Pneumonia In Under-five Children Research Articles

Determinants of Pneumonia Status in Under-five Children in Indonesia

Background: Pneumonia is a communicable disease that causes the largest under-five children death in the world. Meanwhile, Indonesia contributed 19.000 cases of under-five deaths due to pneumonia in 2018. Pneumonia can inhibit the growth and development in under-five children, cause decreased lung function or even lead to death. The pneumonia symptoms is less specific and almost the same as the flu or a common cough, makes this disease difficult to detect and difficult to treat optimally. This study was aimed to determine variables that affect the pneumonia in under-five children in Indonesia in 2018.Methods: This study used descriptive analysis and multilevel binary logistic regression. It used secondary data from the Riskesdas 2018, publication of Profil Kesehatan Indonesia 2018, and official website of Badan Pusat StatistikResult: The results indicated that in 2018, there were about 6.4 percent of under-five children who experienced pneumonia. The age of under-five children, gender, nutritional status, maternal education level, type of residence, house’s ventilation, and poverty rate per province significantly affected the status of pneumonia in under-five children in Indonesia.Conclusion : This study was expected to be able to increase public awareness about pneumonia in under-five children and can prevent under-five deaths due to pneumonia. Further research can use more up-to-date primary data and can also focus on provinces that have high rates of pneumonia in under-five children.

Time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga Zone public hospitals, western Ethiopia, 2023; a retrospective cohort study

BackgroundGlobally, pneumonia is one of the leading causes of morbidity and mortality as well as hospitalization burden for under-five children. Despite significant initiatives implemented to reduce morbidity and mortality from pneumonia in under-five children, little is known regarding the time to recovery and its predictors among under-five children admitted with severe pneumonia in Ethiopia. Hence, this study intended to estimate the median time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga zone public hospitals, western Ethiopia; 2023.MethodsAn institution-based retrospective cohort study was conducted among 383 under-five children who were admitted with severe pneumonia in East Wallaga zone public hospitals from January 2017 to December 2022. A systematic sampling method was used to select eligible medical records. EpiData Version 4.6 was used to enter the data and analyzed using STATA Version 17.0. Cox-proportional hazard assumption test and model fitness were checked. Variables with P-value ˂ 0.25 at bivariable Cox regression analysis were selected for the multivariable Cox proportional model. A multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from severe pneumonia at a P-value < 0.05.ResultsAt the end of the follow-up, 356 observations were developed an event (recovered) with the median time to recovery of 4 days with IQR of 3–5 days. The overall incidence rate of recovery was 22.26 per 100 (95% CI: 20.07–24.70) person-days observations. Being rural residency (AHR: 0.75, 95% CI: 0.60–0.93), late presenters for seeking care (AHR = 0.70, 95% CI: 0.53–0.93), presence of danger sign at admission (AHR = 1.46, 95% CI: 1.15–1.83), and presence of comorbidity (AHR = 1.63, 95% CI, 1.31–2.04) were found to have a statistically significant association with prolonged recovery time.ConclusionThe median time to recovery from severe pneumonia was long, and factors such as Residence, co-morbidity, presence of danger signs, and duration prior to seeking care were statistically significant predictors of recovery time from severe pneumonia. Hence, due attention has to be given to increasing the community’s health-seeking behavior to visit health facility early and especial attention should be given for children with danger signs and comorbidity.

Determinants of under-five pneumonia in randomly selected health facilities at Aleta Wondo Woreda, Sidama Region Ethiopia: Case-control study.

