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Factors associated with severe pneumonia among children <5 years, Kasese District, Uganda: a case-control study,
Mercy Wendy Wanyana1, Richard Migisha2, Patrick King2
1Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda. mwanyana@uniph.go.ug.
Insights
Severe pneumonia in Ugandan children is linked to co-existing illnesses like diarrhea and malaria, lack of exclusive breastfeeding, and indoor air pollution. Interventions should focus on these factors to reduce child mortality.
Area of Science:
- Pediatrics
- Public Health
- Infectious Diseases
Background:
- Pneumonia is a leading cause of mortality in children under five globally, especially in sub-Saharan Africa.
- Uganda faces a high burden of pneumonia, with severe cases concentrated in Kasese District.
- This study aimed to identify factors contributing to severe pneumonia in young children in Kasese District.
Purpose of the Study:
- To investigate risk factors for severe pneumonia in children under five in Kasese District, Uganda.
- To inform targeted prevention and control strategies for severe pneumonia.
- To understand the role of comorbidities, feeding practices, and environmental exposures.
Main Methods:
- A hospital-based case-control study was conducted among children aged 2-59 months.
- Cases were defined by pneumonia with danger signs; controls had non-severe pneumonia.
- Data were collected via medical record review and caregiver questionnaires, with logistic regression analysis.
Main Results:
- Children with co-existing diarrhea or malaria had significantly higher odds of severe pneumonia.
- Lack of exclusive breastfeeding for at least six months was associated with increased severe pneumonia risk.
- Exposure to indoor air pollution from cooking combustion sources also significantly increased the odds of severe pneumonia.
Conclusions:
- Comorbidities (diarrhea, malaria), inadequate exclusive breastfeeding, and indoor air pollution are critical factors in severe pneumonia development.
- Promoting exclusive breastfeeding for at least six months is crucial for prevention.
- Advocating for clean energy sources can mitigate severe pneumonia morbidity in the region.
Background:
Pneumonia is one of the leading causes of infant mortality globally, particularly in sub-Saharan Africa. In Uganda, pneumonia was the fourth leading cause of death in children <5 years in 2018. Analysis of 2013-2022 data for children <5 years from the District Health Information System indicated a high incidence of severe pneumonia in Kasese District, Uganda. We investigated to identify factors associated with severe pneumonia among children <5 years in Kasese District to inform prevention and control strategies.
Methods:
We conducted a 1:1 hospital-based case-control study among children aged 2-59 months presenting with pneumonia at five high-volume facilities in Kasese District from January to April 2023. A case was defined as pneumonia with ≥1 of the following danger signs: low oxygen saturation, central cyanosis, severe respiratory distress, feeding difficulties, altered consciousness, and convulsions. Controls were outpatient children aged 2-59 months with a diagnosis of non-severe pneumonia. We reviewed medical records at facilities and used an interviewer-administered questionnaire with caregivers to obtain information on socio-demographic and clinical characteristics. Logistic regression was used to identify factors associated with severe pneumonia.
Results:
We enrolled 199 cases and 174 controls. The odds of severe pneumonia were higher among children with diarrhoea only (adjusted odds ratio [aOR] = 2.9, 95%CI: 1.7-4.9), or malaria and diarrhoea (aOR = 3.4, 95%CI: 2.0-5.9), than those without a co-existing illness at the time of pneumonia diagnosis. Not being exclusively breastfed for ≥ 6 months (aOR = 2.0, 95%CI: 1.1-3.3) and exposure to indoor air pollution from cooking combustion sources (aOR = 2.9, 95%CI: 1.8-4.7) increased odds of severe pneumonia.
Conclusion:
The findings highlight the significance of comorbidities, lack of exclusive breastfeeding, and exposure to indoor air pollution in the development of severe pneumonia. Promoting exclusive breastfeeding for ≥ 6 months and advocating for the use of clean energy sources, could mitigate morbidity attributable to severe pneumonia in the region.
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