Risk Factors For Childhood Pneumonia Research Articles

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 dilutiondue 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.

Determinants of under-five pneumonia among children visited in nine public health Hospitals in Ethiopia

BackgroundPneumonia is a top serious problem for under-five children. Although pneumonia affects children worldwide, the disease's risk and consequences are more widespread in low- and middle-income countries. ObjectivesThis study aimed to identify predictors of childhood pneumonia among children who visited public Hospitals located in West Shoa Zone, Oromia, Ethiopia. MethodsA case–control study was conducted among 375 (125 cases and 250 controls) to identify predictors of childhood pneumonia among children who visited in nine public health Hospitals from May to July 2022. Binary logistic regression was used to analyze the data. Variables with a p-value less than 0.05 in a multivariable logistic regression were declared statistically significant. ResultsAmong respondents 42.1% were males and 57.9% were females. Factors such as using water without soap for hand washing before child feeding [AOR: 3.09, 95% CI: 1.59–6.00] and house near the street [AOR: 2.87, 95% CI: 1.54–5.37] were found to be the determinant of under-five pneumonia. Similarly, animal dung as a source of fuel [AOR: 2.26, 95% CI: 1.06–4.79], Child care given by the house worker or home maid [AOR: 3.35, 95% CI: 1.59–7.05], and having acute respiratory tract infection in the last two weeks [AOR: 6.46, 95% CI: 3.32–12.56] were significantly associated with under-five pneumonia. ConclusionsHand washing with soap before child feeding, cooking with animal manure, and a history of acute respiratory tract infection in the previous two weeks were found as risk factors for childhood pneumonia.

Correlation between Infantile Vitamin D Insufficiency and the Incidence of Acute Lower Respiratory Tract Infections

Background: The deficiency of Vitamin D is a common nutritional problem that is often overlooked. However, increasing evidence shows that vitamin D has a vital role in building immunity and protecting against respiratory tract infections. The researchers found that people with lower serum vitamin D levels had a higher chance of experiencing severe respiratory tract infections. It is suggested that a deficiency of vitamin D may be a risk factor for severe respiratory tract infections. Objectives: This study investigated the correlation between vitamin D concentration and the severity of acute respiratory tract infections in infants. Study design: An analytical cross-sectional study Place and Duration This study was conducted in unit 1 Civil Hospital Karachi from April 2022 to April 2023. Methodology: The study examines the link between serum vitamin D concentration and severe acute lower respiratory tract infections (ALRTI) in children aged one month to one year. The study included two groups: a case group of children with severe ALRTI and a control group of children without the infection. The primary outcome measure involved assessing the serum concentration of vitamin D in the two study groups. Results: The median age of the case group was 5 months, with an interquartile range (IQR) of 4.75 months. The median age of the control group was 4 months, with an IQR of 4 months. The baseline demographic and anthropometric characteristics exhibited no significant differences between the two groups. Nevertheless, it was observed that the median vitamin D levels in the case group were significantly lower compared to the control group (p < 0.05). Conclusion: The findings of our study indicate that vitamin D deficiency represents a significant risk factor for childhood pneumonia, particularly in the context of severe Acute Lower Respiratory Tract Infections (ALRTI). We found that a significant number of infants with ALRTI had a severe deficiency in vitamin D. Notably, the deficiency was seen more in infants who were exclusively breastfed. These findings suggest that increasing vitamin D quantity in diets can help to reduce the chance of severe ALRTI. Keywords: Respiratory Tract Infections, Infants, Vitamin D

Risk factors for childhood pneumonia at Adama Hospital Medical College, Adama, Ethiopia: a case-control study

