Prevalence and associated factors of pneumonia among children from 2-59 months at public health facilities in Hulet Ejju Enesie District, Northcentral Ethiopia: multi facility based study

¹Department of Paediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia, ²Shegaw Motta General Hospital, East Gojjam, Motta Town, Ethiopia

^&Corresponding author
Solomon Demis, Department of Paediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia

Introduction    

Pneumonia is an inflammatory condition involving the lungs, which includes the visceral pleura, connective tissue, airways, alveoli, and vascular structures [1]. In a person with pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and reduces the oxygen intake. There are various causative agents of Pneumonia such as viruses (rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus, adenovirus, and parainfluenza), and bacteria (Streptococcus pneumonia, Haemophilus influenza, Chlamydophila pneumonia and Mycoplasma pneumonia), and fungi [1,2]. The clinical manifestation of pneumonia in children includes cough, the difficulty of breathing, fast breathing, fever, and chest in the drawing. However, children with cough and cold were not classified as “pneumonia” but with fast breathing were classified as “pneumonia” and were given an oral antibiotic to take at home for five days. Furthermore, children who had chest in drawing with or without fast breathing were classified as “severe pneumonia” and were subjected to injectable penicillin treatment. Children who had any general danger signs were classified as “severe pneumonia or very severe disease” [3]. Children can be protected from pneumonia by preventive interventions such as routine pneumococcal vaccination, exclusive breastfeeding, and complementary feeding; main treatment strategies that rely on community capacity development can reduce pneumonia mortality in developing countries [4].

Pneumonia is a leading cause of death among children worldwide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority [5]. Globally, 19% of all deaths by pneumonia in children aged less than 5 years. In the previous, between 2000 and 2015, global hospital admissions accounted for over 1,400 cases of pneumonia per 100,000 children in South-East Asia and the African Region [3,5] and about 490,000 children under-five died by pneumonia in 2016 in sub-Saharan Africa (SSA) [6]. In developing countries, pneumonia is the leading cause of death for children [3] which accounted for up to 21% of deaths in children under the age of five years [3,6]. The mortality rates of children under the age of five years in most developing countries range from 60 to 100 per 1000 live births, one-fifth of these deaths are due to pneumonia [7]. Ethiopia is one of the developing countries which are fifth (62 deaths in 1000) among 15 countries having the highest death rate of under five years of pneumonia. On the other hand, it is estimated as 3,370,000 children with pneumonia annually, which contributes to 18% of all causes of deaths killing over 40,000 under-five children every year. Even if, these problems easily preventable and treatable, pneumonia continued to cause a high rate of death on under-five children in this country. However, there was a limited and inconsistent study on prevalence and associated factors of pneumonia among (2-59) month children in Northcentral part of Ethiopia in general and in Hulet Ejju Enseie District in particular. Hence, this study aimed to assess the prevalence of pneumonia and its associated factors among 2-59 month children at public health facilities of Hulet Ejju Enesie District, Northwest Ethiopia [7-9].

Methods     

Study design, period, and area: institutional based cross-sectional study was carried out from 1-30, October 2020 on five selected public health facilities in Hulet Ejju Enesie District such as Shegaw Motta General Hospital (SMGH), Debre Gubaye Health Centre (DGHC), Konter Health Centre (KHC), Motta Health Centre (MHC) and Muger Health Centre (MHC).

Study population and participants: all 2-59 months age children who visited the outpatient departments (OPD) at public health facilities of Hulet Ejju Enesie District were the source population. Those randomly selected (2-59) months of children visited outpatient departments of selected public health facilities in Hulet Ejju Enesie District during the data collection period were our study population.

Inclusion and exclusion criteria: children of 2-59 months of age with mother/caregivers visiting OPD ofHulet Ejju Enesie District public health facilities were recruited in this study. Whereas, mothers or caregivers of children who were having hearing impairments or unable to talk, referred children with pneumonia from the data collection site to SMGH, and children with ageless than two months were excluded.

Sample size and technique: the sample size was determined using single population proportion formula by taking prevalence of pneumonia among under five children in Jimma, Southwest Ethiopia [11], based on the assumption; degree of freedom (d) =5%, 95% confidence level;

Sampling procedure: first, public health facilities were selected by random lottery method. Five public health facilities were selected, then after study participants were proportionally allocated for each health facility (HFs) based on client flow rate. Accordingly, every other (K^th= 2) client presented with pneumonia in each selected health facility was enrolled in this study.

