نورالدائم pneumonia-1.pdf pdf presentation

نورالدائم pneumonia-1.pdf pdf presentation

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Chapter one
Introduction

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1. INTRODUCTION
1.1 Background:
1.2. Problem statement:
Sudan is considered one of the developing countries facing an increase in morbidity
and mortality from pneumonia in children under 5 years of age due to low living standards and
low socio-economic status. In Sudan, each year, approximately 1 million children suffer from
pneumonia, and approximately 50% of outpatients are children under 5 years of age, and 30%
of hospital admissions are attributed to pneumonia. According to the latest WHO data
published in May 2014, deaths from influenza and pneumonia in Sudan amounted to 37,775
(14.50%) of total deaths. Pneumonia kills up to 5 million children under 5 years of age each
year in developing countries [1]. Each year, 12 million children die before their fifth birthday,
many of them in their first year of life. Seven out of ten deaths are due to acute respiratory
infections, mainly pneumonia. Mortality rates for children under five years of age in most
developing countries range from 60 to 100 per 1,000 live births, a fifth of these deaths are due
to pneumonia, and these deaths from childhood pneumonia are closely linked to poverty
factors, such as malnutrition, lack of clean water and sanitation, indoor air pollution, and
inadequate access to water health care. Pneumonia is a lower respiratory tract infection that
affects only the lungs. Although it can affect anyone, children under five are particularly at risk
of pneumonia. A variety of bacterial and viral pathogens are known to cause pneumonia in
children, with streptococcal pneumonia responsible for most cases. In addition, 1 in 5 children
had two symptoms that indicate pneumonia: rapid breathing and difficulty breathing. Previous
research has shown that in low-resource settings, risk factors for pneumonia in children include
malnutrition, inadequate parental education, poorly ventilated rooms, and parental smoking
habits, the child’s age and gender, and varied significantly between regions of the world.

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1.3. Justification:
Pneumonia is a major cause of morbidity and mortality among children under five, especially in
low- and middle-income countries. It is the single largest infectious cause of death in this age
group, responsible for 700,000 deaths annually. Despite being preventable through vaccines
and treatable with antibiotics, many children do not receive timely diagnosis or treatment due to
lack of awareness, health system challenges, or socio-economic barriers. Pneumonia also
contributes significantly to hospital admissions and healthcare costs, creating a burden on
health systems. Research can help identify social determinants and high-risk populations,
leading to targeted interventions. Antibiotic resistance and climate and environmental factors
are also linked to respiratory illnesses in children.
1.4. Research questions and hypotheses:
1.4.1. Null Hypothesis (H0):
A. There is no significant association between socioeconomic factors (such as family income,
maternal education, water, and hygiene practices) and the risk of pneumonia among children
under five years old in Ad Dueim Teaching Hospital.
B. There is no significant association between malnutrition and the risk of pneumonia among
children under five years old.
C. There is no significant association between breastfeeding practices and the risk of
pneumonia among children under five years old.
1.4.2. Alternative Hypothesis (H1):
A. There is a significant association between socioeconomic factors (such as family income,
maternal education, water, and hygiene practices) and the risk of pneumonia among children
under five years old in Ad Dueim Teaching Hospital.
B. There is a significant association between malnutrition and the risk of pneumonia among
children under five years old.
C. There is a significant association between breastfeeding practices and the risk of pneumonia
among children under five years old.

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1.5. Objective
1.5.1. General objective
 To identify main risk factors of pneumonia among children under five years.
1.5.2. Specific Objectives
• To identify nutritional status in relation to pneumonia among children under the age of
5 years.
• To examine standard of living among families of child with pneumonia.
• To establish baseline data and statistical information about pneumonia under five years
of age for the future use.

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Chapter Two
Literature review

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2.1. Literature review
Pneumonia is an acute inflammation of the lower respiratory tract.Lower respiratory tract
infection is a major cause of mortality worldwide. Pneumonia is most common at the
extremes of life.
Predisposing factors in children include an under-developed immune system together with
other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the
single most important preventable risk factor.
The commonest infecting organisms in children are respiratory viruses and Streptoccocus
pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest
radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia
producing an interstitial pattern.
Lobar pneumonia is most commonly associated with community acquired pneumonia,
bronchopneumonia with hospital acquired infection and an interstitial pattern with the so
called atypical pneumonias, which can be caused by viruses or organisms such as
Mycoplasma pneumoniae.
Most cases of pneumonia can be managed with chest radiographs as the only form of
imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of
value, particularly in the hospital setting. Complications of pneumonia include pleural
effusion, empyema and lung abscess.
The chest radiograph may initially indicate an effusion but ultrasound is more sensitive,
allows characterization in some cases and can guide catheter placement for drainage.
CT can also be used to characterize and estimate the extent of pleural disease. Most lung
abscesses respond to medical therapy, with surgery and image guided catheter drainage
serving as options for those cases who do not respond.
Streptococcus pneumoniae (pneumococcus) is a major cause of diseaseworldwide [2]. In
recent years, an estimated 300,000 children <5 years of age die of pneumococcal diseases

