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Pneumonia among under-five children in Alexandria, Egypt: a case-control study.

ABSTRACT: BACKGROUND:Pneumonia among under-five children constitutes a major public health concern. Studies examining risk factors for pneumonia in Egypt are limited. AIM:To identify risk factors of pneumonia among under-five children in Alexandria, Egypt. METHODS:An observational case-control study was conducted over a 5-month period (September 2017-January 2018) in three main pediatric hospitals in Alexandria. A predesigned questionnaire was used to interview 660 mothers of under-five children (330 pneumonia cases and 330 control). The questionnaire included potential risk factors for pneumonia which were categorized into child-related factors, socio-demographic factors, and environmental factors. RESULTS:The mean age of the children was 23.14 ± 18.61?months with a range of 1-59?months. Nearly two-thirds (58.5%) were boys. Nine factors were found to be independently associated with pneumonia: age ? 12?months (OR = 1.925; 95% CI, 1.356-2.733; P < 0.001), male gender (OR = 1.646; 95% CI, 1.162-2.332; P = 0.005), birth order ? 4 (OR = 2.154; 95% CI, 1.282-3.617; P = 0.004), low birth weight (OR = 2.562; 95% CI, 1.718-3.821; P < 0.001), prematurity (OR = 2.019; 95% CI, 1.154-3.531; P = 0.014), place of delivery either at home (OR = 5.669; 95% CI, 1.063-30.237; P = 0.042) or at a public hospital (OR = 1.616; 95% CI, 1.131-2.310; P = 0.008), presence of concomitant illness (OR = 1.902; 95% CI, 1.043-3.469; P = 0.036), poor home aeration (OR = 3.586; 95% CI, 1.971-6.522; P < 0.001), and exposure to outdoor air pollution (OR = 2.403; 95% CI, 1.417-4.076; P = 0.001). CONCLUSION:Several risk factors were significantly related to pneumonia among under-five children. Identifying such factors is important for developing interventions to reduce pneumonia burden among under-five in Egypt.

SUBMITTER: Fadl N

PROVIDER: S-EPMC7364693 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Pneumonia among under-five children in Alexandria, Egypt: a case-control study.

Fadl Noha N Ashour Ayat A Yousry Muhammad Yasmine Y

The Journal of the Egyptian Public Health Association 20200701 1

<h4>Background</h4>Pneumonia among under-five children constitutes a major public health concern. Studies examining risk factors for pneumonia in Egypt are limited.<h4>Aim</h4>To identify risk factors of pneumonia among under-five children in Alexandria, Egypt.<h4>Methods</h4>An observational case-control study was conducted over a 5-month period (September 2017-January 2018) in three main pediatric hospitals in Alexandria. A predesigned questionnaire was used to interview 660 mothers of under-f ...[more]

PMID: 32813163

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Project description:BackgroundThere are very limited data on children with pneumonia in Mali. The objective was to assess the etiology and factors associated with community-acquired pneumonia in hospitalized children <5 years of age in Mali.MethodsA prospective hospital-based case-control study was implemented in the Pediatric department of Gabriel Touré University Hospital at Bamako, Mali, between July 2011-December 2012. Cases were children with radiologically-confirmed pneumonia; Controls were hospitalized children without respiratory features, matched for age and period. Respiratory specimens, were collected to identify 19 viruses and 5 bacteria. Whole blood was collected from cases only. Factors associated with pneumonia were assessed by multivariate logistic regression.ResultsOverall, 118 cases and 98 controls were analyzed; 44.1% were female, median age was 11 months. Among pneumonia cases, 30.5% were hypoxemic at admission, mortality was 4.2%. Pneumonia cases differed from the controls regarding clinical signs and symptoms but not in terms of past medical history. Multivariate analysis of nasal swab findings disclosed that S. pneumoniae (adjusted odds ratio [aOR] = 3.4, 95% confidence interval [95% CI]: 1.6-7.0), human metapneumovirus (aOR = 17.2, 95% CI: 2.0-151.4), respiratory syncytial virus [RSV] (aOR = 7.4, 95% CI: 2.3-23.3), and influenza A virus (aOR = 10.7, 95% CI: 1.0-112.2) were associated with pneumonia, independently of patient age, gender, period, and other pathogens. Distribution of S. pneumoniae and RSV differed by season with higher rates of S. pneumoniae in January-June and of RSV in July-September. Pneumococcal serotypes 1 and 5 were more frequent in pneumonia cases than in the controls (P = 0.009, and P = 0.04, respectively).ConclusionsIn this non-PCV population from Mali, pneumonia in children was mainly attributed to S. pneumoniae, RSV, human metapneumovirus, and influenza A virus. Increased pneumococcal conjugate vaccine coverage in children could significantly reduce the burden of pneumonia in sub-Saharan African countries.

