry season, NO2 content in the air undergoes photochemical reactions that increase O3 levels, while in the rainy season, pneumonia is affected by rainfall and wind velocity that causes air to become moist. The smoke haze generated by forest and land fires in the form of gases and particles has no direct effects on pneumonia in under-five children. Further research to decrease O3 levels in the air, especially in the dry season needs to be done. In addition, policies related to the reduction of hotspots in the dry season also need to be done by the government to minimize the risk factors of pneumonia events.Pneumonia disease in under-five children was influenced by seasons. In the dry season, NO2 content in the air undergoes photochemical reactions that increase O3 levels, while in the rainy season, pneumonia is affected by rainfall and wind velocity that causes air to become moist. The smoke haze generated by forest and land fires in the form of gases and particles has no direct effects on pneumonia in under-five children. Further research to decrease O3 levels in the air, especially in the dry season needs to be done. In addition, policies related to the reduction of hotspots in the dry season also need to be done by the government to minimize the risk factors of pneumonia events.

Pneumonia is among the top causes of morbidity and mortality among the under-fives worldwide. A cross-sectional study was conducted to assess health-seeking behaviour and first medical management of pneumonia among children aged under 5 years in Alexandria, Egypt from the mothers' perspectives. Using a pre-designed questionnaire, we interviewed 507 mothers of pneumonic children aged under 5 years who had been admitted at 4 governmental children's hospitals. The study was conducted during August-November 2017. We found that 57.2% of children received home treatment before seeking medical advice. Around 26% of mothers waited ≥ 2 days before seeking medical advice; insufficient knowledge about the disease was their main contention (89%). Factors significantly associated with the delay were: rural residence (P = 0.006); low income (P = 0.002); home treatment given before seeking medical advice (P < 0.001) and previous episodes of pneumonia (P = 0.002). Diagnosis of pneumonia had not been made by more than half of the first consulted sources (52.7%). There is an urgent need to improve mothers' knowledge and train physicians for appropriate management of pneumonia in children under 5 years.

Background: Pneumonia remains one of the leading causes of morbidity and mortality among under-five children in low- and middle-income countries, including India. Strengthening the knowledge and competencies of primary caregivers through structured skill-based training may contribute significantly to reducing this burden. Objective: To systematically review and synthesise the available evidence on the effectiveness of hands-on skill training programmes for primary caregivers in preventing and managing pneumonia in under-five children, with special reference to community-based interventions in Delhi NCR. Methods: A systematic search of electronic databases (PubMed, CINAHL, Scopus, and Google Scholar) was conducted for studies published between 2005 and 2024. Keywords included “pneumonia,” “under-five children,” “primary caregivers,” “skill training,” “knowledge,” “competency,” and “India.” Studies were screened, appraised using the Joanna Briggs Institute checklist, and data were synthesised narratively. Results: Eleven studies met the inclusion criteria. Evidence suggests that structured hands-on training significantly improves caregivers’ knowledge of pneumonia symptoms, early care-seeking, and home-based management practices. Programmes with practical demonstrations, peer learning, and follow-up support showed higher effectiveness compared to didactic sessions alone. Conclusion: Hands-on skill training programmes are effective in enhancing the knowledge and competencies of primary caregivers regarding pneumonia prevention and management in under-five children.

Background: Obesity in children has its impact when the child experiences infectious conditions common in childhood, such as pneumonia. The increasing incidence of obesity in children in the last three decades forms the basis for compiling this review article. This review article aims to provide current insights about the impact of obesity on respiratory physiology, inflammatory conditions in pneumonia, and drug pharmacodynamics. Methods: This literature review uses the latest literature relevant to matters affecting pneumonia management and clinical approach in children with obesity. This literature was obtained from various sources of other scientific literature. Results: Obesity affects the respiratory physiology of children to collapse more easily, energy use becomes less efficient, children become tired, and hypoxemia occurs easily. Obesity also increases the degree and ease of inflammation in pneumonia and affects the pharmacodynamics of several drugs commonly used to manage pneumonia. Conclusion: Management of pneumonia in children with obesity requires vigilance and more stringent monitoring and adjustment of drug doses.