Under-five mortality reduction due to pneumonia is not Signiant, particularly in developing countries. Pneumonia contributed to 27.5% to 31.3% of health facility visits by children 2 to 59 months in Aleta Wondo Woreda. Previous studies have shown inconclusive evidence on determinants of pneumonia in children. An institution-based unmatched case-control study was conducted to assess determinants of pneumonia among under-five children at Aleta Wondo Woreda, Sidama Region. One-hundred forty-five cases and 290 controls of children aged 2 to 59 months participated in the study. The mean ± (SD) age of the children was 18.81 months (2.1 ± 11.43) and 28.26 months (2.1 ± 16.007) for cases and controls, respectively. Only 56% (n = 145) of cases open house windows daily, whereas most 68.6% (n = 290) of controls house windows open daily. Ninety five (62.8%) of cases and 68.6% of controls were exclusively breastfed for 6 months. Household income ≥1500 Ethiopian birr (AOR = 0.45, 95% CI, 0.017-0.120, p < 0.000), child location outside of cooking house during cooking (AOR = 0.101, 95% CI, 0.43-0.238, p < 0.000), no formal education of the mother (AOR = 2.398, 95% CI, 1.082-5.316, p < 0.031), and presence of history of upper respiratory tract infections (URTIs) in last 2weeks (AOR = 2.183, 95% CI, 1.684-5.273, P < 0.049) were determinants of pneumonia. Determinants of pneumonia in under-five children were multifactorial (socioeconomic, nutritional, and environmental). Addressing these factors by involving all relevant stakeholders is important to reduce pneumonia-related morbidity and mortality among under-five children in the study area.

A Spatio-Temporal Mapping and Bayesian Modelling of Fever, Cough and short Rapid Breaths, as Symptoms of Pneumonia in Under-Five Children in Nigeria

Background Pneumonia remains a public health challenge in most parts of the world, with Nigeria having the highest number of pneumonia-related deaths. Understanding the geographical distribution, trends and risk factors associated with some symptoms of pneumonia can aid an appropriate preventive intervention towards abating its burden in Nigeria. Method This cross-sectional study used data from the 2008, 2013, and 2018 Nigeria Demographic Health Surveys. The outcome variables include fever, cough, and short, rapid breaths as selected symptoms of pneumonia. Optimized hotspot analysis was used to identify areas with a significantly high prevalence of fever, cough, and short rapid breaths, and a MCMC random-intercept logistic regression model was fitted to each symptom. Results The prevalence of cough was 12.1%, 10.1% and 16.9% in 2008, 2013 and 2018 respectively, 16.2%, 13.3%, and 25.7% for fever; and 41.7%, 42.5% and 6.5% for short rapid breaths respectively with variations across the states. Children aged 6-11 months had the highest higher odds (adjusted odds ratio (aOR) =1.95, 95% Credible Interval (CrI): 1.77, 2.18) of having cough, compared to children of other age groups. Similar pattern was noticed for fever and short rapid breaths. Other significantly associated factors with symptoms include the mother’s education, mother’s age, residence type, housing quality, wealth index and region. Conclusion The northern states were more characterized by short, rapid breaths while the southern states were more characterized by fever but both regions have a fair share of cough among under-five children. For cough and fever symptoms, the increased prevalence between 2013 and 2018 indicates more attention is needed. There are also higher odds of finding the symptoms amongst children aged 6-11 months compared to children of other age groups, especially in the North-eastern part of the country. Hence, government needs to strengthen immunization against diseases such as Hib, pneumococcus, measles and whooping cough (pertussis) which has been shown to be the most effective way to prevent pneumonia. Adequate nutrition is also key to improving children's natural defenses. Educated mothers needs to be adequately sensitized to understand that exclusive breastfeeding for the first 6 months of life of a child is paramount.

Association of lipid metabolism with pneumonia risk in under-five children in China

ObjectiveThe relationship between lipid metabolism and pneumonia in under-five children remains unclear. The aim of the study was to explore the association of several lipids, lipoproteins and apolipoproteins with the risk of childhood pneumonia, and to initially reveal the mechanisms involved. MethodsThere were 1000 children with confirmed severe pneumonia and 1000 healthy controls (18–59 months old) in the study. Serum levels of several lipids, lipoproteins and apolipoproteins were measured. The occurrence of hypoxaemia and serum level of C-reactive protein were recorded. Multivariate logistic regression and spearman correlation analysis were adopted to assess the correlation between these variables to achieve the research objective. ResultsFirst, higher triglycerides, total cholesterol, LDL cholesterol, VLDL cholesterol and apolipoprotein B levels were associated with the elevated risk of severe pneumonia (OR: 1.407, 95%CI: 1.336∼1.480; OR: 1.947, 95%CI: 1.741∼2.175; OR: 1.153, 95%CI: 1.116∼1.189; OR: 1.310, 95%CI: 1.222∼1.404; OR: 1.075, 95%CI: 1.003∼1.151). Higher HDL cholesterol and apolipoprotein A1 levels were associated with a decreased risk of the disease (OR: 0.903, 95%CI: 0.873∼0.933; OR: 0.921, 95%CI: 0.891∼0.952). Second, higher triglycerides level was associated with an increased risk of hypoxemia in these children (OR: 1.142, 95%CI: 1.072∼1.215). Third, serum HDL cholesterol level was linearly associated with C-reactive protein level in these children (ρ = -0.343, P < 0.001). ConclusionAbnormal levels of several lipids, lipoproteins and apolipoproteins were related to severe childhood pneumonia. The findings that triglycerides and HDL cholesterol were respectively implicated in hypoxaemia and inflammation might partly explain the mechanisms linking lipid metabolism to severe pneumonia.