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annually, with the majority of deaths occurring in sub-Saharan Africa and Asia [3,4].
Pneumococcal colonization is a precursor to disease [5,6], which occurs when pneumococcus
spreads from the nasopharynx to other organs such as the lungs, bloodstream, and meninges,
causing pneumonia, sepsis, and meningitis, respectively [5]. Healthy children under five
years of age are the main reservoirs of pneumococcus and therefore play an important role in
transmission [5]. An estimated 27–85 % of children are pneumococcal carriers, with higher
rates in lower income countries [7]. Pneumococcal conjugate vaccines (PCVs) provide
protection againstseveral of the over 100 serotypes of S. pneumoniae bacteria. Serotypes
included in the vaccines are among those that cause the most morbidity and mortality.
Currently the two most widely used formulations provide protection against 10 (Synflorix,
GlaxoSmithKline product [PCV10]) and 13 (Prevnar13, Pfizer [PCV13]) serotypes, while
recently licensed formulations for use in children contain up to 15 or 20 serotypes [8]. A
relatively less expensive 10-valent PCV (Pneumonias, Serum Institute of India [PCV10-SII])
that protects against two of the serotypes covered by PCV13 has been available since 2020
[9]. In addition to protecting individuals who receive the vaccines (i.e., direct effects), PCVs
prevent carriage and spread of vaccine serotypes, protecting the broader com- munity (i.e.,
indirect effects) [7,10,11]. Carriage studies, which assess prevalence of colonization, can
provide important information around circulating serotypes, antimicrobial susceptibility, and
community-wide impact of PCVs [12].
Mozambique introduced PCV10 on April 10, 2013, with supportfrom Gavi, the Vaccine
Alliance, using a 3-primary dose schedule (at 2, 3, and 4 months of age; “3 + 0”). Analysis of
repeated cross-sectional carriage studies conducted in Mozambique found that within 2–3
years after introduction, PCV10-type carriage had declined by approximately 50 % in
children under five years of age [13]. However, PCV10- type serotypes continued to
circulate, and serotype 19 A (included in PCV13 but not in PCV10) was increasingly
common [13]. Beginning in 2017, Mozambique switched from PCV10 to PCV13
formulation for new birth cohorts, using a phased approach starting in the northern part of
the country, and reaching the southern region on May 5, 2019. Additionally, on September
23, 2019, Mozambique changed the PCV dosing schedule nationwide from the original “3 +

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0” schedule (three primary doses without a booster) to a “2 + 1” schedule (two primary doses
at two and four months followed by a booster at nine months of age), which provides
vaccinated children higher levels of antibodies in the second year of life, potentially
contributing to more robust direct and indirect effects [14]. We conducted a cross-sectional
carriage survey among children aged<5 years and their household contacts in southern
Mozambique from October 16, 2018 to July 4, 2019, during which time PCV coverage in
Mozambique was estimated to be 80–95 % [15], to provide a baseline for evaluating the
impact of the PCV schedule and formulation changes and to assess the longer-term impact of
PCV10 introduction.

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Chapter Three
Methodology

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3. Methodology
It is a descriptive cross-sectional hospital based study. This study was carried out on children
less than five year of Age at ad Dueim teaching hospital.
3.1. Study Design:
The main aim of this study was to determine the risk factors contributing to pneumonia
among children under five of age. Data was collected using a questionnaire. The
questionnaire gathered information regarding background information on mother and
child, (breastfeeding, weaning and immunization). It also gathered information regarding
the socio-economic information and educational level of the mother and fathers, as well as
determined the water and hygiene information.
3.2. Study Area:
Ad Dueim is a mid-size place in the region of White Nile state in Sudan, between Khartoum
and kosti,195 km from Khartoum, it is a big city contains approximately about 100.000 person
(19104) family, and is one of the largest places in Sudan.
Ad Dueim is located in the region of White Nile. As the crow files, the distance to the
regional capital of White Nile, (Rabak), is Approximately 102.3 Km (63.6 mi).
The distance from Ad Dueim to the capital of Sudan, (Khartoum) is approximately 174.0 Km
(108.1 mi) as the crow files.
It contains a lot of health centers like: Alhia alsape center, alhia alasher center, BakhtAlRuda
center, the police center and the alrabeya center are the five institutions on which this study
focuses out of the numerous health centers in the city of Al-Dueim.
Ad Dueim teaching hospital was built in 1908 in the eastern part of the city.