Data collection: the data were collected by trained nurses and the principal investigator. English version prepared questionnaire was translated into the Amharic version and finally, it was translated back to the English version to check its consistency. Thus, socio-demographic, environmental factors, health facility factors, child care factors, and pre-existing medical conditions of the child were collected by structured pre-tested Amharic version questionnaire using face-to-face interviews with parents/guardians. Clinical diagnosis, co-morbid disease, weight, and height of the child were undertaken soon after interview from hospital record.

Data quality control: the training was given for data collectors on the aim of the study, data collection tool, and procedures. The 5% questionnaires were pretested at Ginde Woin Health Center and Chemo Health center in Goncha Siso Enesie district on 18 children to ensure consistency and completeness of the structured questioners. Data collectors were supervised throughout the data collection period and the overall process was coordinated and controlled by the principal investigator to ensure data completeness.

Data analysis: data were entered by EpiData version 3.1 and exported to SPSS version 20 for analysis. The prevalence of pneumonia, frequency tables, percentages, and figures were determined by descriptive statistics to describe the study population with other variables. Multivariable logistic regression was done by entering the variables with P< 0.2 in bivariable logistic regression to identify the associated factor and clinical predictors by considering P< 0.05 as statistically significant association with pneumonia (2-59) month children.

Ethical consideration: the ethical approval by Debre Tabor University, College of Health Science Institutional Review Board (IRB) (Reference number 061/10), and a permission letter were obtained from Hulet Ejju Enesie district health office. Written informed consent was obtained from the children´s parents/guardians after they were informed about the objectives and procedures of the study. Furthermore, their rights to refuse participation at any time were entirely volunteer-based and their confidentiality was kept by coding rather than a name for identification.

Operational definition: under-five children: children age less than 59 months, pneumonia: there are 8 symptoms to diagnose pneumonia in the questionnaire, diagnosed with cough and one of the other symptoms considered to have pneumonia.

Results     

Socio-demographic characteristic of study participants: among a total of 343 study participants, 176 (50.3%) were males and 167 (48.7%) were female participants. The mean age of the study participant was 22.78, age of median 21 with standard deviation (SD) 14.65. However, the majority; 132 (38.5%) were 24-59 months age followed by 12-23 months who accounted for 109 (31.8%). The majority of children had both mother and father alive accounting for 258 (75.2%). The majority of participants were from rural which accounted for 182 (53.1%) (Table 1).

Prevalence: the prevalence of pneumonia was 99 (28.9%) at [95% CI; 24.2-33.5]. The majority of pneumonia were reported in males 58 (16.9%) and rural 54 (15.7%). On the other hand, the highest pneumonia was also recorded from married parents 70 (20.4%), mothers who was unable to read and write 34 (9.9%), and farmer mothers 51 (14.9%) (Table 1). Prevalence of pneumonia per selected health facilities were in Shegaw Motta General Hospital (SMGH) 134 (39.1%), Debre Gubaye Health Center (DGHC) 72 (21.0%), Konter Health Center (KHC) 96 (28.0%) and Muger Health Center (MHC) 41 (12.0%). The highest prevalence of pneumonia report was from Shegaw Motta General Hospital (SMGH) and the least was from Muger Health Center (MHC) which accounted for 40 (11.7%) and 16 (4.7%) respectively (Figure 1).

Factors associated with pneumonia: all independent variables showing P-value of < 0.2 in the bivariable analysis were entered into multivariable logistic regression analysis. Caring mothers back or besides during cooking (AOR 15.64; 95% CI, 3.10-49.23, p-value = 0.004), children sleep in the same cooking room (AOR 6.63, 95% CI, 3.88-50.09, p-value = 0.007) and presence of any smokers in family (AOR 13.72, CI, 1.74-21.09, P = 0.022)at P < 0.05 were significantly associated with pneumonia (Table 2). Thus, caring for a child on the mother's back or besides during cooking was 15.64 times more likely to develop pneumonia than those who were not. Children who slept in the same cooking room were 6.63 times more likely to develop pneumonia than those who were not. And, the presence of any smokers in the family was 13.72 times more likely to develop pneumonia than those children living with no smoker (Table 2).