Malnutrition and Pneumonia among Under-five Children in Sadewa Maternal and Child Hospital, Yogyakarta, Indonesia

Background: Pneumonia is one of the top causes of morbidity in children younger than 5 years old. In Indonesia, pneumonia was the second leading cause of death in children under five years in 2017. The most important risk factors for pneumonia in children are malnutrition, household air pollution, non-exclusive breastfeeding, low birth weight (2500 g), overcrowding (≥ 7 or more person in the same household), and lack of measles immunization. This study aimed to determine the relationship between nutritional status and pneumonia in under-five children in Sadewa Maternal and Child Hospital, Yogyakarta, Indonesia.&#x0D; Methods: Analytical observational studies with a cross-sectional approach. A total of 191 subjects took part in the study. Observations of the nutritional status and degree of pneumonia were carried out in this study. Univariate and bivariate data analysis was carried out with the help of SPSS version 25 software.&#x0D; Results: The majority of study subjects with pneumonia had normal nutritional status. Meanwhile, study subjects with severe pneumonia conditions had malnutrition nutritional status. The results showed that nutritional status was associated with pneumonia, with a p-value of &lt; 0.05.&#x0D; Conclusion: There is a relationship between nutritional status and the severity level of pneumonia in children under five years old in Sadewa Maternal and Child Hospital, Yogyakarta, Indonesia.

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

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. 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. 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. 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.

Determinants of pneumonia among children attending public health facilities in Worabe town

Childhood pneumonia is common in developing countries, with significant morbidity and mortality. Taking the significance of the problem and variability of risk factors into account, a study was needed to identify the potential determinants of pneumonia in under-five children. A facility-based unmatched case–control study was conducted among 435 children (145 cases and 290 controls) aged 2–59 months at public health facilities in Worabe town from December 28, 2016, to January 30, 2017. Data were collected using interviewer-administered questionnaire and analysed using SPSS version 22. Bivariable and multivariable binary logistic regression were used to determine association between dependant and independent variables. Among the factors assessed, stunting [AOR = 3.6,95% CI: 1.9–6.9], carrying the child on the back during cooking [AOR = 2.0,95% CI: 1.2–3.2], absence of chimney in the cooking room [AOR = 2.2, 95% CI: 1.3–3.7], having a history of asthma [AOR = 5.0,95% CI: 2–12], and a previous acute upper respiratory tract infection [AOR = 3.7,95% CI:2.3–6.1] were significantly associated with pneumonia.

Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis.

Pneumonia is the leading cause of death in children globally with the majority of these deaths observed in resource-limited settings. Globally, the annual incidence of clinical pneumonia in under-five children is approximately 152 million, mostly in the low- and middle-income countries. Of these, 8.7% progressed to severe pneumonia requiring hospitalization. However, data to predict children at the greatest risk to develop severe pneumonia from pneumonia are limited. Secondary data analysis was performed after extracting relevant data from a prospective cluster randomized controlled clinical trial; children of either sex, aged two months to five years with pneumonia or severe pneumonia acquired in the community were enrolled over a period of three years in 16 clusters in urban Dhaka city. The analysis comprised of 2,597 children aged 2-59 months. Of these, 904 and 1693 were categorized as pneumonia (controls) and severe pneumonia (cases), respectively based on WHO criteria. The median age of children was 9.2 months (inter quartile range, 5.1-17.1) and 1,576 (60%) were male. After adjustment for covariates, children with temperature ≥38°C, duration of illness ≥3 days, male sex, received prior medical care and severe stunting showed a significantly increased likelihood of developing severe pneumonia compared to those with pneumonia. Severe pneumonia in children occurred more often in older children who presented commonly from wealthy quintile families, and who often sought care from private facilities in urban settings. Male sex, longer duration of illness, fever, received prior medical care, and severe stunting were significantly associated with development of WHO-defined severe childhood pneumonia in our population. The results of this study may help to develop interventions target to reduce childhood morbidity and mortality of children suffering from severe pneumonia.