Project description:Previous studies conducted in Nepal have not identified the potential maternal risk for underweight among children under-five years of age in resource-poor settings. Therefore, to identify these risk factors for being underweight among children under-five years old, a community-based case-control study was conducted in a rural village in the Chitwan District in Nepal. Cases were defined as children who were diagnosed as underweight based on low weight per age, whereas controls were the children with normal weight for their age. Mothers of 93 cases and 186 controls were invited for an interview to collect the data. More than half of underweight children were female (51.6%) and nearly one third of them (31.2%) were aged 13-24 months. Nearly, 30% of the cases belonged to families in the lowest wealth quintile and 82% of cases were from food insecure families. Logistic regression analysis showed that children of mothers who were illiterate had 1.48 times the odds of being underweight compared to whose mothers were not illiterate (95% Confidence Interval [CI]: 1.53-3.07)). Children whose mother had not completed their postnatal care (PNC) were 3.16 more times likely to be underweight compared to children of mothers who completed PNC (95% CI: 1.24-8.03). The children who received care from other family members besides their mothers were 6.05 times more likely to be underweight (95% CI: 1.44-25.42); the children having mothers who had no income at all had 5.13 times the odds of being underweight (95% CI: 1.27-20.71) and children with diarrhea episodes within one month were 2.09 times more likely to be underweight (95% CI:1.02-4.31) compared to those children without any diarrhea episodes within one month. Women should be encouraged to take care of their children themselves, seek PNC services and take precautions to protect their children from diarrhea. Also, enabling factors such as education and improved income for women can help to reduce malnutrition among children.

Project description:BackgroundThe problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa.MethodsA community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics.Main findingsDuring the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3-17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1-10.1), water retrieved from water storage containers using handle-less vessels (adjusted mOR = 16.3; 95% CI: 4.4-60.1), and water retrieved by interchangeably using vessels both with and without handle (adjusted mOR = 5.4; 95% CI: 1.1-29.1) were independently associated with acute diarrhea.ConclusionWe conclude that provision of continuously available piped water supplies and education of caregivers about proper water retrieval methods of household stored water can effectively reduce POU contamination of water at the household level and thereby reduce acute diarrhea among under-five children in slums of Addis Ababa. Promotion of household water treatment is also highly encouraged until the City's water authority is able to deliver continuously available piped water supplies.

Project description:BackgroundFood labeling is an important public health tool allowing consumers to make informed and healthy choices. Considering how important it is for consumers to be aware of food labels while choosing healthy foods, this study aims at assessing public awareness, attitude, and practice regarding food labeling in Alexandria Governorate, Egypt.MethodsA cross sectional study using a predesigned interview questionnaire to collect data from 719 adult consumers from both sexes (28.2% males: 71.8% females), recruited from different branches of one of the largest supermarkets in Alexandria.ResultsMore than half of the participants (55.6%) reported reading food labels. The most frequently read information was production/ expiry date (76.8%), product name (68.3%), and ingredients (38.0%) while the least frequently read was nutritional facts (29.9%). More than half of the study sample (50.9%) had low awareness about the content of food labels, nevertheless, having higher scores on awareness about food labels predicted reading practice. Nearly three-quarters of the respondents had average to good food label reading practice. Most respondents (81.8%) had a favorable attitude about food labeling in its present form, however, higher attitude scores did not seem to influence their use of food labels. Being older (β = 0.045, CI; 0.014-0.076, p = 0.005), being female (β = 1.162, CI; 0.541-1.784, p = 0.000), having secondary education or equivalent (β = 1.042,CI; 0.050-2.034, p = 0.040), having university education or beyond (β = 3.090, CI; 2.132-4.048, p = 0.000), and having higher scores on awareness about food labels (β = 1.407, CI; 1.324-1.490, p = 0.000) were significant predictors of reading food labels.ConclusionsMost of the studied consumers had a positive attitude towards food labeling, however, more than half of them had low awareness of food labeling content. Nutritional facts were the least frequently read by consumers. Reading food labels was significantly predicted by having higher education, being older, being a female, and having better awareness.

Project description:Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs).Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14-0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19-8.94). There were two deaths in the intervention and one in the control arm.The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia.ClinicalTrials.govNCT00513500

Dataset Information

Pneumonia among under-five children in Alexandria, Egypt: a case-control study.

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Pneumonia among under-five children in Alexandria, Egypt: a case-control study.

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