Risk factors for severe acute lower respiratory infections in children – a systematic review and meta-analysis

Abstract

AimTo identify the risk factors in children under five years of age for severe acute lower respiratory infections (ALRI), which are the leading cause of child mortality.MethodsWe performed a systematic review of published literature available in the public domain. We conducted a quality assessment of all eligible studies according to GRADE criteria and performed a meta-analysis to report the odds ratios for all risk factors identified in these studies.ResultsWe identified 36 studies that investigated 19 risk factors for severe ALRI. Of these, 7 risk factors were significantly associated with severe ALRI in a consistent manner across studies, with the following meta-analysis estimates of odds ratios (with 95% confidence intervals): low birth weight 3.18 (1.02-9.90), lack of exclusive breastfeeding 2.34 (1.42-3.88), crowding – more than 7 persons per household 1.96 (1.53-2.52), exposure to indoor air pollution 1.57 (1.06-2.31), incomplete immunization 1.83 (1.32-2.52), undernutrition – weight-for-age less than 2 standard deviations 4.47 (2.10-9.49), and HIV infection 4.15 (2.57-9.74).ConclusionThis study highlights the role of the above seven risk factors in the development of severe pneumonia in under-five children. In addition, it emphasizes the need for further studies investigating other potential risk factors. Since these risk factors are potentially preventable, health policies targeted at reducing their prevalence provide a basis for decreasing the burden of childhood pneumonia.

Is parent–child bed-sharing a risk for wheezing and asthma in early childhood?

“…Although the latter finding is in line with the increased risk theory [1][2][3][4], the finding that early bed-sharing did not associate with more wheezing or asthma suggests that a causal relationship is unlikely.…”

“…Crowded household conditions place young children at risk of acute lower respiratory infections [1][2][3], or increased severity of such infections [4]. This is potentially due to a higher viral load, either through interpersonal transmission or through contact with more infectious particles [5].…”

Low Hemoglobin Level a Risk Factor for Acute Lower Respiratory Tract Infections (ALRTI) in Children

“…Various risk factors have been proposed to increase the chances of development of lower respiratory infections some of them are definite some are likely and few are possible [7]. Since infections of the lower respiratory tract are the major morbidity and mortality indicators among the children, gaining control over the risk factors will have a promising effect on the wholesome growth and development of children.…”

Ambient and household air pollution: complex triggers of disease

“…This study did not demonstrate a systematic association between the risk for wheezing symptoms and levels of indoor air pollutants. These results may suggest that indoor air pollution is not causally related to the initial onset of wheezing; rather, this exposure may trigger and worsen symptoms of previously developed asthma (35).…”