This paper describes challenges in etiologic diagnosis and treatment of childhood community-acquired pneumonia and the means of addressing some of them. From about one-third to two-thirds of cases of pneumonia can be attributed to a specific etiology depending on which culture, antigen detection and specialized serologic techniques, some of which are unavailable to clinicians, are used. Results of studies in which microbiologic causes have been sought confirm the importance of Streptococcus pneumoniae as the primary bacterial cause of pneumonia in infants and children. Viral etiologies become less prevalent and mycoplasmal and chlamydial infections become more prevalent with increasing age. Because definitive information about causative pathogens is seldom available, treatment of pneumonia is most often empiric. Antibiotic therapy can be withheld in mildly ill, ambulatory patients in whom viral infection is likely. Most guidelines suggest initial treatment with orally administered amoxicillin or amoxicillin/clavulanate or with intravenous cefuroxime when patients require hospitalization. In May, 2000, the Centers for Disease Control-convened Drug-Resistant S. pneumoniae Therapeutic Working Group identified oral beta-lactams including cefuroxime axetil, amoxicillin and amoxicillin/clavulanate as appropriate options for first line therapy of community-acquired pneumonia in ambulatory adults and children. New diagnostic techniques such as pneumococcal serologies and polymerase chain reaction testing have improved the ability to determine the microbiologic etiology of childhood pneumonia. Because these tests are not generally available, empiric treatment is necessary. Efforts to identify new intervention strategies, diagnostic tools, therapies and vaccines will be helpful in managing this disease.

BackgroundWhile evidence-based recommendations for the management pneumonia in under-5-year-olds at the community level with amoxicillin dispersible tablets (DT) were made by the World Health Organisation, initiatives to promote the integrated community case management (iCCM) of pneumonia through the proprietary and patent medicine vendors (PPMVs) have been poorly utilized in Nigeria, possibly due to low financial support and perceived benefit. This study provides costs, benefits and cost-effectiveness estimates and implications of promoting the iCCM through the PPMVs’ education and support. The outcome of this study will help inform healthcare decisions in Nigeria.MethodsThis study was a cost-effectiveness analysis using a simulation-based Markov model. Two approaches were compared, the ‘no promotion’ and the ‘promotion’ scenarios. The health outcomes include disability-adjusted life years averted and severe pneumonia hospitalisation cost averted. The costs were expressed in 2019 US dollars.ResultsThe promotion of iCCM through the PPMVs was very cost effective with an incremental cost-effectiveness ratio of US$143.77 (95% CI US$137.42–150.50)/DALY averted. The promotion will prevent 28,359 cases of severe pneumonia hospitalisation with an estimated healthcare cost of US$390,578. It will also avert 900 deaths in a year.ConclusionPromoting the iCCM for the treatment of pneumonia in children under 5 years through education and support of the PPMVs holds promise to harness the benefits of amoxicillin DT and provide a high return on investment. A nationwide promotion exercise should be considered especially in remote areas of the country.

Background. The introduction of pneumococcal conjugate vaccines (PCVs) has significantly reduced the burden of pneumonia in children worldwide, leading to decreased hospitalization rates, lower severity of disease, and a reduction in antibiotic resistance. However, regional disparities persist, particularly in low- and middle-income countries where healthcare infrastructure and access to vaccines are often limited. Methods. This review synthesizes findings from recent studies on the impact of PCVs on the incidence, severity, and management of pneumonia in children. It includes analyses of studies conducted in various regions, highlighting the global and regional effects of PCVs on pneumonia hospitalization rates, vaccine effectiveness against severe disease, and antibiotic resistance. Discussion. The review underscores the importance of PCVs in reducing pneumonia-related hospitalization rates, disease severity, and antibiotic resistance globally. Nevertheless, challenges persist in addressing regional disparities, particularly in underserved areas with limited healthcare infrastructure and vaccine accessibility. Conclusion. Continued surveillance and research are essential to evaluate the long-term effectiveness of newer PCV formulations. Developing strategies to improve vaccination coverage in underserved populations and monitoring the emergence of new serotypes are critical for adapting public health strategies. By addressing these challenges, the protective benefits of PCVs can be sustained, ultimately improving health outcomes for children Keywords:Pneumococcal conjugate vaccine, pneumonia, children, hospitalization, vaccine effectiveness, antibiotic resistance

Background: In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children’s Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA).Methods: Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis.Results: All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended.Conclusion: Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.

