Search

Background: Childhood pneumonia (CP) is a common respiratory infectious disease in children with high morbidity and mortality. However, differential changes in miRNAs may interact with the regulation of CP. The aim of this paper was to discuss the miR-200b expression in CP and its diagnostic and prognostic value. Methods: RT-qPCR was used to measure the miR-200b expression in venous blood. ROC curve was adopted to assess the diagnostic ability of miR-200b in children with CP. Logistic analysis was adopted to study the risk factors are related to CP. Kaplan-Meier was employed to analyze the prognostic ability of miR-200b in CP. Transfection of MRC-5 cells in vitro was used to verify the impact of miR-200b on cell proliferation and apoptosis. Results: The expression of miR-200b in serum of CP children was upregulated. ROC analysis prompted that upregulation of miR-200b could be effective in distinguishing between CP and healthy children. Compared with the good prognosis group, miR-200b expression was elevated in the poor prognosis group. Kaplan-Meier reminded that high expression of miR-200b led to a poor prognosis in CP. Cells experiments demonstrated that transfection with miR-200b inhibitor encouraged cell proliferation and inhibited apoptosis, whereas transfection with miR-200b mimic had the contrary result. Conclusions: miR-200b had high diagnostic and prognostic value for children with CP and may become a biomarker for clinical diagnosis and prognosis. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

This study explored the clinical characteristics of Chlamydia trachomatis (C. trachomatis) pneumonia in children and the risk factors for severe C. trachomatis pneumonia. This retrospective case-control study included children with C. trachomatis pneumonia who were admitted to the Department of Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University (Xiamen, China) between January 2018 and December 2021. Among 117 children, 33 (28.2%) had severe C. trachomatis pneumonia and 84 children had mild-to-moderate C. trachomatis pneumonia. According to the results of the binary logistic regression analysis, congenital heart disease [odds ratio (OR) = 0.09, 95% confidence interval (CI): 0.01–0.74, P -value = .024], mixed infection (OR = 0.17, 95%CI: 0.05–0.51, P -value = .002), white blood cell count greater than 15 000 cells/dl (OR = 1.20, 95%CI: 1.03–1.40, P -value = .022), and partial pressure of carbon dioxide (PaCO2) (OR = 1.14, 95%CI: 1.02–1.26, P -value = .016) were found as independent predictive factors for severe C. trachomatis pneumonia in children. This study explored key risk factors for severe C. trachomatis pneumonia, a condition underreported in tropical regions where pediatric respiratory infections are a leading cause of morbidity and mortality. By identifying risk factors, such as congenital heart disease, mixed infections, and elevated PaCO2, this research may guide early intervention strategies in resource-limited settings, potentially reducing pediatric pneumonia deaths. [ABSTRACT FROM AUTHOR]

Abstract Background Childhood pneumonia (CP) is a common respiratory infectious disease in children with high morbidity and mortality. However, differential changes in miRNAs may interact with the regulation of CP. The aim of this paper was to discuss the miR-200b expression in CP and its diagnostic and prognostic value. Methods RT-qPCR was used to measure the miR-200b expression in venous blood. ROC curve was adopted to assess the diagnostic ability of miR-200b in children with CP. Logistic analysis was adopted to study the risk factors are related to CP. Kaplan-Meier was employed to analyze the prognostic ability of miR-200b in CP. Transfection of MRC-5 cells in vitro was used to verify the impact of miR-200b on cell proliferation and apoptosis. Results The expression of miR-200b in serum of CP children was upregulated. ROC analysis prompted that upregulation of miR-200b could be effective in distinguishing between CP and healthy children. Compared with the good prognosis group, miR-200b expression was elevated in the poor prognosis group. Kaplan-Meier reminded that high expression of miR-200b led to a poor prognosis in CP. Cells experiments demonstrated that transfection with miR-200b inhibitor encouraged cell proliferation and inhibited apoptosis, whereas transfection with miR-200b mimic had the contrary result. Conclusions miR-200b had high diagnostic and prognostic value for children with CP and may become a biomarker for clinical diagnosis and prognosis. Clinical trial number Not applicable.

Background Fosfomycin is gaining increasing attention for its activity against MDR or XDR pathogens. Currently, IV fosfomycin is a potential option for treating various infections, including urinary tract infections, pneumonia and skin infections when first-line treatments fail. Objectives To evaluate the demographic, clinical, microbiological and treatment modality of children received IV fosfomycin to treat infections caused by MDR pathogens since there are few data on the use of fosfomycin in children. Methods This study was conducted retrospectively with patients under 18 years of age who were treated with IV fosfomycin for at least 72 h due to infections caused by MDR pathogens between January 2019 and October 2023 at Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye. Data on demographic and clinical features, microbiological findings, treatment modalities and side effects were evaluated. Results Twenty-five children, for a total of 32 cases of infection episodes, with a mean age of 11.4 ±   3.92 years who received IV fosfomycin were included. The most frequent comorbidity was chronic pulmonary diseases, and the most common infection needed for IV fosfomycin was MDR Pseudomonas aeruginosa pneumonia. In all cases, fosfomycin was administered in combination with other antibiotics, mainly meropenem–colistin (68.7%) or meropenem (15.6%). Twenty-two (71.9%) cases had favourable clinical responses at the end of therapy. Conclusions Our results suggest that IV fosfomycin may be an effective treatment option for MDR pathogens in the paediatric population. Nevertheless, careful stewardship is necessary to maintain efficacy and reduce antimicrobial resistance selection risk. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in young children and associated with most bronchiolitis- and pneumonia-related hospitalizations. A new preventive monoclonal antibody (MAb), nirsevimab, has been launched in the United States, Luxembourg, and France, and was recently approved to be given in a population-based manner throughout Spain. This study aimed to have a first pre-immunization insight into the Spanish parental knowledge about bronchiolitis, RSV, and nirsevimab immunization. Parents in Murcia with children

Background: Studies have shown that abnormal temperature at night is a risk factor for respiratory health. However, there is limited evidence on the impact of hot and cold nights on cause-specific diseases such as pneumonia, which is a leading cause of morbidity and mortality in children. Methods: We collected daily data on pneumonia hospitalisations in children under five years from 2011 to 2017 in three low-, middle- and high-income countries (Bangladesh, China, and Australia). The intensity of hot and cold nights was measured by excess temperature. A space–time-stratified case-crossover analysis was used to estimate the association between hot and cold nights and childhood pneumonia hospitalisations. We further estimated the fraction of childhood pneumonia hospitalisations attributable to hot and cold nights. Results: Both hot and cold nights were associated with an increased risk of hospitalisations for childhood pneumonia in low-, middle-, and high-income countries, with a greater disease burden from hot nights. Specifically, the fraction of childhood pneumonia attributable to hot nights was the largest in Australia [21.2%, 95% confidence interval (CI): 11.8%-28.1%], followed by Bangladesh (15.2%, 95% CI: 4.1%–23.8%) and China (2.7%, 95% CI: 0.4%-4.7%). Additionally, the fraction of childhood pneumonia attributable to cold nights was 1.3% (95% CI: 0.4%-2.0%) in Bangladesh and 0.4% (95% CI: 0.1%-0.7%) in China. Conclusion: This multi-country study suggests that hot and cold nights are not only associated with a higher risk of pneumonia hospitalisations in children but also responsible for substantial fraction of hospitalisations, with a greater impact from hot nights.

Abstract Background Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP). Methods Randomized, blinded, comparative effectiveness clinical trial. Children 1 ng/mL, antibiotics were recommended. Results 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39–554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs. Conclusions Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management. Clinical Trial Registration: NCT04217980.

Background: Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP). Methods: Randomized, blinded, comparative effectiveness clinical trial. Children < 18y with suspected BP admitted to the PICU from September 2017 to December 2019, were included. PCT was determined at admission. Patients were randomized into the experimental group (EG) and control group (CG) if LUS or chest X-ray (CXR) were done as the first image test, respectively. Patients were classified: 1.LUS/CXR not suggestive of BP and PCT < 1 ng/mL, no antibiotics were recommended; 2.LUS/CXR suggestive of BP, regardless of the PCT value, antibiotics were recommended; 3.LUS/CXR not suggestive of BP and PCT > 1 ng/mL, antibiotics were recommended. Results: 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39–554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT < 1 ng/ml; 29/52 in the EG and 11/23 in the CG did not receive antibiotics. 2. In 101 patients, the image was suggestive of BP; 34/34 in the EG and 57/67 in the CG received antibiotics. Statistically significant differences between groups were observed when PCT resulted < 1 ng/ml (p = 0.01). 3. In 18 patients the image test was not suggestive of BP but PCT resulted > 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs. Conclusions: Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management. Clinical Trial Registration: NCT04217980. [ABSTRACT FROM AUTHOR]

The pharmacoeconomic aspect of the treatment of pneumonia in the pediatric population is scarce analyzed in the countries of the Balkan region. This research aimed to determine the value of total hospital costs of treating childhood pneumonia from the Republic Fund of Health Insurance perspective. This retrospective cost of illness study was performed using the "from the bottom to the top" approach. It included 82 patients with childhood pneumonia who were treated at Clinical for pediatrics at Clinical Centre Kragujevac. The total costs of hospital treatment of pneumonia for the examined population were 4,095,293.73 RSD. The largest share in total hospital costs has the length of patient hospitalization (22%). The median total hospital costs per patient per year amounted to 40,249.91 RSD (4,793.10 - 142,149.63 RSD). Since the main determinants of overall costs of treating childhood pneumonia are the length of stay and noninvasive ventilation rate, therapeutic strategies should provide not only efficient treatment in compliance with current guidelines as also decreasing these determinants to offer a better pharmacoeconomic profile of childhood pneumonia. [ABSTRACT FROM AUTHOR]

Background In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children’s Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA).Methods Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis.Results All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended.Conclusion Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.

Abstract Background Considering the high frequency of respiratory infections among children in low- and middle-income countries (LMICs), the World Health Organization (WHO) developed a pragmatic guideline for managing pneumonia in low-resource settings. The guideline’s low specificity leads to many false-positive pneumonia cases receiving antibiotic treatment. Integrating diagnostic technology to incorporate lung sounds into WHO guidelines could improve childhood pneumonia diagnosis and management. This qualitative study aimed to explore the acceptability of a prototype digital stethoscope device among potential end-users in Bangladesh. Methods We conducted four focus group discussions (FGDs) with beneficiaries and service providers who used a 2018 digital stethoscope prototype. The data collection was conducted in November 2020. The study was carried out at Zakiganj Upazila (sub-district) of Sylhet district of Bangladesh. A total of 34 respondents, including parents of under-5 children, Community Health Care Providers (CHCPs), and community leaders were enrolled. Two researchers (TJ and a research assistant (not a co-author of this manuscript) conducted the FGDs. Verbatim transcripts were prepared, and translations were completed. Coding was executed in Microsoft Excel, and relevant quotes were extracted to ascertain the emerging themes. To ensure validity, two researchers coded the dataset independently and inconsistencies were resolved through discussion. Findings Mothers were more aware of the digital stethoscope than fathers. Except for the female community leaders, male leaders were unaware of the stethoscopes. Most CHCPs had positive perceptions of the digital stethoscope. They appreciated stethoscope training as they learned about new technology and diagnostic approaches. The users mentioned several technical shortcomings of the prototype device. A few stakeholders expressed dissatisfaction with the level of community involvement and information sharing from the study. The use of the device plummeted during the COVID-19 pandemic for fear of infection, to counteract which the CHCPs cleaned the device with chlorhexidine after every application as a precaution. Conclusion Overall, device use was supported by stakeholders despite perceptions that the prototype had some technological limitations, community engagement was suboptimal, and the COVID-19 pandemic caused disruptions. Stronger community engagement, addressing technological issues, and further research on its health systems application would improve the acceptability and effective use of the digital stethoscope.

Introduction: Childhood pneumonia, if identified early, is readily treatable through low-cost antibiotics. The study aimed to understand the family caregivers' knowledge and care-seeking behavior for the management of childhood pneumonia. The study was cross-sectional, with mixed methods assessing knowledge, perceptions, and practices of caregivers of under-five children on pneumonia using a vignette. Methodology: Systematic random sampling was used to select the participants. Of 107, more than half of the respondents were 18–25 years old. Results: Less than one-fourth were illiterate. Cough, flu, and stomach distention were the commonly reported symptoms. Food ingestion was reported as a main perceived cause; private doctors and traditional healers were the most reported source of help-seeking. Friend/family were reported as leading sources of information. Health education is to be imparted using local knowledge regarding childhood pneumonia. Traditional healers and private practitioners sensitize in early management and referral of childhood pneumonia cases. Conclusions: Information, education and communication messages need to be prepared in the local languages. Strengthening the public health sector is suggested. [ABSTRACT FROM AUTHOR]

Abstract Background Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. Methods This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. Results Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0–2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2–3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4–3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1–5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4–1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. Conclusions Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized. Keywords: Childhood pneumonia, epidemiology, health care seeking behavior, Nepal.

Abstract Background Pneumonia is an acute respiratory infection of the lungs. A child dies of pneumonia every 39 s globally. Even though pneumonia affects children worldwide, the risk and repercussions of the disease are more prevalent in poor and middle-income nations. Despite the initiatives by the Ethiopian government, there are still numerous instances and deaths caused by childhood pneumonia. Therefore, this study aimed to identify the risk factors for pneumonia among 2–59 months-old children visiting Adama Hospital Medical College, Adama, Ethiopia. Methods An institution-based unmatched case-control study was conducted among 124 cases and 124 controls from January 1, 2021, to March 15, 2021. Cases were selected using a consecutive sampling technique. For each case, the next patient from the same pediatric outpatient room who met the inclusion criteria was taken as a control. Data were collected using a pretested, structured interviewer-administered questionnaire containing sociodemographic, environmental, and nutritional factors, comorbid illnesses, and related care practices. A multiple logistic regression model was fitted. Results Family size of ≥ 5 compared to 5000 birr (AOR: 3.94, 95% CI: 1.06, 14.6), use of charcoal as the main fuel for cooking (AOR: 7.03, 95% CI: 2.38, 20.78), and wood or dung as the main fuel for cooking compared to electricity (AOR: 6.58, 95% CI: 2.07, 20.9), malnutrition compared to no malnutrition (AOR: 4.77, 95% CI: 1.89, 12.06), diarrhea compared to no diarrhea in the past 2 weeks (AOR: 3.3, 95% CI: 1.52, 7.14) and upper respiratory tract infection (URTI) compared to no infection in the past 2 weeks (AOR: 3.29, 95% CI: 1.31, 8.23) were found to be risk factors for pneumonia. Conclusion In this study, risk factors for pneumonia were family size, monthly income, type of energy used for cooking, malnutrition, and diarrhea or URTI in the past 2 weeks. Relatively simple interventions such as cooking with electricity, and other interventions like prevention, early detection and treatment of malnutrition, diarrhea, and URTI, and promotion of family planning are important.

Background: Pneumonia is a top serious problem for under-five children. Although pneumonia affects children worldwide, the disease's risk and consequences are more widespread in low- and middle-income countries. Objectives: This study aimed to identify predictors of childhood pneumonia among children who visited public Hospitals located in West Shoa Zone, Oromia, Ethiopia. Methods: A case–control study was conducted among 375 (125 cases and 250 controls) to identify predictors of childhood pneumonia among children who visited in nine public health Hospitals from May to July 2022. Binary logistic regression was used to analyze the data. Variables with a p-value less than 0.05 in a multivariable logistic regression were declared statistically significant. Results: Among respondents 42.1% were males and 57.9% were females. Factors such as using water without soap for hand washing before child feeding [AOR: 3.09, 95% CI: 1.59–6.00] and house near the street [AOR: 2.87, 95% CI: 1.54–5.37] were found to be the determinant of under-five pneumonia. Similarly, animal dung as a source of fuel [AOR: 2.26, 95% CI: 1.06–4.79], Child care given by the house worker or home maid [AOR: 3.35, 95% CI: 1.59–7.05], and having acute respiratory tract infection in the last two weeks [AOR: 6.46, 95% CI: 3.32–12.56] were significantly associated with under-five pneumonia. Conclusions: Hand washing with soap before child feeding, cooking with animal manure, and a history of acute respiratory tract infection in the previous two weeks were found as risk factors for childhood pneumonia.

Background: Considering the high frequency of respiratory infections among children in low- and middle-income countries (LMICs), the World Health Organization (WHO) developed a pragmatic guideline for managing pneumonia in low-resource settings. The guideline's low specificity leads to many false-positive pneumonia cases receiving antibiotic treatment. Integrating diagnostic technology to incorporate lung sounds into WHO guidelines could improve childhood pneumonia diagnosis and management. This qualitative study aimed to explore the acceptability of a prototype digital stethoscope device among potential end-users in Bangladesh. Methods: We conducted four focus group discussions (FGDs) with beneficiaries and service providers who used a 2018 digital stethoscope prototype. The data collection was conducted in November 2020. The study was carried out at Zakiganj Upazila (sub-district) of Sylhet district of Bangladesh. A total of 34 respondents, including parents of under-5 children, Community Health Care Providers (CHCPs), and community leaders were enrolled. Two researchers (TJ and a research assistant (not a co-author of this manuscript) conducted the FGDs. Verbatim transcripts were prepared, and translations were completed. Coding was executed in Microsoft Excel, and relevant quotes were extracted to ascertain the emerging themes. To ensure validity, two researchers coded the dataset independently and inconsistencies were resolved through discussion. Findings: Mothers were more aware of the digital stethoscope than fathers. Except for the female community leaders, male leaders were unaware of the stethoscopes. Most CHCPs had positive perceptions of the digital stethoscope. They appreciated stethoscope training as they learned about new technology and diagnostic approaches. The users mentioned several technical shortcomings of the prototype device. A few stakeholders expressed dissatisfaction with the level of community involvement and information sharing from the study. The use of the device plummeted during the COVID-19 pandemic for fear of infection, to counteract which the CHCPs cleaned the device with chlorhexidine after every application as a precaution. Conclusion: Overall, device use was supported by stakeholders despite perceptions that the prototype had some technological limitations, community engagement was suboptimal, and the COVID-19 pandemic caused disruptions. Stronger community engagement, addressing technological issues, and further research on its health systems application would improve the acceptability and effective use of the digital stethoscope. [ABSTRACT FROM AUTHOR]

Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed. [ABSTRACT FROM AUTHOR]

Abstract Background Community-acquired pneumonia (CAP) is the leading cause of death in children globally. Indonesia is ranked 1st in South East Asia with the highest burden of pneumonia. Identification of risk factors is necessary for early intervention and better management. This study intended to describe CAP’s clinical signs and laboratory findings and explore the risk factors of severe CAP among children in Indonesia. Methods This was a retrospective study of childhood hospitalizations in Siloam General Hospitals and Siloam Hospitals Lippo Village from December 2015 to December 2019. Demographic data, clinical signs, and laboratory findings were collected and processed using IBM SPSS 26.0. Results This study included 217 participants with 66 (30.4%) severe pneumonia cases. Multivariate analysis shows that fever that lasts more than 7 days (ORadj = 4.95; 95%CI 1.61–15.21, P adj = 0.005) and increase in respiratory rate (ORadj = 1.05, 95%CI 1.01–1.08, P adj = 0.009) are two predictors of severe pneumonia. Meanwhile, a normal hematocrit level (ORadj = 0.9; 95%CI 0.83–0.98, P adj = 0.011) and children with normal BMI (ORadj = 0.7; 95%CI 0.57–0.84, P adj < 0.001) are significant independent predictors of severe pneumonia. The Hosmer-Lemeshow test shows that this model is a good fit with a P-value of 0.281. The AUC for this model is 0.819 (95%CI = 0.746–0.891, P-value < 0.001) which shows that this model has good discrimination. Conclusion Pediatric CAP hospitalizations with fever lasting > 7 days and tachypnea were at higher risk for progressing to severe pneumonia. A normal hematocrit level and a normal BMI are protective factors for severe pneumonia.

Background: Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. Methods: This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. Results: Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0–2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2–3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4–3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1–5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4–1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. Conclusions: Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized. Keywords: Childhood pneumonia, epidemiology, health care seeking behavior, Nepal. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children’s Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). Methods: Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. Results: All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended. Conclusion: Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is an acute respiratory infection of the lungs. A child dies of pneumonia every 39 s globally. Even though pneumonia affects children worldwide, the risk and repercussions of the disease are more prevalent in poor and middle-income nations. Despite the initiatives by the Ethiopian government, there are still numerous instances and deaths caused by childhood pneumonia. Therefore, this study aimed to identify the risk factors for pneumonia among 2–59 months-old children visiting Adama Hospital Medical College, Adama, Ethiopia. Methods: An institution-based unmatched case-control study was conducted among 124 cases and 124 controls from January 1, 2021, to March 15, 2021. Cases were selected using a consecutive sampling technique. For each case, the next patient from the same pediatric outpatient room who met the inclusion criteria was taken as a control. Data were collected using a pretested, structured interviewer-administered questionnaire containing sociodemographic, environmental, and nutritional factors, comorbid illnesses, and related care practices. A multiple logistic regression model was fitted. Results: Family size of ≥ 5 compared to < 5 (Adjusted odds ratio (AOR): 3.08, 95% CI: 1.23, 7.71), household monthly income of < 2500 compared to > 5000 birr (AOR: 3.94, 95% CI: 1.06, 14.6), use of charcoal as the main fuel for cooking (AOR: 7.03, 95% CI: 2.38, 20.78), and wood or dung as the main fuel for cooking compared to electricity (AOR: 6.58, 95% CI: 2.07, 20.9), malnutrition compared to no malnutrition (AOR: 4.77, 95% CI: 1.89, 12.06), diarrhea compared to no diarrhea in the past 2 weeks (AOR: 3.3, 95% CI: 1.52, 7.14) and upper respiratory tract infection (URTI) compared to no infection in the past 2 weeks (AOR: 3.29, 95% CI: 1.31, 8.23) were found to be risk factors for pneumonia. Conclusion: In this study, risk factors for pneumonia were family size, monthly income, type of energy used for cooking, malnutrition, and diarrhea or URTI in the past 2 weeks. Relatively simple interventions such as cooking with electricity, and other interventions like prevention, early detection and treatment of malnutrition, diarrhea, and URTI, and promotion of family planning are important. [ABSTRACT FROM AUTHOR]

Pneumococcal conjugate vaccine ten valent (PCV 10) was introduced into Nigeria in three phases. Phase 3 introduction started in August 2016. However, its impact on pneumonia admissions and mortality among vaccinated Nigerian children has not been determined. Data in the period before PCV-10 introduction (3 August 2013–2 August 2016), and after (3 August 2017–2 August 2020) were retrospectively extracted from the medical charts of eligible patients aged 3–24 months with hospitalized radiological pneumonia at the University College Hospital (UCH), Ibadan; National Hospital (NH), Abuja; and Federal Teaching Hospital (FTH), Gombe, allowing for an intervening period of 1 year. Proportions of the patients with hospitalized pneumonia and case fatality rates were determined during both periods. The results were compared using z-test, multiple logistic regression analysis and p

Objectives: The relative scarcity of paediatric COVID-19 disease infers protection from its direct harms. We aim to highlight the potentially severe indirect effects of COVID-19 upon global childhood pneumonia. Study design: This is a discussion piece written from the authors’ perspective. Methods: We use the social determinants of health to describe the indirect impact of COVID-19 upon global childhood pneumonia. Results: The social determinants of health are a range of social, economic, and environmental factors used to explore and explain global health differences and inequalities. Global childhood pneumonia is a significant public health problem with clear linkage to the social determinants of health. COVID-19 is a significant threat to the health and wellbeing of children around the world through its potentially severe effects on all strata of the social determinants of health. Conclusions: The COVID-19 pandemic could undermine years of progress in reducing both global childhood pneumonia incidence and mortality, and most significantly affect vulnerable children living in poverty.

