Pneumonia In Under-five Children Research Articles

Predisposing Factors of Community Acquired Pneumonia in Under-Five Children

Objective: Pneumonia is a leading cause of mortality and morbidity in under five children in developing countries. Hence, the present study was undertaken to identify the various predisposing factors for pneumonia in children aged 1 month to 5 years. Methods: Sixty pneumonia cases fulfilling the inclusion criteria, in the age group of 1 month to 5 years were interrogated for potential predisposing factors as per a predesigned proforma. Sixty healthy control children in the same age group were also interrogated. Results: The significant predisposing factors for pneumonia were overcrowding (p value < 0.001), lack of exclusive breastfeeding for first 6 months in babies less than 1 year old (p value < 0.05), incomplete immunization for age (p value < 0.001) and malnutrition (p value < 0.001). On logistic regression analysis, overcrowding and malnutrition were significant independent risk factors. Conclusion: The present study has identified many demographic, nutritional and environmental pre-disposing factors for pneumonia which can be tackled by effective health education of the community and appropriate initiatives taken by the government.

Treatment of severe community-acquired pneumonia with oral amoxicillin in under-five children in developing country: a systematic review.

ObjectiveTo assess the evidence regarding efficacy of oral amoxicillin compared to standard treatment for WHO-defined severe community acquired pneumonia in under-five children in developing country.DesignSystematic review and meta-analysis of data from published Randomized trials (RCTs).Data sourcesMEDLINE (1970– July 2012) via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 7, July 2012), and EMBASE (1988– June 2012).MethodsEligible trials compared oral amoxicillin administered in ambulatory setting versus standard treatment for WHO-defined severe community acquired pneumonia in children under-five. Primary outcomes were proportion of children developing treatment failure at 48 hr, and day 6. GRADE criteria was used to rate the quality of evidence.ResultsOut of 281 full text articles assessed for eligibility, 5 trials including 12364 children were included in the meta-analysis. Oral amoxicillin administered either in hospital or community setting is effective in treatment of severe pneumonia and is not inferior to the standard treatment. None of the clinical predictors of treatment failure by 48 hr (very severe disease, fever and lower chest indrawing, and voluntary with-drawl and loss to follow up) was significant between the two groups. The clinical predictors of treatment failure that were significant by day 6 were very severe disease, inability to drink, change of antibiotic, and fever alone. The effect was almost consistent across the studies.ConclusionThough oral amoxicillin is effective in treatment of severe CAP in under-five children in developing country, the evidence generated is of low-quality. More trials with uniform comparators are needed in order to strengthen the evidence.

Risk factors for severe acute lower respiratory infections in children – a systematic review and meta-analysis

AimTo identify the risk factors in children under five years of age for severe acute lower respiratory infections (ALRI), which are the leading cause of child mortality.MethodsWe performed a systematic review of published literature available in the public domain. We conducted a quality assessment of all eligible studies according to GRADE criteria and performed a meta-analysis to report the odds ratios for all risk factors identified in these studies.ResultsWe identified 36 studies that investigated 19 risk factors for severe ALRI. Of these, 7 risk factors were significantly associated with severe ALRI in a consistent manner across studies, with the following meta-analysis estimates of odds ratios (with 95% confidence intervals): low birth weight 3.18 (1.02-9.90), lack of exclusive breastfeeding 2.34 (1.42-3.88), crowding – more than 7 persons per household 1.96 (1.53-2.52), exposure to indoor air pollution 1.57 (1.06-2.31), incomplete immunization 1.83 (1.32-2.52), undernutrition – weight-for-age less than 2 standard deviations 4.47 (2.10-9.49), and HIV infection 4.15 (2.57-9.74).ConclusionThis study highlights the role of the above seven risk factors in the development of severe pneumonia in under-five children. In addition, it emphasizes the need for further studies investigating other potential risk factors. Since these risk factors are potentially preventable, health policies targeted at reducing their prevalence provide a basis for decreasing the burden of childhood pneumonia.

Vitamin D supplementation for severe pneumonia — A randomized controlled trial

To determine the role of oral vitamin D supplementation for resolution of severe pneumonia in under-five children. Randomized, double blind, placebo-controlled trial. Inpatients from a tertiary care hospital. Two hundred children [mean (SD) age: 13.9 (11.7) months; boys: 120] between 2 months to 5 years with severe pneumonia. Pneumonia was diagnosed in the presence of fever, cough, tachypnea (as per WHO cut-offs) and crepitations. Children with pneumonia and chest indrawing or at least one of the danger sign (inability to feed, lethargy, cyanosis) were diagnosed as having severe pneumonia. The two groups were comparable for baseline characteristics including age, anthropometry, socio-demographic profile, and clinical and laboratory parameters. Oral vitamin D (1000 IU for <1 year and 2000 IU for >1 year) (n=100) or placebo (lactose) (n=100) once a day for 5 days, from enrolment. Both the groups received antibiotics as per the Indian Academy of Pediatrics guidelines, and supportive care (oxygen, intravenous fluids and monitoring). Primary: time to resolution of severe pneumonia. Secondary: duration of hospitalization and time to resolution of tachypnea, chest retractions and inability to feed. Median duration (SE, 95% CI) of resolution of severe pneumonia was similar in the two groups [vitamin D: 72 (3.7, 64.7-79.3) hours; placebo: 64 (4.5, 55.2-72.8) hours]. Duration of hospitalization and time to resolution of tachypnea, chest retractions, and inability to feed were also comparable between the two groups. Short-term supplementation with oral vitamin D (1000-2000 IU per day for 5 days) has no beneficial effect on resolution of severe pneumonia in under-five children. Further studies need to be conducted with higher dose of Vitamin D or longer duration of supplementation to corroborate these findings.

A Randomized Controlled Trial of Oral Zinc in Acute Pneumonia in Children Aged between 2 Months to 5 Years

To evaluate the effectiveness and safety of zinc supplementation as adjuvant in treatment of pneumonia. Ninety-eight children with acute bacterial pneumonia, aged between 2 months to 5 years, were studied in a randomized controlled single blind design. They received either zinc supplementation, as zinc acetate syrup, or placebo, as vitamin B-complex syrup, for 14 days, concomitantly with antimicrobial treatment (49 per group). Chest radiograph and blood tests were done for confirmation of diagnosis and severity of pneumonia was assessed by breathing rate, chest in-drawing and body temperature. Potentially immunosuppressed children or those with serious comorbidity were excluded. Follow-up was done daily while subjects were admitted (generally 7 days) and the final assessment made on the 14th day on out-patient basis. Children enrolled in zinc and placebo groups were of comparable age [17 ± 10 and 10 ± 30 months (median ± interquartile range) respectively] and sex distribution [34 (69.4%) vs 31 (63.3%) males respectively]. Duration of illness at diagnosis was also comparable. Patients supplemented with zinc showed no difference in clinical cure rate at 14 days when compared with placebo. Fast breathing was present after 1 wk of treatment in 49% subjects in zinc supplemented vs 43% on placebo (p = 0.685). There was also no difference in breathing rate at study end. Regarding fever, the mean temperature was <99°F in both groups at study end. Hemoglobin, total leukocyte count, standard liver function tests and creatinine showed no difference between groups either at baseline or at study end. There were no treatment emergent adverse events attributable to zinc. Though well tolerated; the addition of zinc does not improve symptom duration or cure rate in acute bacterial pneumonia in under-five children.