Intravenous Amoxicillin Plus Intravenous Gentamicin for Children with Severe Pneumonia in Bangladesh: An Open-Label, Randomized, Non-Inferiority Controlled Trial.

The World Health Organization (WHO) recommends intravenous (IV) ampicillin and gentamicin as first-line therapy to treat severe pneumonia in children under five years of age. Ampicillin needs to be administered at a six-hourly interval, which requires frequent nursing intervention and bed occupancy for 5–7 days, limiting its utility in resource-poor settings. We compared the efficacy of IV amoxicillin over IV ampicillin, which is a potential alternative drug in treating severe pneumonia in children between 2–59 months. We conducted an unblinded, randomized, controlled, non-inferiority trial in the Dhaka hospital of icddr,b from 1 January 2018 to 31 October 2019. Children from 2–59 months of age presenting with WHO defined severe pneumonia with respiratory danger signs were randomly assigned 1:1 to either 50 mg/kg ampicillin or 40 mg/kg amoxicillin per day with 7.5 mg/kg gentamicin. The primary outcome was treatment failure as per the standard definition of persistence of danger sign(s) of severe pneumonia beyond 48 h or deterioration within 24 h of therapy initiation. The secondary outcomes were: (i) time required for resolution of danger signs since enrolment, (ii) length of hospital stay, (iii) death during hospitalization, and (iv) rate of nosocomial infections. Among 308 enrolled participants, baseline characteristics were similar among the two groups. Sixty-two (20%) children ended up with treatment failure, 21 (14%) in amoxicillin, and 41 (27%) in ampicillin arm, which is statistically significant (relative risk [RR] 0.51, 95% CI 0.32–0.82; p = 0.004). We reported 14 deaths for serious adverse events, 4 (3%) and 10 (6%) among amoxicillin and ampicillin arm, respectively. IV amoxicillin and IV gentamicin combination is not inferior to combined IV ampicillin and IV gentamicin in treating severe pneumonia in under-five children in Bangladesh. Considering the less frequent dosing and more compliance, IV amoxicillin is a better choice for treating children with severe pneumonia in resource-limited settings.

Clinical Characteristics and Underlying Factors Related to Recovery from Severe Pneumonia in Under-Five Children with or without Malnutrition Treated at Health Care Facilities in Bangladesh.

Severe pneumonia with co-morbidity of malnutrition is one of the leading causes of death among children younger than five years of age. We aimed to compare the clinical features related to recovery from severe pneumonia in malnourished and well-nourished under-five children. A significantly lesser proportion of malnourished children compared to well-nourished recovered from rapid breathing (86.5% vs. 90.2%; p = 0.035), chest wall in-drawing (90.5% vs. 93.9%; p = 0.019), and fever (92.2% vs. 95.2%; p = 0.021) on day six after admission to health-care facilities. Malnourished children with severe pneumonia had significantly more rapid breathing (Adjusted Odds Ratio (AOR)) 1.636, 95% Confidence interval (CI) 1.150–2.328 p = 0.006), chest wall in-drawing (AOR 1.698, 95% CI 1.113–2.590, p = 0.014), and fever (AOR 1.700, 95% CI 1.066–2.710, p = 0.026) compared to those in well-nourished children. The study results suggested the lesser disappearance of clinical features among the malnourished children in Bangladesh underscores their vulnerability to severe pneumonia.

Effect of Vitamin D Supplementation in the Prevention of Recurrent Pneumonia in Under-Five Children.

