Contributing Risk Factors to Pneumonia in Children Under Five Years in Madhesh Province of Nepal


Authors : Dr. Deepak Raj Paudel; Dr. Dipak Kumar Gupta; Dr. Ram Hari Chapagain; Dr. Anil Kumar Shrestha

Volume/Issue : Volume 9 - 2024, Issue 8 - August

Google Scholar : https://rb.gy/tkrd7j

Scribd : https://rb.gy/mwup5a

DOI : https://doi.org/10.38124/ijisrt/IJISRT24AUG1085

Abstract : Introduction: Pneumonia is the significant cause of morbidity and mortality in under five year children worldwide. In Nepal, pneumonia is the second most common cause of childhood mortality. Exclusive breastfeeding and basic immunization in preventing pneumonia cannot be underestimated. This study aims to assess the contributing risk factors associated with childhood pneumonia among children aged 16 months to under-5 year.  Methods: A case-control study was conducted from January to July 2022 including children under 5 years visiting the pediatric out-patient department of JMCTH. A total of 200 subjects aged 16–59 months were enrolled, in which ‘cases’ included 100 patients diagnosed with pneumonia and ‘controls’ included 100 patients with non-pneumonia illnesses, matched by age and setting. The WHO guideline was followed for the diagnosis of pneumonia. The data on contributing risk factors were collected from both cases and controls via interview method from their parents.  Results: The study showed non-exclusive breastfeeding [odds ratio (OR) =7.82 in 95% confidence interval (CI)], indoor air pollution [OR=7.47 in 95% CI], incomplete basic immunization [OR= 4.44 in 95% CI], low birth weight [OR=3.11 in 95% CI] and severe acute malnutrition i.e. high degree of wasting [OR=2.70 in 95% CI] were the major contributing factors of pneumonia in children under age five in the Madhesh Province of Nepal. However, nutritional status (height-for-age z score), age, sex, and educational status of mother did not appear to be contributing risk factors for pneumonia.  Conclusion: This study highlights non-exclusive breastfeeding, indoor air pollution, incomplete basic immunizations, low birth weight, and severe acute malnutrition significantly increase the risk of childhood pneumonia. Exclusive breastfeeding plays a vital role, while gender seems to influence the relationship between exclusive breastfeeding and pneumonia incidence.

Keywords : Breastfeeding; Immunization; Nutritional Status; Pneumonia.

References :

