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


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          Acute 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.


          Our goal was to assess the risk factors for childhood pneumonia in regions with a high prevalence of pneumonia in Indonesia.


          This 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.


          The 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.


          No 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.

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          Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles.

          Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight. The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight. Data were obtained from investigators of 10 cohort studies with both weight-for-age category ( -1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition. The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea. A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.
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            Household air pollution from domestic combustion of solid fuels and health

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              Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study.

              Acute respiratory infections (ARI) are the leading cause of the global burden of disease and have been causally linked with exposure to pollutants from domestic biomass fuels in less-developed countries. We used longitudinal health data coupled with detailed monitoring of personal exposure from more than 2 years of field measurements in rural Kenya to estimate the exposure-response relation for particulates smaller than 10 mm in diameter (PM(10)) generated from biomass combustion. 55 randomly-selected households (including 93 infants and children, 229 individuals between 5 and 49 years of age, and 23 aged 50 or older) in central Kenya were followed up for more than 2 years. Longitudinal data on ARI and acute lower respiratory infections (ALRI) were recorded at weekly clinical examinations. Exposure to PM(10) was monitored by measurement of PM(10) emission concentration and time-activity budgets. With the best estimate of the exposure-response relation, we found that ARI and ALRI are increasing concave functions of average daily exposure to PM(10), with the rate of increase declining for exposures above about 1000-2000 mg/m(3). After we had included high-intensity exposure episodes, sex was no longer a significant predictor of ARI and ALRI. The benefits of reduced exposure to PM(10) are larger for average exposure less than about 1000-2000 mg/m(3). Our findings have important consequences for international public-health policies, energy and combustion research, and technology transfer efforts that affect more than 2 billion people worldwide.

                Author and article information

                Clin Exp Pediatr
                Clin Exp Pediatr
                Clinical and Experimental Pediatrics
                Korean Pediatric Society
                November 2021
                15 March 2021
                : 64
                : 11
                : 588-595
                [1 ]Master in Public Health Sciences Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
                [2 ]Department of Child Health, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
                [3 ]Dapertment of Biostatistics, Epidemiology and Population Health Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
                Author notes
                Corresponding author: Abdul Wahab, Dr, MPH. Department of Biostatistics, Epidemiology and Population Health Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Jl. Kaliurang Km 6.2 Pandega Padma I/ B06A, Yogyakarta, Indonesia Email: awahab@ 123456ugm.ac.id
                Author information
                Copyright © 2021 by The Korean Pediatric Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 12 March 2020
                : 21 December 2020
                : 23 February 2021
                Original article
                General Pediatrics

                pneumonia,respiratory tract infections,breast feeding,immunization,nutritional status


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