To assess the effect of vitamin D supplementation in the prevention of recurrent pneumonia in under-five children. The present one year 8 months longitudinal, community-based randomized controlled study included a total of 100 under-five children with pneumonia. Children were divided into two groups: intervention group (Group I: standard treatment with vitamin D 300,000IU; n = 50) and control group (Group C: standard treatment only; n = 50). As nine samples were hemolyzed, groups I and C comprised of 46 and 45 children, respectively. The children were followed up for 1 y and signs of upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), vitamin D deficiency, and vitamin D toxicity were recorded. The male to female ratio in group C and I was 1.27:1 and 1.5:1, respectively (P = 0.420). Age, gender, birth, anthropometric and clinical characteristics, and feeding habits were not statistically significant (P > 0.05) between both the cohorts (Group C and I). Children with reduced vitamin D levels were high in group C (25) when compared to the group I (15). During all the follow-ups, the URTI and LRTI episodes, severity of pneumonia, number of hospital admissions, complications, mean episodes of LRTI, and mean duration of LRTI were comparable between group I and group C (P > 0.05). Overall, the present study highlights that oral vitamin D (300,000IU bolus dose quarterly) has some beneficial effect in the prevention of recurrent pneumonia in under-five children, although, not to a significant degree. Hence, it is recommended that further studies are required to demonstrate a significant effect of vitamin D in the prevention of pneumonia.

The effectiveness of WhatsApp video to increase knowledge of pneumonia early detection among mothers of children under five years

Background and purpose: Number of people in Indonesia who have access to smartphones is quite high, but their use for health education media specifically for the detection of pneumonia is still limited. This study aims to determine the effectiveness of use of video information through the WhatsApp (WA) application compared to leaflets in order to increase maternal knowledge about early detection of pneumonia among under-five children.Methods: A pretest-posttest randomized control trial was conducted in three of the six sub-villages (called banjar) in the Gelgel Village, Klungkung District. Banjar was selected purposively by considering the distance between banjar. As many as 30 mothers were selected as samples from around 45-50 mothers of children under five in each banjar. The intervention was conducted randomly where one banjar was given intervention with videos through WA, one banjar with leaflets and one banjar as a control group. The intervention was carried out for three weeks (August-September 2018). Data were collected before and after the intervention through face-to-face interviews with the mothers in their homes which included social demographics, mother's knowledge about pneumonia detection and educational media preferences. Bivariate data analysis was conducted with paired t-test and multivariate analysis with General Linear Model.Results: Characteristics of respondents in all three groups were similar in terms of age, education, employment and parity. The results of interviews on educational media choices showed that most respondents (64%) preferred WA media. The increase in mean knowledge score after the intervention was significantly higher in the WA group which was 6.93 (95%CI: 6.38-7.49) and leaflet 5.90 (95%CI: 5.49-6.44) compared to the control group 1.87 (95%CI: 1.26-2.47). There was no significant difference between the WA and the leaflet group. The results of multivariate analysis showed that educational media (F=110.99; p&lt;0.001) and education (F=16.69: p&lt;0.001) were significantly associated with the increase in knowledge after adjustments were made based on age, employment and parity.Conclusion: WA videos and leaflets were found to be effective in increasing maternal knowledge about early detection of pneumonia in under-five children. Because the use of WA application is increasing, efforts to increase health knowledge with WA videos need to be enhanced.

The effectiveness of WhatsApp video to increase knowledge of pneumonia early detection among mothers of children under five years