Childhood pneumonia remains a major public health concern worldwide, but the critical meteorological factors that contribute to it are unknown. To investigate the relationship between childhood pneumonia and prenatal and postnatal exposure to meteorological factors to identify the critical factors and vulnerable timing windows. We conducted a retrospective cohort study of 8689 preschoolers in China. We gathered information on personal factors, health status, and indoor environment through questionnaires. We considered meteorological factors including temperature (mean, maximum, minimum), diurnal temperature variation (DTV), relative humidity, wind speed, rainfall, pressure and sunshine during early life. Using multiple logistic regression models, we investigated the links between childhood pneumonia and early life exposure to meteorological factors. Exposure to mean, maximum, and minimum temperatures was associated with childhood pneumonia in the first month and first trimester, with ORs (95% CI) of 1.32 (1.07–1.62), 1.26 (1.04–1.52) and 1.33 (1.08–1.64) in the first month, and 1.42 (1.12–1.81), 1.36 (1.08–1.71) and 1.47 (1.15–1.88) in the first trimester for per IQR increase in each meteorological factor exposure. Wind speed, rainfall, and sunshine exhibited significant associations with pneumonia during the first, second, and third trimesters, respectively. Exposure to various temperatures, DTV, relative humidity, rainfall, air pressure, and sunshine were linked to childhood pneumonia in the postnatal period, particularly in the previous year. The sensitivity analysis revealed that boys are more vulnerable to meteorological factors. Keeping dogs or plants may offer protection against the pneumonia risk of prenatal and postnatal meteorological exposure. Exposure to meteorological factors during both the prenatal and postnatal periods, especially in early pregnancy, was found to elevate the risk of childhood pneumonia. [Display omitted] • Effect of climatic factors on childhood pneumonia in different windows is unclear. • Pneumonia in children was associated with prenatal exposure to ambient temperature. • Early pregnancy was identified as a critical time window for climatic exposure. • Postnatal exposure to climatic factors had the highest risk of childhood pneumonia. • Our study support "Fetal origin of pneumonia" hypothesis by meteorological factors. [ABSTRACT FROM AUTHOR]

Despite mounting evidence linked pneumonia with air pollution, it is unclear what main pollutant(s) exposure in which critical window(s) play a key role in pneumonia. To examine effects of intrauterine and post-natal exposure to air pollution on children's doctor-diagnosed pneumonia (DDP). A combination of cross-sectional and retrospective cohort study was conducted at Changsha, China during 2019–2020. Personal exposure to outdoor air pollutants at each child's home address was estimated using inverse distance weighted (IDW) method based on data from 10 air quality monitoring stations. Associations between personal air pollution exposure and DDP were evaluated. Children's DDP was associated with intrauterine and post-natal exposure to PM 2.5 , PM 2.5–10 , and PM 10 , adjusted ORs (95% CI) of 1.17 (1.04–1.30), 1.09 (1.01–1.17), and 1.07 (1.00–1.14) for IQR increase in intrauterine exposure and 1.12 (1.02–1.22), 1.13 (1.06–1.21), and 1.28 (1.16–1.41) for post-natal exposure. Intrauterine PM 2.5 exposure and post-natal PM 10 exposure were associated with a higher risk of pneumonia. We identified the 2nd trimester, 3rd trimester, and first year as critical windows respectively for PM 2.5 , PM 2.5–10 , and PM 10 exposure. Daytime exposure to traffic-related air pollution especially during early life increased DDP. Intrauterine and post-natal exposure to particulate matters played a dominant role in children's DDP. [Display omitted] • Childhood pneumonia was dominantly affected by particulate matters (PMs) exposure. • Intrauterine exposure to PM 2.5 especially in 2nd trimester enhanced pneumonia risk. • Postnatal exposure PM 10 particularly in first year elevated pneumonia risk. • Daytime was identified as key time for traffic pollution in relation to pneumonia. • Our study supports and develops the hypothesis of 'fetal origin of infection. [ABSTRACT FROM AUTHOR]

Introduction. Early and accurate diagnosis of Mycoplasma pneumoniae ( MP ) infection of children with pneumonia is at the core of treatment in clinical practice. Gap Statement. Serological immunoglobulin M (IgM) tests for MP infection of children in south China have been rarely described. Aim. To assess the diagnostic performance and clinical application of serodiagnosis of MP infection in paediatric pneumonia patients. Methodology. Serum samples from 144 children diagnosed with MP pneumonia were subjected to a particle agglutination (PA)-based IgM assay. Meanwhile, we used an established suspension array as the reference standard method for the detection of MP DNA in bronchoalveolar lavage fluid (BALF) from all patients to assess the reliability of serological assays. Results. When running immunological testing in single serum samples, 80.6 %(79/98) of cases were diagnosed with MP infection, whereas only 55 (56.1 %) cases were positive in MP DNA analysis. Furthermore, single serum tests for IgM during acute MP infection resulted in 85.5 % (47/55) sensitivity and 25.6 % (11/43) specificity. Nevertheless, immunological testing and MP DNA analysis yielded the same results when paired sera were available for MP IgM antibody testing. Conclusion. Paired serological IgM assays are necessary for the determination of an acute MP infection, whereas single serological IgM testing is unreliable. Moreover, even a short interval of two MP serological tests works well.

Increasing evidence have associated pneumonia with early exposure to ambient air pollution. However, the role of indoor environmental factors exposure in early life on childhood pneumonia remains unclear. To examine the association between indoor environmental factors exposure during different timing windows and childhood pneumonia, and to identify the key indoor factor(s) in different critical window(s). A retrospective cohort study of 8689 pre-schoolers was performed in Changsha, China during 2019–2020. Our questionnaire survey was designed to collect information on pre-schooler's outcome and residential environmental exposure containing indoor pollution and allergens during 1 year before pregnancy, pregnancy, first year, and past year. The associations were further estimated stratified by personal exposure level of outdoor NO 2 , CO, temperature (T) and different covariates. Associations were assessed by multiple logistic regression model in terms of odds ratio (OR) of 95% confidence interval (CI). Pre-schooler's pneumonia was significantly related with exposure of new furniture, redecoration, mold/damp stains, and mold or damp clothing or bedding exposure during the four periods, with the strongest associations observed during 1 year before pregnancy based on multi-window model, with ORs (95% CI) of 1.27 (1.12–1.44), 1.26 (1.09–1.46), 1.34 (1.14–1.57), and 1.28 (1.05–1.56) respectively. Environmental tobacco smoke (ETS) including both parental and grandparental smoking were significantly related with increased risk of pre-schooler's pneumonia, and ETS played a more important role in early life, with ORs (95% CI) of 1.17 (1.01–1.36) and 1.19 (1.02–1.39) in pregnancy and first year. Indoor plants particularly nonflowering plants significantly elevated pneumonia risk but only in past year, with ORs (95% CI) of 1.17 (1.05–1.30) and 1.14 (1.03–1.26). Higher pneumonia risk was observed for renovation exposure in pre-birth compared to post-birth, while mold/dampness exerted an accumulative effect with the highest risk for exposure during both pre- and post-birth. Living near traffic road and exposure to high level of traffic-related air pollution and high temperature significantly increased pneumonia risk. Sensitivity analysis found that some sub-groups were more susceptible to pneumonia risk of home environment exposure. Early life exposure to indoor environmental factors plays an important role in pneumonia development, supporting the hypothesis of "Preconceptional and Fetal Origin of Childhood Pneumonia" and "Developmental Origins of Health and Pneumonia". [Display omitted] • Pre- and post-birth exposure to indoor pollution and allergen were related with childhood pneumonia. • 1 year before pregnancy was identified as a critical window for pneumonia risk of indoor exposure. • Renovation and mold/dampness exposure posed higher risk of pneumonia in pre-birth periods. • Mold or damp stains and clothing or bedding have a cumulative effect on childhood pneumonia. • Traffic pollution and high temperature increased pneumonia risk of indoor environmental factors. [ABSTRACT FROM AUTHOR]