Lung Flute in the Management of Pneumonia in Children

Objective: To evaluate the mean recovery time in pediatric pneumonia patients receiving zinc as an adjunct to standard treatment compared to those who do not receive zinc supplementation. Methods: This randomized clinical trial was conducted in pediatric unit of Islamabad Medical Complex Hospital, NESCOM Islamabad from January 2024 to July 2024. A total of 110 children of age 2-5 years admitted with pneumonia were included. In group Z; 15 mg Zinc twice daily was given as an adjuvant to standard treatment till the hospital stay of patient in the hospital or up-to 7 days after starting the treatment. In group C; only standard treatment of pneumonia was given. Time of recovery from pneumonia was the primary study outcome. Results: The mean age of participants was 3.32 ± 0.9 years in group Z and 3.55 ± 0.83 years in group C, with a p-value of 0.17. In terms of gender distribution, group Z comprised 34 female patients (61.8%), compared to 27 female patients (49.1%) in group C (p-value 0.25). Mean time of recovery was significantly lower in group Z in comparison to group C patients with mean recovery time of 32.27±6.38 hours in group Z and 52.61±6.96 hours in group C (p-value &lt;0.0001). Conclusion: Zinc supplantation has a significant beneficial effect in enhancing recovery from pneumonia symptoms in hospitalized children. So, zinc supplementation can be added to the standard treatment regimen of pneumonia treatment.

Background and Objectives: Recognizing the crucial gaps in our understanding of pediatric pneumonia post-SARS-CoV-2 infection, this study aimed to assess the relationship between Pediatric Pneumonia Ultrasound Scores (PedPne) and inflammatory biomarkers. The primary objective of this study is to evaluate the predictive value of PedPne in comparison with inflammatory biomarkers (IL-6 and dNLR) for the development of pneumonia in pediatric patients following SARS-CoV-2 infection. Materials and Methods: This longitudinal observational study collected data from pediatric patients diagnosed with pneumonia after an acute SARS-CoV2 infection. The study focused on analyzing changes in PedPne scores and inflammatory markers such as IL-6 and dNLR from initial admission to follow-up at 7 days. Statistical analysis involved calculating the sensitivity, specificity, and Area Under the Curve (AUC) for each biomarker, alongside regression analysis to determine their hazard ratios for predicting pneumonia development. Results: The analysis identified significant cutoff values for dNLR at 1.88 (sensitivity 77.0%, specificity 85.7%, AUC 0.802, p < 0.001), IL-6 at 6.1 pg/mL (sensitivity 70.3%, specificity 92.9%, AUC 0.869, p < 0.001), and PedPne score at 3.3 (sensitivity 75.7%, specificity 78.6%, AUC 0.794, p < 0.001). Conversely, NLR showed lower diagnostic performance (AUC 0.485, p = 0.327). Regression analysis further highlighted the strong predictive power of these markers, with IL-6 showing a fourfold increase in pneumonia risk (HR = 4.25, CI: 2.07-9.53, p < 0.001), dNLR indicating more than a twofold increase (HR = 2.53, CI: 1.19-6.97, p = 0.006), and PedPne score associated with more than a doubling of the risk (HR = 2.60, CI: 1.33-5.18, p < 0.001). Conclusions: The study conclusively demonstrated that both PedPne ultrasound scores and specific inflammatory biomarkers such as dNLR and IL-6 are significant predictors of pneumonia development in pediatric patients post-COVID-19 infection. These findings advocate for the integration of these biomarkers in routine clinical assessments to enhance the diagnostic accuracy and management of pneumonia in children following SARS-CoV-2 infection.

Pneumonia kills about 3 million children every year in developing countries, and it is now clear that most fatal pneumonia is caused by Haemophilus influenzae or Streptococcus pneumoniae. To reduce mortality associated with pneumonia, the World Health Organization has developed guidelines for the treatment of children in developing countries who have cough or difficulty breathing: children without tachypnea or chest indrawing do not need antibiotic therapy; children with tachypnea but no chest indrawing should have antibiotic therapy at home; and children with chest indrawing should be admitted to the hospital for intramuscular injections of benzylpenicillin or chloramphenicol. Universal application of these guidelines would save the lives of approximately 600,000 children every year. Other important issues are oxygen therapy, fluid restriction, limitation of the use of acetaminophen, pneumonia in neonates, and the emergence of antibiotic resistance. There is an urgent need for vaccines that protect infants against infection with S. pneumoniae and all strains of H. influenzae, including nonserotypeable strains.

Much more than a telephone, today's mobile device has become an integral part of the way we interface with the world. Mobile devices have the computing capability, display, and battery power to become powerful medical devices that measure vital signs and provide intelligent interpretation or immediate transmission of information. The widespread adoption of mobile devices, even in low-resource settings, promises to make vital signs monitoring available anywhere and at low cost. This readily available computing power will also extend the utility of vital signs monitoring to new clinical indications, especially with the use of additional processing and integration of information. This review will focus on the universal promotion of pulse oximetry and advanced processing of plethysmography to assess variables such as respiratory rate, capillary refill time, and fluid responsiveness, and how these measurements may assist with perioperative monitoring, diagnosis, and management of pneumonia in children and preeclampsia in pregnancy when combined with mobile devices.