Discussion     

The prevalence of pneumonia was 99 (28.9%) at [95% CI; 24.2-33.5]. Hence, this finding is comparable with the previous studies accounted for 27.68%, 27.2%, 33.5%, and 28% in Nigeria [8], Uganda [9], Sidama Zone Ethiopia [10] and Jimma Ethiopia [11] respectively. However, it was much higher than studies 16.4% in India [12], 22% in Tanzania [13], in 16.1% Ethiopia [14], 17.7% in Arsi, Ethiopia [15], 5.6% in Addis Ababa [16], 12% in Gondar [16], 17.1% in peri-urban areas of Northeastern Ethiopia [17]. The possible reason for the difference in the prevalence of pneumonia might include the time of data collection, assessment method used, and difference in the level of advancement as well as the aggregation of risk factors. Prevalence of pneumonia in this study was much lower than findings accounting for 43.7% in Ethiopia [17], 34% in East Africa [18], 56% in Uganda [19], 74.3% in Kenya [20] and 65% in Sudan [21]. Such variation could be attributed to different geographical regions, methodology, socio-economic conditions, sample size, climatic conditions. Holding children back or besides during cooking foods [AOR 15.64; 95% CI = 3.10-49.23, p-value = 0.004] was the factor found to be significantly associated with pneumonia. Similarly, children sleep in the same cooking room [AOR= 6.63, 95% CI = 3.88-50.09, p-value = 0.007] was another factor demonstrated as significant association with pneumonia among 2-59 months children. The consistent finding was report as carrying the child on the back during cooking food in Ethiopia [11], Jimma [14], Munesa District, Arsi Zone [15], Gumay district, South-west of Ethiopia [17], and place of the child during cooking in [22]; systematic review and meta-analysis in East Africa [23] including food cooking in the main house in Ethiopia [24].

This association might be due to the reason that cooking foods in living rooms may cause indoor air pollution and holding a child on the back while cooking foods can increase the probability of inhaling smokes and food vapours (steams) which in turn may increase the risk of acquiring pneumonia by altering the structure and function of the respiratory tract. The presence of any smokers in the family [AOR = 13.72, CI =1.74-21.09, P = 0.022] was also significantly associated with pneumonia among (2-59) months old children. A similar finding in the previous study was reported in Hiwot Fana Specialized University Hospital, Harar, Ethiopia [25]. This association might be due to the presence of any smoker in the home leads to children inhaled smoke. This cigarette smoke inhalation kills normal flora which able to compete for pathogen from adherence and altered bacterial acquisition and oral mucosal colonization in favour of periodontal pathogens. On the other hand, presence of cough [AOR =35.13; P=0.001], having difficulty of breathing [AOR = 19.39; P= 0.001], fast breathing [AOR =39.41; P = 0.001], fever [AOR=24.09;P = 0.001], and having chest in drawing [AOR= 34.53; P = 0.001] were the identified clinical predictor for pneumonia among 2-59 month children in the current study. This also in agreement with a chest in drawing in Addis Ababa, Ethiopia [16], and the result of systematic reviews and Meta-analysis in developing countries showed that having fast breathing, chest in drawing, cough, and fever were clinical predictors of pneumonia in 2-59 month children [26].

Conclusion     

The prevalence of pneumonia in Hulet Ejju Enesie district was relatively high. Holding children back or besides during cooking foods, children slept in the cooking room and the presence of a smoker in the family were factors associated with pneumonia.

Limitation of the study: the data was obtained by a face-to-face interview questionnaire which was subjected to recall bias.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

NM: Participated in the conception, design, data collection, analysis, and interpretation of the study. SD: facilitated the data collection and management, drafted, analysis and critically reviewed the manuscript. All authors read and approved the final manuscript.

Acknowledgments     

The authors would like to appreciate the study participants, the data collectors and Debre Tabor University.

Tables and figures     

Table 1: sociodemographic characteristics of study participants among children 2-59 months in public health facilities in Hulet Ejju Enesie District, 1-30, October 2020

Table 2: factors associated with pneumonia among children 2-59 month at public health facilities in Hulet Ejju Enesie District, 1-30, October 2020

Figure 1: prevalence of pneumonia per health facilities among children (2-59) months in Hulet Ejju Enesie District, 1-30, October 2020

References