BackgroundPneumonia is an acute respiratory infection of the lungs. A child dies of pneumonia every 39 s globally. Even though pneumonia affects children worldwide, the risk and repercussions of the disease are more prevalent in poor and middle-income nations. Despite the initiatives by the Ethiopian government, there are still numerous instances and deaths caused by childhood pneumonia. Therefore, this study aimed to identify the risk factors for pneumonia among 2–59 months-old children visiting Adama Hospital Medical College, Adama, Ethiopia.MethodsAn institution-based unmatched case-control study was conducted among 124 cases and 124 controls from January 1, 2021, to March 15, 2021. Cases were selected using a consecutive sampling technique. For each case, the next patient from the same pediatric outpatient room who met the inclusion criteria was taken as a control. Data were collected using a pretested, structured interviewer-administered questionnaire containing sociodemographic, environmental, and nutritional factors, comorbid illnesses, and related care practices. A multiple logistic regression model was fitted.ResultsFamily size of ≥ 5 compared to < 5 (Adjusted odds ratio (AOR): 3.08, 95% CI: 1.23, 7.71), household monthly income of < 2500 compared to > 5000 birr (AOR: 3.94, 95% CI: 1.06, 14.6), use of charcoal as the main fuel for cooking (AOR: 7.03, 95% CI: 2.38, 20.78), and wood or dung as the main fuel for cooking compared to electricity (AOR: 6.58, 95% CI: 2.07, 20.9), malnutrition compared to no malnutrition (AOR: 4.77, 95% CI: 1.89, 12.06), diarrhea compared to no diarrhea in the past 2 weeks (AOR: 3.3, 95% CI: 1.52, 7.14) and upper respiratory tract infection (URTI) compared to no infection in the past 2 weeks (AOR: 3.29, 95% CI: 1.31, 8.23) were found to be risk factors for pneumonia.ConclusionIn this study, risk factors for pneumonia were family size, monthly income, type of energy used for cooking, malnutrition, and diarrhea or URTI in the past 2 weeks. Relatively simple interventions such as cooking with electricity, and other interventions like prevention, early detection and treatment of malnutrition, diarrhea, and URTI, and promotion of family planning are important.

Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia.

BackgroundAcute respiratory infections (ARIs), especially pneumonia, remain a major cause of infant mortality worldwide. In Indonesia, pneumonia is the second most common cause of infant and toddler deaths. Exclusive breastfeeding and basic immunization can protect infants and children from contracting pneumonia.PurposeOur goal was to assess the risk factors for childhood pneumonia in regions with a high prevalence of pneumonia in Indonesia.MethodsThis case-control study was conducted between March and April 2019. A total of 176 infants and toddlers aged 10–59 months were enrolled and selected from among patients who visited the community health center. Cases of pneumonia were diagnosed clinically based on the World Health Organization guidelines, and the control was nonpneumonia.ResultsThe risk factors for the diagnosis of pneumonia included no or nonexclusive breastfeeding (odds ratio [OR], 7.95; 95% confidence interval [CI], 3.52–17.94), incomplete basic immunizations (OR, 4.47; 95% CI, 2.22–8.99), indoor air pollution (OR, 7.12; 95% CI, 3.03–16.70), low birth weight (OR, 3.27; 95% CI, 1.19–8.92), and a high degree of wasting (OR, 2.77; 95% CI, 1.06–7.17). Other variables such as nutritional status (height-for-age z score), age, sex, and educational status of the mother were not risk factors for pneumonia.ConclusionNo or nonexclusive breastfeeding, incomplete basic immunizations, indoor air pollution, a history of low birth weight, and severe malnutrition were risk factors for childhood pneumonia. Breastfeeding was the dominant factor, while sex modified the relationship between exclusive breastfeeding and the incidence of pneumonia.