  1. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? The lancet. 2003 Jun 28;361(9376):2226-34. DOI: 10.1016/S0140-6736(03)13779-8.
  2. Sugihartono S, Rahmatullah P, Nurjazuli N. Analisis faktor risiko kejadian pneumonia pada balita di wilayah kerja Puskesmas Sidorejo Kota Pagar Alam. Jurnal Kesehatan Lingkungan Indonesia. 2012 Apr;11(1):82-6. DOI: 10.14710/jkli.11.1.82-86.
  3. Hug L, Sharrow D, You D. Levels & trends in child mortality: report 2017. New York: UNICEF; 2017. https://www.unicef.org/reports/levels-and-trends-child-mortality-report-2017.
  4. Hartati S. Analisis Faktor Risiko Yang Berhubungan Dengan Kejadian Pneumonia Pada Anak Balita Di RSUD Pasar Rebo. Jakarta: FK UI. 2011. https://lontar.ui.ac.id/detail?id=20282632&lokasi=lokal.
  5. Fekadu GA, Terefe MW, Alemie GA. Prevalence of pneumonia among under-five children in Este Town and the surrounding rural Kebeles, Northwest Ethiopia: a community based cross sectional study. Sci J Pub Health. 2014;2(3):150-5. DOI: 10.11648/j.sjph.20140203.12.
  6. César JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. BMJ. 1999 May 15;318(7194):1316-20. DOI: 10.1136/bmj.318.7194.1316.
  7. Madhi SA, Levine OS, Hajjeh R, Mansoor OD, Cherian T. Vaccines to prevent pneumonia and improve child survival. Bull World Health Organ. 2008;86:365-72. DOI: 10.2471/BLT.07.044503.
  8. Hastuti P, Wijayanti IT. Analisis deskriptif faktor yang mempengaruhi pengeluaran asi pada ibu nifas di desa sumber kecamatan sumber kabupaten rembang. URECOL. 2017 Sep 8:223-32. https://journal.unimma.ac.id/index.php/urecol/article/view/1028.
  9. Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006 Feb 1;117(2):425-32. DOI: 10.1542/peds.2004-2283.
  10. Fikri BA. Analisis Faktor risiko pemberian asi dan ventilasi kamar terhadap kejadian pneumonia balita. Indo J Pub Health. 2016;11:14–27.  DOI: 10.20473/ijph.v11i1.2016.14-27.
  11. Damanik P, Siregar MA, Aritonang EY. Hubungan Status Gizi, Pemberian ASI. Eksklusif, Status Imunisasi Dasar dengan Kejadian Infeksi Saluran Pernapasan Akut (ISPA) pada Anak Usia 12-24 Bulan di Wilayah Kerja Puskesmas Glugur Darat Kota Medan. Gizi, Kesehatan Reproduksi dan Epidemiologi. 2014;1:1–7. DOI: 10.32584/jika.v3i1.485.
  12. Muhe L, Lulseged S, Mason KE, Simoes EA. Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet. 1997;349:1801–4. DOI: 10.1016/S0140-6736(96)12098-5.
  13. Tanjung WW, Batubara NS, Siregar PK. Faktor-Faktor Risiko Yang Berpengaruh Terhadap Kejadian Pneumonia Pada Balita Di Rumah Sakit Tentara Nasional Indonesia Angkatan Darat (Tni-Ad) Kota Padangsidimpuan. Indo Health Sci J. 2017;2:1–10. https://jurnal.unar.ac.id/index.php/health/article/view/33.
  14. Sukamawa AA, Sulistyorini L, Keman S. Determinan sanitasi rumah dan sosial ekonomi keluarga terhadap kejadian ISPA pada anak balita serta manajemen penanggulangannya di Puskesmas. Jurnal Kesehatan Lingkungan. 2006 Jul 1;3(1). https://www.neliti.com/publications/3966/determinan-sanitasi-rumah-dan-sosial-ekonomi-keluarga-terhadap-kejadian-ispa-pad#id-section-title
  15. Nieminen H, Rinta-Kokko H, Jokinen J, Puumalainen T, Moreira M, Borys D, et al. Effectiveness of the 10-valent pneumococcal conjugate vaccine among girls, boys, preterm and low-birth-weight infants - results from a randomized, double-blind vaccine trial. Vaccine. 2019;37:3715-21. DOI: 10.1016/j.vaccine.2019.05.033.
  16. Budiati E. Kondisi Rumah dan Pencemaran Udara Dalam Rumah Sebagai Faktor Risiko Kejadian Pneumonia Balita. YARSI Med J. 2016;20:87–101. DOI: 10.33476/jky.v20i2.163.
  17. Fatmi Z, White F. A comparison of ‘cough and cold’and pneumonia: risk factors for pneumonia in children under 5 years revisited. Int J Infect Dis. 2002;6:294–301. DOI: 10.1016/S1201-9712(02)90164-5.
  18. Tiewsoh K, Lodha R, Pandey RM, Broor S, Kalaivani M, Kabra SK. Factors determining the outcome of children hospitalized with severe pneumonia. BMC Pediatr. 2009;9:1-8. DOI: 10.1186/1471-2431-9-15.
  19. Nirmolia N, Mahanta TG, Boruah M, Rasaily R, Kotoky RP, Bora R. Prevalence and risk factors of pneumonia in under five children living in slums of Dibrugarh town. Clin Epidemiol Global Health. 2018;6(1):1–4. DOI: 10.1016/j.cegh.2017.07.004.
  20. Fonseca W, Kirkwood BR, Victora CG, Fuchs S, Flores J, Misago C. Risk factors for childhood pneumonia among the urban poor in Fortaleza, Brazil: a case--control study. Bull World Health Organ. 1996;74(2):199-208. PMID: 8706236
  21. Nurnajiah M, Rusdi R, Desmawati D. Hubungan Status Gizi dengan Derajat Pneumonia pada Balita di RS. Dr. M. Djamil Padang. Jurnal Kesehatan Andalas. 2016;5:250–5. DOI: 10.25077/jka.v5i1.478
  22. Caulfield LE, de Onis M, Blössner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. 2004;80:193–8. DOI: 10.1093/ajcn/80.1.193.
  23. Hadisuwarno W, Setyoningrum RA, Umiastuti P. Host factors related to pneumonia in children under 5 years of age. Paediatr Indo. 2015;55(5):248–51. http://repository.unair.ac.id/id/eprint/109194.
  24. Ezzati M, Kammen DM. Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study. Lancet. 2001;358:619–24. DOI: 10.1016/S0140-6736(01)05777-4.
  25. Ezzati M, Kammen DM. Quantifying the effects of exposure to indoor air pollution from biomass combustion on acute respiratory infections in developing countries. Environ Health Perspect. 2001;109:481–8. DOI: 10.1289/ehp.0110948.
  26. Zhang L, Jiang Z, Tong J, Wang Z, Han Z, Zhang J. Using charcoal as base material reduces mosquito coil emissions of toxins. Indoor Air. 2010;20(2):176–84. DOI: 10.1111/j.1600-0668.2009.00639.x.
  27. Karki S, Fitzpatrick AL, Shrestha S. Risk Factors for Pneumonia in Children under 5 Years in a Teaching Hospital in Nepal. Kathmandu Univ Med J 2014;48(4):247-52. DOI: 10.3126/kumj.v12i4.13729
  28. Koirala, R. (2019). Risk Factors of Acute Respiratory Infections in Children under Five Years Attending the Fishtail Hospital, Pokhara, Nepal. J-GMC-N, 12(2), 74–79. DOI: 10.3126/jgmcn.v12i2.27214
  29. Sutriana VN, Sitaresmi MN, Wahab A.  Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia. Clin Exp Pediatr. 2021 Nov; 64(11): 588–595. DOI: 10.3345/cep.2020.00339.
  30. Ghimire P, Gachhadar R, Piya N, Shrestha K, Shrestha K (2022) Prevalence and factors associated with acute respiratory infection among under-five children in selected tertiary hospitals of Kathmandu Valley. PLoS ONE 17(4):e0265933. DOI: 10.1371/journal.pone.0265933.

