FACTORS CONTRIBUTING TO INCREASED CASES OF PNEUMONIA AMONG

CHILDREN UNDER FIVE YEARS ATTENDING OUR LADY OF LOURDES MWEA

HOSPITAL

1.0 CHAPTER ONE: INTRODUCTION

1.1 Introduction

Pneumonia is an inflammatory condition of the lower respiratory tract which mostly affects the
lungs, including airway, alveoli, connective tissue, visceral pleura and vascular structures (Ebell
MH 2010).

According to WHO 2010, pneumonia is a respiratory condition that affects lungs.

The alveoli are responsible for gaseous exchange in the body. When a person is infected with
pneumonia, the alveoli are filled with pus thus reduces volume of air that can be exchanged in
the lungs thus limiting oxygen intake (Miller 2002).

It can be categorized as either community acquired or hospital acquired pneumonia depending

on where the individual got it.

1.2 Back ground information

Pneumonia infection is termed to be the leading cause of mortality among young children with
hospital acquired pneumonia, being most severe due to its resistance to some antibiotics (Rudan
& Igor et al.,2008).

WHO estimated an annual number of acute respiratory infection (ARI) leading to death of young
children was 2.1 million which accounted to about 20%of children deaths (McAllister et
al.,2019) The aim of the research was to estimate the incidences of pneumonia in developing
countries. It was considered a close approximation of global incidences of this condition because
nearly 90% of all children less than five years old live in developing countries and incidences of
pneumonia are greater in developing countries.

Child Health Epidemiology Reference Group (CHERG)made a decision to concentrate on

pneumonia and bronchitis because these were the major components of Acute Lower Respiratory
Infection (ALRI)among children. CHERG and WHO approach to the case management of
pneumonia was introduction of program to standardize and facilitate clinical decision making in
places with limited resources. WHO introduced the Integrated Management of Childhood Illness
(IMCI) programs which trained health workers identify danger signs in children with respiratory
condition.

(Van Malderen et al.,2019) reported an investigation for 16 bacteria and viruses among 184
hospitalized children with pneumonia in brazil. Etiology was established in 144 cases: viral 60%,
bacterial 42% and mixed infection 28%. Rhino virus 21% and streptococcus pneumoniae21%
were the most common pathogen. In Kenya, 19% of all cases seen in outpatient clinics and
hospital are respiratory infections and are mostly in the urban areas.

For the contractions of respiratory infections, you might touch an infected surface or shake hands
of person who is sick. You then touch your mouth, nose or eyes he germs from the hands enter
and infects the body. Since Kenya is a developing country, the plan and strategies to fight
respiratory infections are not to standards and hence more death occur due to population ignoring
the prevention policy put in place. The rate of exposure to respiratory infection in men is
slightly higher in men(Rytter&Maren et al 2014).

The prominence of infection is attributed to poor environmental sanitation and inadequate

access to safe ventilation and unclean air .These conditions leads to continued exposure to the
infection stage of respiratory infections thus increasing the rate of infection among people
(Balmes 2019).The government and other stakeholders have to increase number of clean water
in the areas without clean water ,good ventilations to ensure clean air circulation as well as
knowledge on use of protective gears such as mask in congested areas or when there is
breakdown of respiratory infection in the area.

1.3 Problem statement

Pneumonia has been a high risk cause of death among children below five years, with a global
estimate that 20% of children death below five years are as a result of lower respiratory infection
(Diling et al 2019).
The annual incidence of lower respiratory tract infection (LRTI)hospitalization ranged from
2530-3173among a population of 100,000 people and was higher in infants ranging from 8446-
10532 among a population of 100,000 people(McAllister et al.,2019.)

In 2010,11.9 million episodes of severe and 3.0 million episodes of very severe Acute respiratory
tract infection (ALTI)resulted in hospital admission in young children worldwide with incidence
higher in boys than girls .

According to WHO in 2010,1.4million children died because of pneumonia infection which was
a burden to the health care system.

People living in rural areas are at high risk of getting pneumonia due to presence of more
population that can cause irritation or which can affect the respiratory tract. In OLLMH, it has
been noted that a large percentage of children admitted in the pediatric ward are suffering from
pneumonia.

This predisposes the children to nosocomial infection due to hospitalization for a long period and
their immune system is not strong enough to defend them from infections.

1.4 Study justification

The aim of the research was to figure out practices which can be carried out by the health care
providers or parents/guardians so as to minimize the increasing rate of pneumonia infection
among children below five years attending OLLMH .It aims at educating guardians and parents
on health precautions to take when handling young children because of their weak immunity so
as to prevent infection from attacking young children.