Household Air Pollution (HAP) is Associated With Increased Pneumococcal Carriage in Malawian Infants – Malawi&amp;nbsp; &lt;i&gt;Streptococcus pneumoniae&lt;/i&gt;&amp;nbsp;Carriage and Air Pollution Exposure (MSCAPE) Study

Background: Household air pollution (HAP) from solid cooking fuels is a risk factor for childhood pneumonia. Nasopharyngeal carriage of Streptococcus pneumoniae is a necessary step in development of pneumococcal pneumonia. We hypothesised that HAP influences S. pneumoniae carriage. MSCAPE assesses the relationship between HAP from solid cooking fuels and prevalence/density of S. pneumoniae carriage among children. Methods: MSCAPE is a prospective study of children participating in a trial of a cleaner burning cookstove to reduce childhood pneumonia incidence in Malawi (CAPS). MSCAPE assessed the impact of HAP exposure on prevalence of S. pneumoniae carriage in 6 week and 6 month old children through intention-to-treat and adjusted exposure-response analyses. Exposure to HAP (PM2·5) was assessed through RTI Micropem and S. pneumoniae detection in nasopharyngeal swabs. Findings: S. pneumoniae carriage prevalence was 39% (n=89) and 85% (n=398) in 6 week and 6 month old children respectively. A higher mean PM2·5 exposure was observed in intervention children (53·9 µg/m3) than controls (49·0 µg/m3), although not significant (p>0.05). Intention-to-treat analysis found a non-significant increased risk of S. pneumoniae carriage in intervention children (OR=1·36; 95% CI:0·97, 1·92). Exposure-response analysis found a significant association between HAP exposure and S. pneumoniae carriage with a 10% increase in risk per decile of PM2·5 exposure (OR=1·10; 95% CI:1·01, 1·20, p=0·035). Interpretation: Despite the lack of observed impact from the cleaner burning cookstove intervention, HAP exposure (PM 2·5) was significantly associated with S. pneumoniae prevalence giving empirical evidence for the potential mechanistic relationship between HAP and childhood pneumonia. Funding Statement: This work was supported by Bill and Melinda Gates Foundation through grant number OPP1131425. The CAPS was funded by a Joint Global Health Trials Grant from the Medical Research Council, the UK Department for International Development and Wellcome Trust (MR/K006533/1). Declaration of Interests: There are no financial competing interests in relation to the work described. Ethics Approval Statement: Ethical approval was provided by the College of Medicine Research and Ethics Committee (COMREC), Malawi (P.08/15/1794) and the Central Ethics Committee of the University of Liverpool (RETH000839).

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses.

Background: Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives: We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods: A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011–2012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child’s parents. Results: In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95–2.37), croup (1.46, 1.24–1.73), wheeze (1.44, 1.30–1.60), asthma (1.38, 1.19–1.61), food allergy (1.29, 1.13–1.46), and allergic rhinitis (1.23, 1.07–1.41), and as well as current (one year before the survey) common cold (≥3 times) (1.38, 1.25–1.52), dry cough (1.27, 1.13–1.42), atopic dermatitis (1.25, 1.09–1.43), wheeze (1.23, 1.10–1.38), and rhinitis symptoms (1.15, 1.04–1.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions: Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.

Lifetime-ever pneumonia among pre-school children across China – Associations with pre-natal and post-natal early life environmental factors