Background and purpose: Number of people in Indonesia who have access to smartphones is quite high, but their use for health education media specifically for the detection of pneumonia is still limited. This study aims to determine the effectiveness of use of video information through the WhatsApp (WA) application compared to leaflets in order to increase maternal knowledge about early detection of pneumonia among under-five children. Methods: A pretest-posttest randomized control trial was conducted in three of the six sub-villages (called banjar) in the Gelgel Village, Klungkung District. Banjar was selected purposively by considering the distance between banjar. As many as 30 mothers were selected as samples from around 45-50 mothers of children under five in each banjar. The intervention was conducted randomly where one banjar was given intervention with videos through WA, one banjar with leaflets and one banjar as a control group. The intervention was carried out for three weeks (August-September, 2018). Data were collected before and after the intervention through face-to-face interviews with the mothers in their homes, which included social demographics, mother's knowledge about pneumonia detection and educational media preferences. Bivariate data analysis was conducted with paired t-test and multivariate analysis with General Linear Model. Results: Characteristics of respondents in all three groups were similar in terms of age, education, employment, and parity. The results of interviews on educational media choices showed that most respondents (64%) preferred WA media. The increase in mean knowledge score after the intervention was significantly higher in the WA group which was 6.93 (95%CI: 6.38-7.49) and leaflet 5.90 (95%CI: 5.49-6.44) compared to the control group 1.87 (95%CI: 1.26-2.47). There was no significant difference between the WA and the leaflet group. The results of multivariate analysis showed that educational media (F=110.99; p&lt;0.01) and education (F=16.69; p&lt;0.01) were significantly associated with the increase in knowledge after adjustments were made based on age, employment and parity. Conclusion: WA videos and leaflet were found to be effective in increasing maternal knowledge about early detection of pneumonia in under-five children. Because the use of WA application is increasing, efforts to improve health knowledge with WA videos need to be enhanced.

Risk factors for acute severe pneumonia in under five children

Background: Acute severe pneumonia is the leading cause of death in children below five years of age. India tops in the list amongst the 15 countries having a high incidence of childhood pneumonia with 43 million episodes of pneumonia annually. Identification of modifiable risk factors of acute severe pneumonia can help in reducing the burden of disease.Methods: A hospital-based case control study was undertaken to determine risk factors associated with acute severe pneumonia in under-five children. A case definition of acute severe pneumonia as given by world health organization (WHO) was used for cases. Healthy children attending Pediatrics outpatient Department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in pre-designed proforma. 732 children including 366 cases and 366 controls were enrolled in the study.Results: On stepwise logistic regression analysis it was found that low literacy status of the mother (OR:9.46; 95%CI:7.31-19.0); inappropriate immunization for age (OR:38.04; 95%CI 14.59-110.18);cooking fuel other than liquid petroleum gas (OR:3.79; 95%CI: 2.40-6.78); low socioeconomic status (OR: 6.12; 95%CI: 2.42-35.48); overcrowding (OR:1.21; 95%CI: 1.03- 2.21) and upper respiratory infection in family (OR:5.08; 95%CI: 3.79-7.67) were the significant contributors to the occurrence of acute severe pneumonia in children under five years.Conclusions: Low literacy status of mother, incomplete immunization status, use of fuel other than LPG, low socioeconomic status, overcrowding, family history of URTI emerged as risk factors for occurrence of acute severe pneumonia in under five children.

HUBUNGAN KONDISI LINGKUNGAN RUMAH DENGAN KEJADIAN PNEUMONIA PADA BALITA DI WILAYAH KERJA PUSKESMAS TAMAN KABUPATEN SIDOARJO

Pneumonia is the cause of 16% of underfive children deaths worldwide. The number of cases of pneumonia in Sidoarjo had been continued to increase from 2013-2015. This study aims to describe the condition of home environment with the incidence of pneumonia in underfive children. This research was descriptive observational study with case control study approach. The sample in this study consisted of 32 cases of underfive children who suffering ISPA pneumonia and 32 cases of ARI without pneumonia. The independent variables in this study were occupancy density, ventilation area, floor type, wall type, and cigarette smoke exposure. The results showed that underfive children who suffering ISPA pneumonia have high home density (68,8%), often exposed by cigarette smoke (75,0%), and ventilation respondents was not eligible (100,0%). Based on the results of this study, the parents should to change the behavior not to smoke in their home. In addition, they should get used to open the door of their house so the air circulation in the house can exchange well.

Assessment of medical doctors adherence to national protocol for treatment of severe pneumonia in underfive children admitted to WadMedani pediatric teaching hospital, Gezira State, Sudan (2018)

