Sonego Michela, Pellegrin Maria Chiara, Becker Genevieve, Lazzerini Marzia
WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery, and Health Science, University of Trieste, Trieste, Italy.
Department of Medicine, Surgery, and Health Science, University of Trieste, Trieste, Italy.
PLoS One. 2015 Jan 30;10(1):e0116380. doi: 10.1371/journal.pone.0116380. eCollection 2015.
To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries.
Systematic review and meta-analysis.
Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries.
Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014.
Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.
Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92); age below two months (5.22, 1.70‒16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67‒8.61), chronic underlying diseases (4.76, 3.27‒6.93); HIV/AIDS (4.68, 3.72‒5.90); and severe malnutrition (OR 4.27, 3.47‒5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31); low maternal education (1.43, 1.13‒1.82); low socio-economic status (1.62, 1.32‒2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11‒4.31). Immunisation (0.46, 0.36‒0.58) and good antenatal practices (0.50, 0.31‒0.81) were associated with decreased odds of death.
Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.
评估低收入和中等收入国家儿童急性下呼吸道感染（ALRI）死亡的风险因素。
系统评价和荟萃分析。
报告低收入和中等收入国家5岁以下儿童ALRI死亡风险因素的观察性研究。
截至2014年1月的Medline、Embase、全球健康图书馆、Lilacs和科学网。
采用对预后研究质量工具进行微小调整来评估偏倚风险；用漏斗图和埃格检验评估发表偏倚。
在检索到的10655篇论文中，来自39个国家的77项研究（198359名儿童）符合纳入标准。与ALRI死亡率更密切相关的宿主和疾病特征包括：根据世界卫生组织定义诊断为极重度肺炎（比值比9.42，95%置信区间6.37‒13.92）；2个月以下年龄（5.22，1.70‒16.03）；卡氏肺孢子虫诊断（4.79，2.67‒8.61）、慢性基础疾病（4.76，3.27‒6.93）；艾滋病毒/艾滋病（4.68，3.72‒5.90）；以及重度营养不良（比值比4.27，3.47‒5.25）。与ALRI死亡几率增加显著相关的社会经济和环境因素包括：母亲年龄小（1.84，1.03‒3.31）；母亲教育程度低（1.43，1.13‒1.82）；社会经济地位低（1.62，1.32‒2.00）；二手烟暴露（1.52，1.20至1.93）；室内空气污染（3.02，2.11‒4.31）。免疫接种（0.46，0.36‒0.58）和良好的产前保健措施（0.50，0.31‒0.81）与死亡几率降低相关。
宿主和疾病特征以及社会经济和环境决定因素影响儿童ALRI死亡风险。在降低低收入和中等收入国家儿童ALRI死亡率的策略中，应考虑与慢性病的预防和治疗一起，采取干预措施来改变诸如贫困、女性教育缺失和恶劣环境条件等潜在风险因素。