BackgroundBiomass burning is associated with childhood pneumonia but few studies exist on other indoor factors. AimTo study pneumonia in relation to pre-natal and post-natal exposure among children across China. MethodsChildren (3–6 y) (n = 39,782) from randomized day care centres in seven cities in China. Information on pneumonia and pre-natal and post-natal exposure to home environment factors were assessed by a parental questionnaire. Life-time outdoor temperature and GDP per capita were assessed on city level. Associations were calculated by multilevel logistic regression adjusting for fourteen co-variates. ResultsTotally 32.0% had ever had pneumonia diagnosed by a physician. Children of farmer mothers (OR = 0.65), with breastfeeding (OR = 0.91) and living in rural (OR = 0.85) or suburban (OR = 0.90) areas had less pneumonia. Buying new furniture one year before conception (OR = 1.11) and after first year of life (OR = 1.10) increased the risk. Redecoration one year before conception (OR = 1.20), during pregnancy (OR = 1.18) and after first year of life (OR = 1.17) increased pneumonia risk. Children with mould (OR = 1.17), window pane condensation (WPC) (OR = 1.20) and mould odour (OR = 1.15) at home at birth only had a higher risk of pneumonia. Similar associations were seen for dampness and mould in the current home. Children in the oldest and newest homes had less pneumonia. Cockroaches (OR = 1.08), mosquitos or flies in the current home (OR = 1.18), an exhaust fan in the bathroom (OR = 1.10) and higher economic development level, measured as GDP per capita on city level (OR 1.11 per 10,000 RMB/year) were associated with childhood pneumonia. ConclusionsPerinatal and postnatal exposure to mould, mould odour and window pane condensation at home can be early life risk factors for childhood pneumonia in China. Moreover, pre-natal and post-natal exposure to chemical emissions from new furniture and renovation could increase the risk of childhood pneumonia. Breastfeeding, farm exposure, and living in rural or suburban areas could be protective.

The Relationship between Pneumonia with Parental Smoking in Children under 10 Years Old: A Case- Control Study

Background Recognition of risk factors for childhood pneumonia as the main cause of mortality and morbidity is essential. We aimed to determine the relationship of pneumonia with parental smoking in hospitalized children under 10 years old in Qom city, Iran. Materials and Methods This case-control study was performed among 240 children under 10 years old in Ayatollah Golpayegani hospital in Qom city, Iran. Patients were recruited by convenience sampling; 120 patients with pneumonia as the case group, and 120 patients without pneumonia as the control group were enrolled. Parents were asked about duration of exposure to cigarette smoking, the number of cigarettes smoked per day by parents, the frequency of the smokers in family of children, parental education, age of exposure to cigarette smoking, location of smoking, frequency of hospitalization, and duration of hospitalization. The parental smoking was assessed and compared across two groups. The data were analyzed using SPSS software (version 13.0). Results The mean age in case group was 29.1±30.3 months and in control group was 32.9±31.1 months. In this study it was seen that lower age of smoking exposure was related to pneumonia. In fact significant difference was found between the groups for age of exposure to cigarette smoking (p=0.001), and location of smoking (p=0.048), but the other variables such as duration of hospitalization (day), hemoglobin level, frequency of the smokers in family of children and parental education had no association (P > 0.05). Conclusion Based on the results of this study and comparing with similar studies conducted in this field, it can be concluded that pneumonia is related to parental smoking especially in younger ages.

Residential Ambient Traffic in Relation to Childhood Pneumonia among Urban Children in Shandong, China: A Cross-Sectional Study.

Pneumonia is a leading cause of childhood death. Few studies have investigated associations between residential ambient environmental exposures and pneumonia. In January–April 2015, we conducted a cross-sectional study in Shandong Province (China) and collected 9597 (response rate: 78.7%) parent-reported questionnaires for 3–6-year-old children from 69 urban kindergartens. We then selected 5640 children who had never changed residence since birth and examined associations between residential ambient traffic-related facilities and childhood pneumonia considering residential characteristics. Prevalence of doctor-diagnosed pneumonia during lifetime-ever was 25.9%. In the multivariate logistic regression analyses, residence close to a main traffic road (adjusted odds ratio, 95% confidence interval: 1.23, 1.08–1.40) and automobile 4S shop (1.76, 1.16–2.67) within 200 m, residence close to a filling station within 100 m (1.71, 1.10–2.65; reference: >200 m), as well as having a ground car park in the residential community (1.24, 1.08–1.42) were significantly associated with childhood pneumonia. The cumulative numbers of these traffic-related facilities had a positive dose-response relationship with the increased odds of childhood pneumonia. These associations and dose-response relationships were stronger among boys and among children with worse bedroom ventilation status during the night. Associations of residence close to the main traffic road and ground car parks in the residential community with childhood pneumonia were stronger among children living in the 1st–3rd floors than those living on higher floors. Similar results were found in the two-level (kindergarten-child) logistic regression analyses. Our findings indicate that living near traffic-related facilities is likely a risk factor for childhood pneumonia among urban children. The child’s sex, bedroom floor level, and bedroom ventilation could modify associations of ambient traffic-related facilities with childhood pneumonia.

Residential risk factors for childhood pneumonia: A cross-sectional study in eight cities of China

BackgroundChildren's pneumonia is a heavy health burden. Few studies have been carried out on residential risk factors for pneumonia in children. Potential risks associated with dwelling characteristics are still unknown. MethodsA cross-sectional study was conducted among children in 8 cities in China during 2010–2011 and 41,176 valid data on children aged 3–8 years old were used in this analysis. To obtain the lifetime-ever incidence of pneumonia in children and identify associations between pneumonia and residential risk factors, chi-square analysis and logistic regression methods were employed. Adjusted odds ratios were used as measures of effect with a 95% confidence interval. Confounding variables in the regression model include children's gender, birthweight, breastfeeding duration, parental smoking and family history of atopy. ResultsThe average lifetime-ever incidence of childhood pneumonia was 32.3%. Urban children (33.6%) had more pneumonia than suburban (29.9%) and rural children (24.9%). More residential risk factors were found in urban-dwellings. Boys, low birthweight (<2500 g), breastfeeding duration <6 months, family allergic history, and exposure to parental smoking were found to be associated with higher pneumonia lifetime-ever incidences. Various indicators of dampness, including visible mold spots, damp stains, water damage, water condensation, damp clothing or bedding and mold odor, were also positively associated with pneumonia. Pneumonia incidence increased as the number of dampness indicators increased. Both natural gas and solid cooking fuels were positively associated with pneumonia compared with electricity. Compared with cement, construction materials including synthetic fiber, laminated wood, real wood, paint, emulsion paint and wall paper were positively associated with pneumonia. Daily living habits such as putting bedding to sunshine frequently and cleaning the child's bedroom every day could be effective preventive strategies. A dose-response relationship between the number of residential risk factors and pneumonia was observed when the risk factors number ranged from 7 to 11. Residences with more risk factors had higher lifetime-ever pneumonia odds ratios. ConclusionsIndoor environmental factors including dampness, use of solid fuels or natural gas for cooking and use of new construction materials are risk factors for childhood pneumonia. This study gives evidence for the importance of home environment exposures in the occurrence of childhood pneumonia. Actions against the residential risk factors described in this study may help to prevent pneumonia in children.

Serum vitamin D concentration in acute lower respiratory tract infection in infants: a case control study from Northern India

Background: Vitamin D insufficiency is believed to be the most common nutritional deficiency and one of the most undiagnosed medical conditions in this region. People across the world are becoming increasingly aware of the role played by vitamin D in health and disease, especially its role in immunity and its anti-infective role. The present study was conducted to study the relationship between serum vitamin D levels and severity of respiratory tract infections. To study the relation between serum vitamin D levels and severity of acute respiratory tract infections.Methods: 1-year prospective study from September 2014 to August 2015. Children from 1 month to 1 year of age participated in the study. Serum Vitamin D levels were measured in case group suffering from severe acute lower respiratory tract infections (ALRTI) and in a control group. The primary outcome variable was difference in serum vitamin D levels between case group and control group.Results: The median (IQR) age of cases and controls was 5.0 (4.75) months and 4.0 (4.0) months, respectively. There were no significant differences in baseline demographic and anthropometric parameters between the 2 groups. The median vitamin D level in a case group was significantly lower compared with matched controls (p &lt;0.05).Conclusions: Vitamin D deficiency is an important independent risk factor for childhood pneumonia. We found a severe vitamin D deficiency of our infants suffering from severe acute lower respiratory tract infections. The deficiency was more prevalent in exclusive breast feed infants.