Introduction: Pneumonia is the significant cause of morbidity and mortality in under five year children worldwide. In Nepal, pneumonia is the second most common cause of childhood mortality. Exclusive breastfeeding and basic immunization in preventing pneumonia cannot be underestimated. This study aims to assess the contributing risk factors associated with childhood pneumonia among children aged 16 months to under-5 year.  Methods: A case-control study was conducted from January to July 2022 including children under 5 years visiting the pediatric out-patient department of JMCTH. A total of 200 subjects aged 16–59 months were enrolled, in which ‘cases’ included 100 patients diagnosed with pneumonia and ‘controls’ included 100 patients with non-pneumonia illnesses, matched by age and setting. The WHO guideline was followed for the diagnosis of pneumonia. The data on contributing risk factors were collected from both cases and controls via interview method from their parents.  Results: The study showed non-exclusive breastfeeding [odds ratio (OR) =7.82 in 95% confidence interval (CI)], indoor air pollution [OR=7.47 in 95% CI], incomplete basic immunization [OR= 4.44 in 95% CI], low birth weight [OR=3.11 in 95% CI] and severe acute malnutrition i.e. high degree of wasting [OR=2.70 in 95% CI] were the major contributing factors of pneumonia in children under age five in the Madhesh Province of Nepal. However, nutritional status (height-for-age z score), age, sex, and educational status of mother did not appear to be contributing risk factors for pneumonia.  Conclusion: This study highlights non-exclusive breastfeeding, indoor air pollution, incomplete basic immunizations, low birth weight, and severe acute malnutrition significantly increase the risk of childhood pneumonia. Exclusive breastfeeding plays a vital role, while gender seems to influence the relationship between exclusive breastfeeding and pneumonia incidence.

Keywords : Breastfeeding; Immunization; Nutritional Status; Pneumonia.

Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe