Jackson Stewart, Mathews Kyle H, Pulanic Dražen, Falconer Rachel, Rudan Igor, Campbell Harry, Nair Harish
Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, Scotland, UK.
Croat Med J. 2013 Apr;54(2):110-21. doi: 10.3325/cmj.2013.54.110.
To identify the risk factors in children under five years of age for severe acute lower respiratory infections (ALRI), which are the leading cause of child mortality.
We performed a systematic review of published literature available in the public domain. We conducted a quality assessment of all eligible studies according to GRADE criteria and performed a meta-analysis to report the odds ratios for all risk factors identified in these studies.
We identified 36 studies that investigated 19 risk factors for severe ALRI. Of these, 7 risk factors were significantly associated with severe ALRI in a consistent manner across studies, with the following meta-analysis estimates of odds ratios (with 95% confidence intervals): low birth weight 3.18 (1.02-9.90), lack of exclusive breastfeeding 2.34 (1.42-3.88), crowding - more than 7 persons per household 1.96 (1.53-2.52), exposure to indoor air pollution 1.57 (1.06-2.31), incomplete immunization 1.83 (1.32-2.52), undernutrition - weight-for-age less than 2 standard deviations 4.47 (2.10-9.49), and HIV infection 4.15 (2.57-9.74).
This study highlights the role of the above seven risk factors in the development of severe pneumonia in under-five children. In addition, it emphasizes the need for further studies investigating other potential risk factors. Since these risk factors are potentially preventable, health policies targeted at reducing their prevalence provide a basis for decreasing the burden of childhood pneumonia.
确定五岁以下儿童严重急性下呼吸道感染（ALRI）的风险因素，严重急性下呼吸道感染是儿童死亡的主要原因。
我们对公共领域已发表的文献进行了系统综述。我们根据GRADE标准对所有符合条件的研究进行了质量评估，并进行了荟萃分析以报告这些研究中确定的所有风险因素的比值比。
我们确定了36项研究，这些研究调查了19种严重急性下呼吸道感染的风险因素。其中，7种风险因素在各项研究中均与严重急性下呼吸道感染显著相关，以下是荟萃分析得出的比值比估计值（及其95%置信区间）：低出生体重3.18（1.02 - 9.90），未进行纯母乳喂养2.34（1.42 - 3.88），居住拥挤——每户超过7人1.96（1.53 - 2.52），接触室内空气污染1.57（1.06 - 2.31），免疫接种不完全1.83（1.32 - 2.52），营养不良——年龄别体重低于2个标准差4.47（2.10 - 9.49），以及艾滋病毒感染4.15（2.57 - 9.74）。
本研究强调了上述七种风险因素在五岁以下儿童严重肺炎发病中的作用。此外，它强调需要进一步研究调查其他潜在风险因素。由于这些风险因素具有潜在可预防性，旨在降低其流行率的卫生政策为减轻儿童肺炎负担提供了依据。