Childhood pneumonia and crowding, bed-sharing and nutrition: a case-control study from The Gambia.

Greater Banjul and Upper River Regions, The Gambia. To investigate tractable social, environmental and nutritional risk factors for childhood pneumonia. A case-control study examining the association of crowding, household air pollution (HAP) and nutritional factors with pneumonia was undertaken in children aged 2-59 months: 458 children with severe pneumonia, defined according to the modified WHO criteria, were compared with 322 children with non-severe pneumonia, and these groups were compared to 801 neighbourhood controls. Controls were matched by age, sex, area and season. Strong evidence was found of an association between bed-sharing with someone with a cough and severe pneumonia (adjusted OR [aOR] 5.1, 95%CI 3.2-8.2, P < 0.001) and non-severe pneumonia (aOR 7.3, 95%CI 4.1-13.1, P < 0.001), with 18% of severe cases estimated to be attributable to this risk factor. Malnutrition and pneumonia had clear evidence of association, which was strongest between severe malnutrition and severe pneumonia (aOR 8.7, 95%CI 4.2-17.8, P < 0.001). No association was found between pneumonia and individual carbon monoxide exposure as a measure of HAP. Bed-sharing with someone with a cough is an important risk factor for severe pneumonia, and potentially tractable to intervention, while malnutrition remains an important tractable determinant.

Exposure to fine particulate matter from traffic in early life and childhood pneumonia

Introduction: Exposure to air pollution in early life may increase susceptibility to childhood pneumonia. We examined the association between exposure to fine particulate matter (PM2.5) from traffic and pneumonia in the first two years of life. Methods: Cox proportional hazards regression was used to assess the association between primary PM2.5 from traffic emissions, modeled using A Research LINE-source dispersion model (RLINE) at 250 meter resolution, and pneumonia by age two among 22,517 children from the Kaiser Air Pollution and Pediatric Asthma Study (KAPPA). KAPPA is a historical birth cohort of children born between 2000 and 2010 and insured by Kaiser Permanente Georgia. Average ambient PM2.5 from traffic at a child’s residence was estimated for the first year of life, or until the time of pneumonia diagnosis or insurance enrollment attrition if that occurred before the first birthday. Pneumonia was defined as one diagnosis of pneumonia (ICD-9 codes 480-486) in the medical record after the first 28 days of life (excluding neonatal pneumonia). Results: 2,188 children were diagnosed with pneumonia during follow-up. Average traffic PM2.5 exposure ranged from 0.31 to 2.66 micrograms per cubic meter (ug/m3). We estimated a modest positive association between PM2.5 exposure in early life and pneumonia incidence (hazard ratio (95% confidence interval): 1.17 (0.93, 1.47) for a change of 1 ug/m3 PM2.5) in a model controlling for sex, race, maternal asthma, prenatal smoking, maternal age, maternal education, city region, and neighborhood socioeconomic status. Low maternal education was the strongest risk factor for childhood pneumonia (adjusted model HR (95% CI): 1.57 (1.11, 2.22) comparing a child whose mother did not finish high school to a child whose mother attended at least some college). Conclusions: These preliminary results provide limited evidence for an association between traffic-related PM2.5 and pneumonia in the first two years of life.