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3.3. Sample Size:
The total sample size was 40 children, and the data was collected within two weeks. All
the samples were chosen which included all pneumonia cases of children less than five
years of age, whose mother, father, or family member had admitted to the hospital during
this period of the study at ad Dueim teaching hospital.
3.4. Inclusion Criteria:
All pneumonic children aged between 0-60 months who attended ad Dueim teaching
hospital White Nile state at ad Dueim locality with their mother.
3.5. Exclusion Criteria:
Severely ill children and mothers who have hearing impairments or talking problem.
3.6. Data Collection and Technique:
Data were collected from mothers, fathers or any family member of children who was in
attendance with the admitted children in the hospital at the time of study. Questionnaire
was used to collect data. The questionnaire was designed to match the objectives of this
study. Questions included child gender, child age, and educational level of parents, socio-
economic status, anthropometric measures, and nutrition information. Anthropometric
measures were used to identify the different stages of malnutrition. These measurements
were obtained from the hospital reports at time of interviews.
3.7. Data Analysis:
Statistical analysis was carried out by using the statistical package for the social science (SPSS)
version20 program.

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3.8. Ethical consideration
Ethical approval was secured from the faculty of medicine and hospital administration.
Before starting the study, they have assured that all data would remain confidential and be
assigned a coded serial number, insuring no personal details or information that could identify
would be disclosed

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Chapter Four
Results

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4. Results
Table 1 shows that 23 (57.50%) children were males, while 17 (42.50%) were females.
Majority of them (57.50%) were less than one year while 17 (42.50%) were found 1-4
years of age.
Table1: Distribution of study population according to child gender and age (N=40)

Gender Frequency (N) Percent
Male 23 57.50%
Female 17 42.50%
Total 40 100%
Age Frequency (N) Percent
Less than one year 23 57.50%
1-4 years 17 42.50%
Total 40 100%

Table 2 indicated that majority of families had children less than five years of age 26
(65.0%) and had more than three children, while 14 (35.0%) families had 1-2
children. The number (1-3 children) of children in the family was 22 (55.0%).

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Table2: Frequencies of children distribution among families (N=40)
Number of children less than five
years
Frequency (N) Percent
One child 5 12.50%
Two children 9 22.50%
Three children 9 22.50%
More than 3 children 17 42.50%
Total 40 100.00%
The number of children in the
family
Frequency (N) Percent
1-3 22 55.00%
4-6 18 45.00%
Total 40 100%

Table3: Frequency distribution of feeding practices among children under five years
of age (N=40)

The child breast feeding Frequency(N) Percent
Yes 29 72.50%
No 11 27.50%
Total 40 100.00%
The child is weaned Frequency(N) Percent
Gradually 22 55.00%
Suddenly 18 45.00%

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Table4 indicated child weight, majority of them 23 (57.50%) were 6.0-10.99 kg.
Majority of children mid-arm circumference 27 (67.50%) were found 10.0-14.99 cm,
while 9 (22.50%) were found 15.0-19.99 cm, and 4 (10.0%) were found 5.0-9.99 cm.
Table4: Frequency distribution of anthropometric measurement of children under
five years of age (N=40)

Child weight(kg) Frequency (N) Percent
1.00-5.99 7 17.50%
6.00-10.99 23 57.50%
11.00-15.99 6 15.00%
16.00-20.99 4 10.00%
Total 40 100.00%
Child mid arm
circumference(cm)
Frequency (N) Percent
5.00-9.99 4 10.00%
10.00-14.99 27 67.50%
15.00-19.99 9 22.50%
Total 40 100.00%

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Table5 describes that majority of study participants 26(65.0%) used tap water while
only 14(35.0%) used well and river. Most of the study participants (mothers)
19(47.50%) used zeer pot fridge for drinking water and storage. While 18 (45.0%)
used barrels and jerry cans.
Table5 Frequency distribution of water safety among families (N=40)
Main source of drinking water supply for
household
Frequency (N) Percent
Tap water 26 65.00%
Well 6 15.00%
River 8 20.00%
Total 40 100.00%
Equipment's used for drinking water Frequency (N) Percent
Barrels 9 22.50%
Zeer pot fridge 19 47.50%
Jerry cans 9 22.50%
Barrels and zeer potfridge 3 7.50%
Total 40 100.00%

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Figure1 indicates majority of mothers 27(67.50%) attended health care center, while13
(32.50) did not attended health care center.