1.5 Purpose of the study

The study is of great help to the society as care takers will learn the main cause and predisposing
factors to pneumonia among young children attending OLLMH and the measures, they can take
to prevent the risk of infection among children. It can be used as a point of reference for other
researchers. The research is also a requirement for student in nursing study for the award of
diploma in Kenya Registered Community Health Nursing.
1.6 Objectives

1.6.1Broad objective

To determine factors leading to increased rise in pneumonia infection among children below five
years.

1.6.2Specific objectives

To identify social demographic factors that can lead to pneumonia infections.

To determine children related factors leading to pneumonia infection.

To determine environmental factors leading to pneumonia infection.

1.7Research questions

Which social demographic activities can lead to pneumonia infection among young children?

Which are the child related factors which can lead to pneumonia infection among young
children?

Which environmental factors can lead to pneumonia infection among young children?

2 CHAPTER TWO
2.0 Introduction

In this chapter we will learn in detail the factors contributing to increased cases of pneumonia
among children bellow five years.

We will discuss the social demographic factors, child related factors and environmental factors
on how they result to increased pneumonia cases among children.

2.1 Social demographic factors

2.1.1 House hold crowding

Pneumonia gas become a leading cause of morbidity and mortality in under five years with an
approximately 20% of child deaths globally, a majority of which occur in sub-Sahara Africa and
south Asia.

Over crowding increases transmission of respiratory infection and increases risk of exposure
(Balmes et al.,2019).

The risk of infection is increased if air movement inside the house is enclosed with minimal
ventilations. In a case study carried out in rural Alaska shows that in a family with more than
five people or less than four rooms, children below three years are a high risk for infection
(Nhung& Nguyen., et al 2017). Most of the studies have shown that those people leaving in
congested areas are at a risk of contracting this infection due to poor ventilation and ignorance
from people touching a big group of men who are in working age and see it difficult to isolate
themselves when suffering from signs of respiratory infections like coughing, sneezing and sore
throat. People failing to adhere to the policy put in place are likely to be affected by this
Infections.

A Canadian study explained the association between increased indoor carbon IV oxide levels and
risk of respiratory infection among children (Selvaraj et al.,2014).In OLLMH,at some point the
ward become over crowded with patient due to the inadequate space in the facility and at some
point the number of patient in the facility may increase. There may be also improper measures to
regulate the number of visitors visiting the sick children and some of these visitors may have
symptoms of pneumonia and when they are let in the ward, the young children become exposed
to infection due to their weak immunity.
2.1.2Smoking in the house

In a population-based study conducted in Dallas county, Texas 1995, it indicated that smoking is
greatly associated with invasive pneumococcal disease. The study noted that 17%of the passive
smokers are at a higher risk (Mortimer&Kevin.,2017)

Cigarrete smoke generates lesion on the epithelial cells of the airways. The body cells get
inflamed causing obstruction of the air flow (Balmes 2019).).According to my study, it has come
to my attention that most of the residents around OLLMH and the patient visiting the facility
come from middle class families and use fire wood as their main source of cooking energy. This
predisposes these young group of children to the pneumonia infection.

2.1.3Basic sanitation

Mothers being primary caregivers of children, need knowledge and awareness of prevention of
pneumonia. If mothers are equipped with this knowledge, they improve their management in
prevention of pneumonia thus reducing the burden of disease in the society (Kamm et al.,2014).

Studies have shown that hand washing with soap and running water can help reduce the
incidences of respiratory infection and pneumonia up to 50%

Use of latrines in house holds compound help reduce pneumonia cases by 22% (Le Roux
&Zar2017)

Around the out casts of OLLMH, mostly during the sunny seasons, there is a lot of dust from the
roads due to poorly kept roads. When children are playing around may inhale the dust which
later irritates the respiratory tract thus predisposing the children to pneumonia infection.

2.2Child related factors

2.2.1 Previous hospitalization

Hospitalization on pneumonia has an impact on the health services especially in children. In a

research conducted shown that 5271(4.5%) readmission occurred due to pneumonia in action
within 30 days . The pneumonia mortality rate was 10.7% with an annual pneumonia
hospitalization rate being 256.3 per 100,000 population in children 0-4 years (Rytter & Maren
2017).