Traders’ Perception of Cooking Smoke as a Risk Factor for Childhood Pneumonia

Background: Childhood pneumonia is the foremost killer of under-fives. Indoor air pollution by smoke from cooking fuel is a major risk factor for childhood pneumonia. The knowledge of caregivers about risk factors can facilitate the practice of appropriate preventive measures. This study set out to evaluate the perception of traders about cooking smoke as a risk factor for childhood pneumonia. Methodology: A researcher administered, questionnaire based, cross-sectional study was carried out at a major market in Benin City prior to a market rally to celebrate World Pneumonia Day 2014. The respondents were traders. Information on biodata, place of cooking, fuel for cooking and presence of under-fives in the cooking area of homes of respondents was sought. Results: There were 1374 respondents of which 1192(88.5%) were females. Only 67(4.9%) respondents considered smoke from cooking fuel a risk factor for pneumonia while 99(7.2%) considered avoidance of smoke as a method for preventing pneumonia. Firewood (biomass fuel) was utilized by 272(19.8%) respondents. Respondents with no education were significantly more likely to use firewood (p 0.05. Conclusion: There is poor awareness of smoke as a risk factor for childhood pneumonia while the use of unclean fuel is significant. As part of health education on childhood pneumonia, smoke as a risk factor should be emphasized. Government should make cleaner fuels more available, accessible and affordable. Keywords: Traders, Cooking Smoke, Risk

Iron-deficiency anemia as a risk factor for pneumonia in children

Background Pneumonia is the most common single cause of death among children under 5 years of age in the developing countries. Anemia is the most common ailment affecting health, socioeconomic development, and overall betterment of mankind. Objective The aim of this study was to determine the relationship between iron-deficiency anemia (IDA) and pneumonia in Egyptian children. Patients and methods This case-control study included 100 children aged 9-72 months, selected from Benha University Hospital and Shebin El-Kom Educational Hospital from January to December 2014. A total of 50 children with pneumonia and 50 age-matched and sex-matched controls were included in the study. After taking an informed verbal consent from the parents, our children were subjected to medical history taking, clinical examination, and complete blood count. For children with hemoglobin less than 11 g/dl, serum iron, serum ferritin, and total iron binding capacity were detected. C-reactive protein and chest radiography were performed for the patients. Results Anemia, particularly IDA, was significantly more frequent among patients (54 and 22%, respectively) than among controls (24 and 22%, respectively) ( P = 0.001 and 0.002, respectively). Hemoglobin level was significantly lower in the IDA patients than in the IDA controls ( P = 0.03). Anemia was a risk factor for childhood pneumonia ( P = 0.001, odds ratio 4.03, and confidence interval 1.71-9.49) and recurrent chest infection ( P < 0.001, odds ratio 15.55, and confidence interval 4.88-49.53). Conclusion Anemia, particularly IDA, is a community problem in Egypt. Anemic children are about four times more susceptible to develop pneumonia compared with the nonanemic ones, and IDA is predominating. Prevention, accurate diagnosis, and prompt treatment of anemia are necessary.

Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries.

BackgroundThe recent series of reviews conducted within the Global Action Plan for Pneumonia and Diarrhoea (GAPPD) addressed epidemiology of the two deadly diseases at the global and regional level; it also estimated the effectiveness of interventions, barriers to achieving high coverage and the main implications for health policy. The aim of this paper is to provide the estimates of childhood pneumonia at the country level. This should allow national policy–makers and stakeholders to implement proposed policies in the World Health Organization (WHO) and UNICEF member countries.MethodsWe conducted a series of systematic reviews to update previous estimates of the global, regional and national burden of childhood pneumonia incidence, severe morbidity, mortality, risk factors and specific contributions of the most common pathogens: Streptococcus pneumoniae (SP), Haemophilus influenzae type B (Hib), respiratory syncytial virus (RSV) and influenza virus (flu). We distributed the global and regional–level estimates of the number of cases, severe cases and deaths from childhood pneumonia in 2010–2011 by specific countries using an epidemiological model. The model was based on the prevalence of the five main risk factors for childhood pneumonia within countries (malnutrition, low birth weight, non–exclusive breastfeeding in the first four months, solid fuel use and crowding) and risk effect sizes estimated using meta–analysis.FindingsThe incidence of community–acquired childhood pneumonia in low– and middle–income countries (LMIC) in the year 2010, using World Health Organization's definition, was about 0.22 (interquartile range (IQR) 0.11–0.51) episodes per child–year (e/cy), with 11.5% (IQR 8.0–33.0%) of cases progressing to severe episodes. This is a reduction of nearly 25% over the past decade, which is consistent with observed reductions in the prevalence of risk factors for pneumonia throughout LMIC. At the level of pneumonia incidence, RSV is the most common pathogen, present in about 29% of all episodes, followed by influenza (17%). The contribution of different pathogens varies by pneumonia severity strata, with viral etiologies becoming relatively less important and most deaths in 2010 caused by the main bacterial agents – SP (33%) and Hib (16%), accounting for vaccine use against these two pathogens.ConclusionsIn comparison to 2000, the primary epidemiological evidence contributing to the models of childhood pneumonia burden has improved only slightly; all estimates have wide uncertainty bounds. Still, there is evidence of a decreasing trend for all measures of the burden over the period 2000–2010. The estimates of pneumonia incidence, severe morbidity, mortality and etiology, although each derived from different and independent data, are internally consistent – lending credibility to the new set of estimates. Pneumonia continues to be the leading cause of both morbidity and mortality for young children beyond the neonatal period and requires ongoing strategies and progress to reduce the burden further.