Figure1 Frequency of attending child health care center (N=40)

Figure2 shows majority of mothers 28(70.0%) were given traditional treatment to their
sick children, while12 (30.0%) were given medical treatment to their sick children.
Figure2 Frequency of kind of treatment that child takes (N=40)





32%
68%
Did not attend health care centre Attended health care centre

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Figure3 indicates that majority of mothers 20(50.0%) were using gas, while 20(50.0%)
used coal and wood.

Figure3 Frequency of fuel used for cooking (N=40)
Figure4 shows that majority of 27(67.50%) were not cigarettes smokers among family
members, while 13(32.50%) were cigarette smokers.


Figure4 Frequency of cigarette smoking among family members(N=40)

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Figure 5 describes the majority of study participants (mothers) 24 (60.0%), their
house was poorly ventilated, while 16 (40.0%) were well ventilated.


Figure5 Houses ventilation status (N=40)

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Chapter Five
Discussion, conclusion & recommendation

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5.1 Discussion:
This study was designed to examine the main risk factors for pneumonia in ad Dueim
teaching hospital in the city of ad Dueim. The specific objectives were to identify the
nutritional status in relation to pneumonia in children less than five years of age, to
examine the standard of living of families of children with pneumonia, and to establish
basic data and statistical information on to pneumonia of less than five years for future
use. This study included 40 mothers who brought their sick children under five years
old with pneumonia to the ad Dueim teaching hospital in the city of ad Dueim. The
results of this study showed that the number of male children was 23 (57.50%) and the
number of female children was 17 (42.50%). The gender distribution showed that
pneumonia was more prevalent in male children than in female children, which
revealed that there was an association between gender and pneumonia. These results are
consistent with those of the study by Almirall, who found that pneumonia is more
common in men than in women [17]. In some community studies, boys seem to get
pneumonia more often than girls [18]. The increased risk for boys was confirmed in a
pneumonia control study in Brazil [19]. The study showed that 65.7% of children under
two years were more affected by pneumonia than other age groups, this result was
confirmed by a case control study conducted in Pakistan, children younger children
were at greater risk of pneumonia compared to older children. under five years.
Younger age of children (2 to 6 months) was found to be an important risk factor for
pneumonia. In this study, the results showed that pneumonia was higher in 26 (65.00%)
low income families and there was a relationship between family income and
pneumonia. The 2007 Park study said that children from lower socioeconomic
backgrounds tend to have a greater risk of respiratory infections. In addition, this
conclusion was confirmed by a study carried out in Gambia by O'Dempsey et al., in
1996, which found that the children of mothers with a personal source of income are at
greater risk of pneumonia [22]. The majority (34%) of pneumonias affected children
whose mothers were housewives. This result was confirmed by a report from case

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control study by Graham in 1990 which revealed that maternal occupation was
significantly associated with pneumonia in less than five years of age [23]. This study
showed that 40.0% of pneumonia prevailed among children whose mothers had lower
education.
Lack of ventilation can cause dampness and odors, which are risk factors for pneumonia. The
study found no significant association between childhood pneumonia and current smoking
habits of family members. This is inconsistent with reports from the WHO health sector
training module that children whose parents smoke are 60% more likely to develop
pneumonia. Furthermore, this conclusion is not supported by scientific articles published in
Miami and Poland [24]. Exclusive breastfeeding during the first 6 months of life was not
found to be a significant factor in pneumonia in children. This is inconsistent with the
findings of a systematic review and meta-analysis conducted in the 2011 UNICEF report The
integrated action plan for the prevention and control of pneumonia and diarrhea relies on
exclusive breastfeeding, which is one of the factors that can determine the incidence,
prevalence and mortality of pneumonia in children [25].
5.2Conclusion:
The study concluded that pneumonia is more prevalent in children under one year of age, but
it is still a health problem among children under five years of age at ad Dueim teaching
hospital in the city of ad Dueim in Sudan.
Low family income and low educational levels of mothers were found to be major risk
factors of pneumonia among children less than five years of age admitted to ad Dueim
teaching hospital in the city of ad Dueim. Significantly, higher number of males presented
with pneumonia than females in this study. The study had identified a comparatively high
prevalence of pneumonia in children less than five years of age. It also pointed out
modifiable risk factors of the pneumonia as diarrhea, measles and use of primitive latrines
among families. Majority of studied children under five years of age had history of diarrhea.
So, the study indicated diarrhea associated with pneumonia disease.

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5.3 Recommendation:
• Early diagnosis and treatment of pneumonia.
• Community health education programs on the disease
• Completion of the immunization program to be compulsory for all children under
five years of age.
• Families should be sensitized on the importance of early detection of pneumonia.
• Breastfeeding of infants and balanced nutrition for children.
• Health education programs should be introduced in MCH services in all health
centers.

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