According to a study conducted in Kilifi county hospital,364 (8.7%) admitted children died of
pneumonia () A follow up was done to 2279 discharges amongst which 3.1% (70 children) died
and 37% of the children died on subsequent hospital admissions (Troeger &Christopher 2018)

2.2.2 Nutritional status

Poor nutrition affects a child’s ability to resist infections. Low vitamin A status result in greater
bacterial adherence and may increase the risk of bacterial infection (Rudan & Igor 2008).

About 95% of new pneumonia cases in developing countries among children below 5 years are
increased as result of malnutrition.

Studies conducted in developing countries have shown significant response between malnutrition
and mortality because of respiratory infection in children. . There are 2 main mechanisms that
predispose low-birth weight infants to an increased risk of respiratory infections: reduced
immunocompetence and impaired lung function. low-birth-weight babies may have a higher
incidence of pneumonia because low birth weight may lead to a short duration of breast-feeding
and to poor nutritional status. A recent research conducted from longitudinal cohort (Rytter et
al.,2014)reported that there is increased risk of ARI(acute respiratory infection)among children
not breast feeding adequately.

2.2.3 Prematurity

Neonates are one of the highest risk age groups for mortality and morbidity from infection. From
a research conducted in 2010 byWHO,3.7 Million neonates died with 37% of the deaths resulting
from infections among which pre term infants are undoubtedly at highest risk.

In North America nearly one in six premature infants develop an invasive infection during their
first week of life (Van Malderen et al.,2019).
Preterm vulnerability to infection can be caused by either developmental immaturity leading to
low immune system or can be caused by frequent need for life saving medical interventions
which interfere with the body’s protective mucosal and epithelial barriers (Troeger et al.,2018)

Preterm babies lack the beneficial supplemental protection obtained from maternal antibodies
transferred through the placenta.

2.2.4 Nonexclusive breast feeding

From a research conducted by (Rytter& Maren 2017) listed lack of exclusive breast feeding as
one of the risk factors for pneumonia infection among children under five years. Exclusive breast
feeding offers protection against gastrointestinal infection and pneumonia. The baby acquires the
protection through the transfer of immunoglobulin (IgA)from mother to the mucosal surface of
the child.

IgA is a dominant immunoglobulin in the lung mucosa hence part of first line response to
infection.

Children who are not exclusively breast fed for six months are most likely to acquire respiratory
tract infections due to lack of mucosal immunoglobulins (Hanieh & Sarah 2015)

2.2.5 Lack of pneumococcal vaccine

Pneumococcal conjugate vaccines have demonstrated substantial effectiveness in reducing

pneumococcal disease among young children. In England and Wales, immunization of children
with pneumococcal conjugate vaccine commenced in 2006. Over the same period, individuals
with a clinical risk factor for pneumococcal disease and all adults aged ≥65 years have been
offered vaccination with pneumococcal vaccine. pneumococcal vaccine has

Been used to reduce the pneumococcal disease (Pick & Harry 2020)

Streptococcus pneumoniae is the leading cause of bacterial pneumonia among young children
below five years and is transmitted through direct contact with infected respiratory secretions.
The invasive pneumococcal diseases can be treated with antibiotics but can also be prevented
with pneumococcal conjugated vaccine (Lee et al.,2014)
2.3 Environmental factors

2.3.1 Indoor air pollution

Indoor air pollution is mainly caused by indoor burning of solid biomass fuels. Approximately
half the world’s population depend on biomass fuels for domestic energy thus increasing the
amount of smoke to the environment. Biomass fuel release smoke that contain numerous
pollutants such as carbon monoxide (Balmes 2019)

Smoke released from biomass fuel affects the young children mostly because the epithelial
linings of their lungs are not fully developed thus resulting in greater permeability of pollutants
thus limiting their body’s defense against infections.

A research conducted by WHO in 2008 explained that children have narrower airways than
adults thus irritation caused by air pollution can result in greater effect to their health.

2.3.2 Lower family income

Children in developing countries suffer the highest burden of pneumonia.

A study conducted from May 2007 to May 2009, chest radiographs were obtained from 11521
children with clinical pneumonia and 3955cases were diagnosed clinically of which the cases
were highest in very low-income areas compared to high income areas (McAllister et al.,2019)

In 2008, almost half of the deaths occurred in five poor countries in Africa and Asia. Evidences
have shown causal relationship between pneumonia and poor living condition encountered in
poor sanitation, inadequate water, overcrowding and where children are exposed to viral and
bacterial infection like in day care centers (Marangu et al.,2019)

Conclusion of the literature review

Paragraph one

References
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