Home risk factors for childhood pneumonia in Nanjing, China

Pneumonia is a major cause of childhood morbidity in China. Many studies of rural areas have found an association between pneumonia and air pollution from burning of bio-mass. The present study is of children living in urban, modern homes without burning of bio-mass. In order to investigate potential home risk factors associated with children’s pneumonia, China Child Home Health (CCHH) questionnaires were randomly distributed to parents of 6461 children in 23 kindergartens in all 11 districts of Nanjing, covering urban, suburban, and industrial areas. The 4014 valid questionnaires (response rate 65.7%) were returned and have been analyzed. The lifetime incidence of pneumonia in Nanjing children 1–8 years old is 26.7%. The incidence of croup, asthma and frequent common colds was strongly associated with pneumonia, as was a history of allergies in the family, and persons other than parents (for example grandparents or nanny) taking care of the child. Several home environmental factors, namely, dampness, lack of ventilation, using coal or natural gas (electricity as reference) for cooking, new furniture, and “modern” floor and wall covering materials were also significantly associated with pneumonia. The indoor environment typical of modern apartments in China was a risk factor for pneumonia among children.

Risk factors for childhood pneumonia associated with length of stay at Sanglah Hospital, Denpasar, Bali

Risk factors for childhood pneumonia associated with length of stay at Sanglah Hospital, Denpasar, Bali

Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial

SummaryBackgroundVitamin D has a role in regulating immune function, and its deficiency is a suggested risk factor for childhood pneumonia. Our aim was to assess whether oral supplementation of vitamin D3 (cholecalciferol) will reduce the incidence and severity of pneumonia in a high-risk infant population.MethodsWe did a randomised placebo-controlled trial to compare oral 100 000 IU (2·5 mg) vitamin D3 with placebo given to children aged 1–11 months in Kabul, Afghanistan. Randomisation was by use of a computer-generated list. Vitamin D or placebo was given by fieldworkers once every 3 months for 18 months. Children presenting at the study hospital with signs of pneumonia had their diagnosis confirmed radiographically. Our primary outcome was the first or only episode of radiologically confirmed pneumonia. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00548379.Findings1524 children were assigned to receive vitamin D3 and 1522 placebo. There was no significant difference between the incidence of first or only pneumonia between the vitamin D (0·145 per child per year, 95% CI 0·129–0·164) and the placebo group (0.137, 0·121–0·155); the incidence rate ratio was 1·06 (95% CI 0·89–1·27). From 652 children during five separate periods of testing serum calcifediol, only one child in each of two testing periods had results greater than 375 nmol/L in the intervention group—a toxic level.InterpretationsQuarterly bolus doses of oral vitamin D3 supplementation to infants are not an effective intervention to reduce the incidence of pneumonia in infants in this setting.FundingWellcome Trust and British Council.