The Causes And Effects Of Pneumonia In Under Five Years Old Children

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1.1 Background


Child mortality, also known as under – five mortality refers to the deaths of infants and children under the age of five. Globally, child mortality continues to fall and the total number of under five deaths decreased to 8.1million per year in 2009 from 12.4 million per year in 1990 (UNICEF report, 2010).

The highest child mortality rates are still in sub-Saharan Africa where one in eight children dies before their fifth birthday nearly twenty  times the average for developed regions (1 in 67). Southern Asia has the second highest rate with about one in fourteen children dying before reaching five. Sub-Saharan Africa have achieved only around a thirty percent reduction in under five mortality, less than half that required to reach MDG4. (IGME report 2011).

Six conditions account for about 70% of all child deaths: acute lower respiratory infections, mostly pneumonia (18%), diarrhea (18%), malaria (9%), Measles (1%), HIV/AIDS (2%) and neonatal conditions mainly pre-term birth, birth asphyxia and infections (37%)

Pneumonia is a form of acute respiratory infection that affects the lungs and is the leading cause of death in children worldwide. Pneumonia can be caused by bacteria, viruses or fungi. Streptococcus pneumonia is the most common cause of bacterial pneumonia in children whilst Haemophilus influenza type b is the second most common cause of bacterial pneumonia. Respiratory synctial virus is the most common cause of viral cause of pneumonia. It can be prevented by immunization, adequate nutrition and by addressing environmental factors. Pneumonia can be treated with antibiotics.

Pneumonia is frequently an associated cause of mortality in children with other underlying conditions. Co-morbid conditions especially malnutrition, measles or HIV increase the severity and risk mortality from pneumonia (Black et al., 2003.,Zar, 2004; Duke et al., 2003.)There are multiple risk factors identified to increase the risk of pneumonia in children under five. These have been grouped into demographic (gender and age), nutritional (low birth weight, malnutrition, inadequate breastfeeding, vitamin and micronutrient deficiencies, environmental (crowding, air pollution, smoking), lack of immunization, attendance to day-care centres and socio-demographic factors such as large family size, short birth interval, low income, low level of parental education, poor housing and in-appropriate child care practices.

Pneumonia accounts for approximately 1.9million deaths globally in children under five each year (Black et al., 2003; Campbell, 1995; Malholland, 1999; Williams et al., 2002). The WHO estimates that there are more than 150 million cases of pneumonia each year in children under five.  It is the leading cause of death in children worldwide, killing 1.6 million children yearly and this accounts for 19% of all deaths of children under five years old worldwide. According to Paediatric Association of Nigeria (PAG, 2010), pneumonia has been rated as one of the leading cause of under-five mortality and morbidity in Nigeria, with twenty two percent of children under five dying from it.

Childhood pneumonia has been identified as a major “forgotten killer of children” by UNICEF and WHO.

Fig. 1.1: Causes of Under-five child deaths in low income countries


              Source: WHO World Health Statistics, 2011


1.2 Problem Statement


Pneumonia kills more children under five than AIDS, malaria and measles combined and is the single major killer of children under five in developing world. In spite of these relatively few global resources are dedicated to solving the problem and have received far less attention. Each year, more than two million children under five die of pneumonia in the developing world, compared to an estimated 800,000 children who die from malaria and around 300,000 children under five who die from AIDS (out of about three million total AIDS deaths).

Recognizing the symptoms of pneumonia is the first step in reducing deaths among children under five. Caregivers or mothers play a critical role in recognizing pneumonia’s symptoms and immediately seeking appropriate care for their sick children. Indeed it is critical that caregivers or mothers understand the importance of this disease and the risk it poses to their children’s health. Yet, even though pneumonia is the leading killer of children in the developing world, most mothers and caregivers are ignorant about the danger signs and risk factors for pneumonia. Only about one in five caregivers know the danger signs of pneumonia (UNICEF 2004).

A case-control study in Atlanta (USA) to assess risk factors for pneumonia in children showed the odds ratio for children attending child-care centres was 2.96 (p<0.05) relative to children cared for at home. In another study done in Brazil (1996), odds ratio for attendance at child care facilities compared to home care was 5.2. In Nigeria, there is little information on the association between these risk factors and pneumonia in children under five.

Fig 1.2: Percentage of Caregivers who know the 2 key signs of Pneumonia


Source: UNICEF, 33MIC, 1999-2001

1.3 Justification


In order to achieve MDG4 to reduce child mortality by two-thirds by 2015 there is the need to scale up interventions that contribute to reducing the burden of childhood pneumonia. This study seeks to provide evidence based information on the risk factors for pneumonia in children less than five. This will increase the knowledge and understanding of risk factors for pneumonia which can be used to improve the efficiency of health education programs both for mothers and health workers. The findings may provide information for possible interventions in order to the number of hospitalizations due to pneumonia among children under five. Knowing the risk factors for pneumonia can help us to be aware about various situations when we are at a higher risk of suffering from the infection.

1.4 Objectives

1.4.1 Main Objective


The aim of the study is to assess the causes and effect of  pneumonia in children less than five years at UBTH.

1.4.2 Specific Objectives


  1. To assess socio-demographic factors contributing to risk of pneumonia in children under five
  2. To assess environmental factors contributing to risk of pneumonia in children under five.
  3. To assess nutritional factors contributing to risk of pneumonia in children under


  1. To assess knowledge of mothers about the causes, danger signs/symptoms and prevention of pneumonia.

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