Objective: To assess medical doctors adherence to national protocol for treatment of severe pneumonia in under-five children. Methods: A descriptive, across-sectional among medical doctors and prospective among children study was conducted in the period from 10-25th of October 2018. Children, less than five years of age admitted and treated for severe pneumonia were enrolled. Medical doctors of consultants, registrars, medical officers and house officers in charge of treating the children were enrolled. A pre-constructed questionnaire was distributed among medical doctors and data collection sheets were filled from patient’s admission sheet. The data were organized and analyzed using the SPSS version. Results: Only 80 (72%) out of 110 enrolled patients treated by medical doctors according to national pneumonia protocol. Benzylpenicillin was most single used antibiotic followed by cefotaxime while cefepime was least one majority of patients 77 (70%) were responded to treatment 65 (59%) patients’ responded that prescribed according to national pneumonia protocol. There was association between adherence to national pneumonia protocol and immunization status of patient’s p-value 0.001, while association was not considered significant between response and the immunization status of patients. The barriers to follow the protocol by medical doctors includes lack of awareness about protocol, mimic seniors and patient factors such as low socio-economic status of families. Conclusion: Encouraging dissemination and hospital-level implementation of the national protocol by posters, workshops and better training of healthcare providers especially the junior doctors and critical review of implementing the protocol in prescriptions.

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

The role of caregivers in the successful management and prevention of pneumonia in under-five children goes beyond having the requisite knowledge, it also importantly depends on their attitude and health-seeking behaviour.The study determined the attitude and health-seeking behaviour of caregivers towards management of pneumonia in under-5 children in selected communities in Kaduna State Nigeria.The mixed method research approach used 500 caregivers of under-5 children in urban and rural communities in Kaduna state. Ethical approval and informed consent of participants was obtained before data was collected using a pre-tested semi-structured questionnaire and a focus group discussion guide. Chi-square statistical test was used to test for association between variables, while data from the focus group discussion was analyzed using thematic coding process.The respondents,198 (39.6%) of them in this study strongly agree that pneumonia is a highly dangerous disease in under-five children. Most respondents had fair health seeking behaviour 236 (47.2%). Good health-seeking behaviour was significantly more among the high-income earners and caregivers with higher educational level (p<0.01).Community attributes and household resources were identified as vaccine hesitancy by caregivers of under-5 children towards the management of pneumonia. Provision of good information to caregivers on benefits of proper management of pneumonia may also improve health seeking behaviour.Keywords: Pneumonia, Caregivers, Under-5 children, Attitude, Health-seeking behaviour

The role of indoor air pollution and other factors in the incidence of pneumonia in under-five children

Background The World Health Organization has asked for a spe-cial attention to the relation between pneumonia and indoor airpollution, i.e., household biomass fuel smoke, cigarette smoke,and mosquito coil smoke, especially in developing countries.Objective To analyze the role of indoor air pollution and otherfactors as risk factors for pneumonia in under-five-year children.Methods This case-control study was carried out from August un-til December 2000 at Public Health Centers in Banjarnegara,Kebumen, Jepara, and Pekalongan districts. All children qualify-ing pneumonia classification as recommended by WHO in IMCI(Integrated Management of Childhood Illness) were defined ascases and without pneumonia as controls. Severe pneumonia andno pneumonia (as classified in IMCI) were excluded. Statisticalanalysis was done using bivariate and logistic regression.Results There were three hundreds and five children with pneu-monia and 289 children without pneumonia. By bivariate analysis,biomass fuel smoke (OR=3.25; 95%CI 1.50;7.07) and cigarettesmoke exposure from other family members (OR=1.63; 95%CI1.11;2.38) were risk factors for pneumonia, while mosquito coilsmoke (OR=1.13; 95%CI 0.79;1.69) was not. History of wheezing(OR=2.60; 95%CI 2.7;8.55), malnutrition (OR=2.60; 95%CI1.33;5.07), and male sex (OR=1.47; 95%CI 1.06;2.04) were otherrisk factors.Conclusions Household biomass fuel smoke and cigarette smokewere risk factors for pneumonia. Other variables as risk factorswere history of wheezing, male sex, and malnutrition

Vitamin D Supplementation for Treatment and Prevention of Pneumonia in Under-five Children: A Randomized Double-blind Placebo Controlled Trial.

To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in under-five children. Randomized, double blind, placebo-controlled trial. Tertiary-care hospital. 324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL). 100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment. Outcome variables: Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness. Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness. Median (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1.39 (1.11, 1.76); P = 0.005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22.8%); vitamin D: 39/156 (25%); RR (95% CI): 1.13 (0.67,1.90); P 0.69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention. There is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.