Wanyana Mercy Wendy, Migisha Richard, King Patrick, Muhesi Abraham Kibaba, Kwesiga Benon, Kadobera Daniel, Bulage Lilian, Ario Alex Riolexus
Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
Kasese District Local Government, Kasese, Uganda.
Pneumonia (Nathan). 2024 Jul 25;16(1):13. doi: 10.1186/s41479-024-00134-y.
Pneumonia is one of the leading causes of infant mortality globally, particularly in sub-Saharan Africa. In Uganda, pneumonia was the fourth leading cause of death in children <5 years in 2018. Analysis of 2013-2022 data for children <5 years from the District Health Information System indicated a high incidence of severe pneumonia in Kasese District, Uganda. We investigated to identify factors associated with severe pneumonia among children <5 years in Kasese District to inform prevention and control strategies.
We conducted a 1:1 hospital-based case-control study among children aged 2-59 months presenting with pneumonia at five high-volume facilities in Kasese District from January to April 2023. A case was defined as pneumonia with ≥1 of the following danger signs: low oxygen saturation, central cyanosis, severe respiratory distress, feeding difficulties, altered consciousness, and convulsions. Controls were outpatient children aged 2-59 months with a diagnosis of non-severe pneumonia. We reviewed medical records at facilities and used an interviewer-administered questionnaire with caregivers to obtain information on socio-demographic and clinical characteristics. Logistic regression was used to identify factors associated with severe pneumonia.
We enrolled 199 cases and 174 controls. The odds of severe pneumonia were higher among children with diarrhoea only (adjusted odds ratio [aOR] = 2.9, 95%CI: 1.7-4.9), or malaria and diarrhoea (aOR = 3.4, 95%CI: 2.0-5.9), than those without a co-existing illness at the time of pneumonia diagnosis. Not being exclusively breastfed for ≥ 6 months (aOR = 2.0, 95%CI: 1.1-3.3) and exposure to indoor air pollution from cooking combustion sources (aOR = 2.9, 95%CI: 1.8-4.7) increased odds of severe pneumonia.
The findings highlight the significance of comorbidities, lack of exclusive breastfeeding, and exposure to indoor air pollution in the development of severe pneumonia. Promoting exclusive breastfeeding for ≥ 6 months and advocating for the use of clean energy sources, could mitigate morbidity attributable to severe pneumonia in the region.
肺炎是全球婴儿死亡的主要原因之一，在撒哈拉以南非洲地区尤为突出。在乌干达，2018年肺炎是5岁以下儿童死亡的第四大主要原因。对2013 - 2022年乌干达卡塞塞区5岁以下儿童的地区卫生信息系统数据进行分析后发现，该地区重症肺炎发病率很高。我们进行调查，以确定卡塞塞区5岁以下儿童重症肺炎的相关因素，为预防和控制策略提供依据。
2023年1月至4月，我们在卡塞塞区五家大型医疗机构对2至59个月患肺炎的儿童开展了一项1:1的基于医院的病例对照研究。病例定义为患有以下至少一种危险体征的肺炎：低氧饱和度、中心性发绀、严重呼吸窘迫、喂养困难、意识改变和惊厥。对照为诊断为非重症肺炎的2至59个月门诊儿童。我们查阅了医疗机构的病历，并使用由访员管理的问卷对照顾者进行询问，以获取社会人口学和临床特征信息。采用逻辑回归分析来确定与重症肺炎相关的因素。
我们纳入了199例病例和174例对照。在肺炎诊断时，仅患有腹泻（调整后的优势比[aOR]=2.9，95%置信区间[CI]：1.7 - 4.9）或患有疟疾和腹泻（aOR = 3.4，95%CI：2.0 - 5.9）的儿童患重症肺炎的几率高于无并存疾病的儿童。未进行6个月及以上纯母乳喂养（aOR = 2.0，95%CI：1.1 - 3.3）以及接触烹饪燃烧源产生的室内空气污染（aOR = 2.9，95%CI：1.8 - 4.7）会增加患重症肺炎的几率。
研究结果凸显了合并症、缺乏纯母乳喂养以及接触室内空气污染在重症肺炎发生中的重要性。推广6个月及以上纯母乳喂养并倡导使用清洁能源，可能会降低该地区重症肺炎所致的发病率。
