The Risk Factors For Pneumonia In Children Under The Age Of 5 In Nigeria Case Study

The Risk Factors For Pneumonia In Children Under The Age Of 5 In Nigeria

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CHAPTER 1: RESULTS

1.1 Introduction:

In the present review, a preliminary search using pre-determined search terms yielded 1250 titles and abstracts of relevant studies, which were screened for eligibility based on pre-set inclusion and exclusion criteria. Of these, 950 articles were excluded for not meeting the criteria, and 50 were excluded due to insufficient information for assessment. This resulted in 250 articles that were selected for full-text retrieval. An additional 5 articles were obtained through expert consultation and screening of reference lists of retrieved articles. All retrieved full-text articles were then thoroughly scrutinized for eligibility. After a thorough examination, only 25 articles met the criteria for inclusion, and of those, 19 were further excluded for reasons such as a lack of a comparison group or unavailable correlation values. Ultimately, 6 studies were selected for the review. Only quantitative research was discovered, "even though both qualitative and quantitative studies" were taken into consideration for this study. Between 2014 and 2022, peer-reviewed journals published all of the papers that were chosen as "primary research"; they were all written in "English".

1.2 Summary of the selected study

All of the eleven selected studies for the review by Ibraheem and Abdulkarim (2014), Mulholland (2020), Fakunle, Ana and Ayede (2014), Adedokun (2020), BELLO (2021) and Akeredolu (2021).

Title and abstracts n= 1250

Full text= 300

Excluded n= 900

Insufficient information= 50

Excluded n=275

Study design n= 100

Background n= 75

Child age ≥ 10 n= 25

Outside of Nigeria n= 20

Not related to pneumonia= 15

Duplicate n= 10

Not in English n= 10

Articles meeting study criteria n= 25

Excluded n=19

No clear comparison group n= 9

No correlation between the selected group n = 10

Included n= 6

Identified through contracting n = 7

Identified through screening bibliography n= 8

1.3 Findings of the studies

Particularly in underdeveloped nations, pneumonia is a significant factor in "morbidity and death among children under the age of five”. Hypoxaemia is known to be a serious severe respiratory illness and health a strong “risk factor” for developing an “acute lower respiratory infection” which is highly related to mortality, particularly in the case of pneumonia. Pulse oximetry can be found to be a non-invasive simple, reproducible and reliable tool that can be used to monitor the label of hypoxaemia in clinical examination (Ujunwa and Ezeonu, 2014). The study shows that there were negative correlations between the socioeconomic status of the child, “maternal age, maternal literacy level and birth order of the child” with hypoxaemia. The study was also conducted among 119 males and 81 females in which 32 of the kids or 16.0% had “lobar pneumonia”, while 168 or 84.0% of the kids had “bronchopneumonia” (Ibraheem and Abdulkarim, 2014). According to the study's findings, there are several risk variables related to the severity of pneumonia, but hypoxemia is mostly linked to a child's poor socioeconomic status.

The mortality rate from pneumonia is particularly high in children, and a new approach is required to address the issue. One such approach might involve enhancing one's "vitamin D" status since optimal "vitamin D" levels can support the body's defence mechanisms against acute respiratory infections. Studies have been conducted among "135 children having pneumonia" and their "vitamin D" levels were measured and compared with another "135 healthy children without pneumonia". Pneumonia was diagnosed with the help of WHO criteria with X-rays signs and "vitamin D" levels were measured using a "vitamin D ELISA kit" (Akeredolu et al. 2021). Compared to healthy children without pneumonia, the average blood level of "vitamin D" in "children with pneumonia" was significantly low. The study also discovered that "children with low blood levels" of "vitamin D" were more likely to develop "pneumonia" rather than children who did not. After the consideration of the potential ref factor and analysing of the data, a decreased risk of developing pneumonia was connected with blood levels of "vitamin D >75 nmol/l" (Akeredolu et al.

However, knowing the microorganisms that cause this terrible pediatric sickness can help in choosing the appropriate anti-microbial, preventing the emergence of resistance and unnecessary spending. Clinically, “pneumonia” can be identified by “a constellation of symptoms” and indications, such as “cough”, “fever”, “pleuritic chest pain”, and “rapid breathing”. This study shows that “Staphylococcus aureus” and “Klebsiella sp.” accounted for “41.9% and 27.9%”, respectively, of the community-acquired pneumonia cases that were caused by bacteria (BELLO, 2021). The study was conducted among children under 18 years old who wear “admitted for pneumonia” to the “emergency paediatrics unit DASH Lafia in Nasarawa State, Nigeria '' (BELLO, 2021). The study also shows that "bivariate analysis" revealed no relationship between the length of admission and gender or age group. However, over a year, "community-acquired pneumonia" accounted for "11.3%" of all admissions. On the other hand, compared to the "16.3% recorded in India", the current study's prevalence of pneumonia is lower (BELLO, 2021). Overall, this study found that pneumonia, with a high case fatality rate, continues to be a major cause of "childhood morbidity and mortality", especially in children under the age of five.

Child survival rates have increased recently in the majority of low- and middle-income nations over the last thirty years. Nigeria is not a considerably poor country however with 120 deaths per every 105 live births, the under-five mortality rate is nearly the worst in the world after "Somalia" (Mulholland, 2020). It also describes the management of severe pneumonia together with severe malaria in 12 medium-sized hospitals (Mulholland, 2020). It has been seen that even though most of the hospitals had access to Oxygen and antibiotics however the access was limited. Apart from this where half of the population of Nigeria lives in poverty, some of the hospitals charge $7.50 per day for oxygen (Mulholland, 2020). Along with this a typical three-day admission for pneumonia cost the family around $60 (Mulholland, 2020). Through this paper, it can be concluded that the overall management systems in the hospitals of Nigeria for severe pneumonia and severe malaria are very poor and needs to be maintained according to the guidelines provided by WHO.

In children under the age of five, "acute respiratory infections or ARIs" rank as the fourth most common cause of illness and mortality worldwide. Still, children are more likely to develop ARIs when there is poor indoor air quality and outdoor air pollution. The study was conducted at “Oni Memorial Children's Hospital” and “Otunba-Tunwase Emergency Hospital” which had 220 under-5 children with ARIs admitted (Fakunle, Ana and Ayede, 2014). The usage of lanterns at night emits smoke and particles into the air along with the use of mosquito coils, causing ARIs. It can be stated that carrying children while using firewood for cooking can be considered a factor that influences ARIs (Fakunle, Ana and Ayede, 2014). Based on this study it can be concluded that to prevent and manage ARI, there needs to be a greater understanding of the significance of environmental factors.

CHAPTER 2: DISCUSSION

2.1 Discussion of the findings:

Nigerian children who are mostly under the age of 5 low survival rate due to pneumonia.pneumonia in NigeriaUjunwa and Ezeonu (2014)social demographic factorsagesexparental incomeeducation level of parents risk factors risk factorabsence of normal levels of vitamin d in the child under the age of 5 in NigeriaAkeredolu et al. (2021)risk factorrisk factor arises due to the mother giving many births during a short periodAdedokun (2020)third or fourth child less accessible to their mother's milk causes a low immune system building in the child as a result the child gets pneumonia.risk factoraccurate respiratory infectionBELLO, (2021)malnutritionlow weight at the time of birthnon-exclusive breastfeedingnot getting proper mental education in the community and parentsNigeria in developing pneumonia is the management issues within the hospitalsMulholland (2020)increases the risk of getting pneumonia in children aged below 5 in NigeriaFakunle, Ana and Ayede (2014)last risk factorenvironmentenvironmental receptors ARIs in children aged below 5 in Nigeria.

Pneumonia is a respiratory infection that affects the lungs and can cause inflammation, fluid accumulation, and difficulty breathing. Hypoxemia is a condition with a low level of oxygen in the blood, which can lead to tissue damage and organ failure if left untreated (Nascimento-Carvalho, 2020). The relationship between the two conditions is that pneumonia can cause hypoxemia by impairing the ability of the lungs to transfer oxygen from the air to the blood. A child having pneumonia has their lungs inflamed and filled with fluid, which makes it difficult for oxygen to pass through the alveoli or tiny air sacs into the bloodstream (Iuliano et al. 2020). As a result, the child's oxygen levels in the blood may drop, leading to hypoxemia. Hypoxemia can be a serious complication of pneumonia, and it can increase the risk of death in hospitalised children. The research also included “119 boys and 81 girls and found that 168 children, or 84.0% of the children, had bronchopneumonia whereas 32 children, or 16.0%, had lobar pneumonia”

There is some proof that there could be a connection between vitamin D serum levels and acute pneumonia in 1 to 5 years old children in Nigeriaantimicrobial peptidesfight off infections such as pneumoniaa vitamin D deficitet al.135 children with pneumonia participated in studies, and their levels of vitamin D were assessed and compared to those of 135 more healthy children. Vitamin D levels were evaluated using a "vitamin D ELISA kit," and pneumonia was identified using WHO criteria and X-ray symptoms.D greater than 75 nmol/l a lower chance of acquiring pneumonia

Ordinal analysis of cross-sectional data can provide valuable insights into the correlation between childhood morbidity and pneumonia in Nigeria. More than 50% of under-5-year-old children's deaths in Nigeria are due to comorbidities, therefore single health concerns require a lot of care. The study was conducted using information from the 2013 Nigerian Demographic and Health Survey (DHS), in which it was found that 27,571 children under the age of five had acute respiratory infections, diarrhoea, or fever within two weeks of the survey's data collection (Robitzsch, 2020). A single ailment is more likely to affect infants born in the third or later order of birth than firstborns, with 14% of youngsters suffering from just one health issue and 9% receiving help from commodities (Adedokun, 2020). The results of cross-sectional data on childhood morbidity and pneumonia in Nigeria could provide valuable insights into the correlation between these two variables. The risk also increased when the region where their mother lives changed from north-central to the northeast.

There are several pathogens which are responsible for severe childhood disease so, the pathogens which are responsible for this disease to prevent the development of “acute respiratory infections” in children. About 5 million deaths occur among children below the age of 5 years due to pneumonia and the increasing need to prevent this disease with the correct resources and knowledge is very much critical in healthcare facilities. Pneumonia can be diagnosed clinically by several symptoms and Science that include “cough, fever, pleuritic chest pain, and abnormal breathing” (Yun et al. et al.

The mortality rate due to pneumonia is consistently rising due to the management issues present in the hospitals of Nigeria (Tatochenko, 2021). Even though the doctors have been given clear instructions about the description of severe pneumonia along with severe malaria by the "World Health Organisation" or "WHO", the practices lack proper management (Who. int, 2022). Nigeria has many hospitals and compared with other developing countries it can be stated that this country is not a poor country because its "GDP was per capita $5710 in 2018" (Mulholland, 2020). Yet this country has the worst survival rate under the age of five, slightly better than "Somalia". The study was conducted among '12 hospitals in Nigeria" (Mulholland, 2020). Through the study, it was observed that even though most of the “hospitals had access to Oxygen and antibiotics” the overall access was limited considering the demand. Even though Nigeria is not a poor country however half of the population here lives in poverty this is why most of the time it becomes impossible for them to get oxygen service for "$7.50 per day" (Mulholland, 2020). Along with this approximate pay of "$60" for “an average 3-day admission for pneumonia” (Mulholland, 2020). The study also highlighted that even after getting clear instructions about the description of severe pneumonia from "WHO" still doctors in these hospitals were unable to properly diagnose the symptoms of pneumonia (Who. int, 2022). This kind of "missed" cases is another reason for the low survival rate in Nigeria. Proper monitorisation of hospital management is needed if the country wants to decrease the rate of overall mortality due to severe pneumonia as well as severe malaria. Accordingly, many "missed" diagnosis cases had also been observed which was another poor management that causes the increasing rate of “mortality among children under the age of five in Nigeria”.

ARIs causes about 3.9 million deaths across the globe every year in “children under the age of 5” and they account for "about 30-50%" of the visit to “health facility” and "about 20-40%" of total admissions to hospitals within “Nigeria” (Fonseca Lima et al. 2016). According to WHO, 20% of total death of “children under 5 years” are caused by acute “lung respiratory infections” which include "pneumonia, bronchiolitis and bronchitis" (Goyal et al.risk factors et al.

2.2 Strengths and weaknesses of the research

Investigation revealed that the review significantly contributed to improving knowledge of a recently discovered issue in a particular field of research. The review's credibility and the validity of its conclusions were strengthened by the careful and exact "research methodology" used, which included clearly defined "inclusion and exclusion criteria", thorough and thorough searches across a variety of "databases" and "structured data extraction" and "quality assessment techniques aimed at addressing specific and narrowly focused research questions" (Yun et al. 2019).

There were also some restrictions placed on the review. Initially, all the primary studies designed to evaluate the risk factors of pneumonia were decided to carry out in Nigeria. Due to the variety in study design and in the words used to characterise risk variables and outcomes, the review "additionally included a narrative evidence synthesis" (Fakunle, Ana and Ayede, 2014). It is impossible to tell "whether exposures preceded or followed outcomes as in case-control or cohort studies" since outcome and risk factors are measured simultaneously in "cross-sectional studies".

2.3 Study's implications for practice and policy

"Global", "regional" and "national policymakers" had to rely on "individual studies" up until now to "explain the etiological pathway of childhood obesity in various countries" as they "implemented programmes or policies to combat it". With a more comprehensive understanding of the causes contributing to childhood pneumonia in these nations thanks to this analysis, policymakers may be better able to create a sustainable nutrition plan and more potent intervention programmes. The review's findings can inform the revision of national and regional nutrition policies by replacing broad intervention strategies with targeted interventions aimed at addressing specific obesogenic factors. This may enable policymakers to allocate funding more effectively across different initiatives (Mulholland, 2020). Additionally, the review highlights the association between childhood pneumonia and various other factors that influence children's food and nutrition behaviour. As a result, policymakers can “adopt a multidisciplinary approach” to addressing “obesogenic factors among children in these countries”.

2.4 Plan of Dissemination

The target audiences are reached when a study is deemed successful. Both academics and policymakers are believed to value the current review's addition of significant material to the body of knowledge already known in this sector. Thus, the author plan to use nationally, regionally, and internationally organised symposiums, seminars, conferences, and workshops to disseminate the research findings to both policymakers and academics. To make the review accessible to a wide audience, the author may also attempt to publish it in "BMC Public Health," "Journal of Health, Population & Nutrition," or any other reputable open-access online medical publication. This will make it possible for other researchers to reference the article in their works.

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Akeredolu, F.D., Akuse, R.M., Mado, S.M. and Yusuf, R., 2021. Relationship between serum vitamin D levels and acute pneumonia in children aged 1–59 months in Nigeria. Journal of Tropical Pediatrics, 67(1), p.fmaa101.

BELLO, S.O., 2021. aetiology and outcome of community-acquired pneumonia at a tertiary hospital in Lafia Nigeria. Moroccan Journal of Public Health, 3(2).

Fakunle, G.A., Ana, G.R. and Ayede, A.I., 2014. Environmental risk factors for acute respiratory infections in hospitalized children under 5 years of age in Ibadan, Nigeria. Paediatrics and international child health, 34(2), pp.120-124.

Fonseca Lima, E.J.D., Mello, M.J.G., Albuquerque, M.D.F.P.M.D., Lopes, M.I.L., Serra, G.H.C., Lima, D.E.P. and Correia, J.B., 2016. Risk factors for community-acquired pneumonia in children under five years of age in Brazil's post-pneumococcal conjugate vaccine era: a case-control study. BMC pediatrics, 16, pp.1-9.

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Gritly, S.M., Elamin, M.O., Rahimtullah, H., Ali, A.Y.H., Dhiblaw, A., Mohamed, E.A. and Adetunji, H.A., 2018. Risk factors of pneumonia among children under 5 years at a pediatric hospital in Sudan. International Journal of Medical Research & Health Sciences, 7(4), pp.60-68.

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