Causes And Effect Of Pneumonia Under Five Years Old Children

Project and Seminar Material for Public Health

Abstract

This study was carried out to examine the causes and effect of pneumonia under five years old children using Owan West local government of Edo State as a case study. The study was carried out to ascertain the prevalence of pneumonia among under five years old children, find out the causes of pneumonia among under five years old children, and determine the effect of pneumonia among under five years old children. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprised of parents residing in Owan West local government of Edo State. In determining the sample size, the researcher purposefully selected 160 respondents and 141 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. While the hypotheses was tested Chi-square statistical tool. The result of the findings reveals that the causes of pneumonia among under five years old children includes: virus, bacteria, fungi and parasites. The study also revealed that the effect of pneumonia among under five years old children includes: restrictive or obstructive lung function deficits, increased risk of asthma, non-smoking related COPD, and bronchiectasis. Therefore, it is recommended that there is need for agencies to train, encourage and empower community health workers to provide continuous health education to mothers on pneumonia prevention and control and appropriate home management practices. To mention but a few.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli (McLuckie, 2009; Leach et al, 2009) It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases (McLuckie, 2009; Jeffrey et al, 2010). Typical signs and symptoms include a cough, chest pain, fever, and difficulty breathing (Ashby et al, 2007). Diagnostic tools include x-rays and culture of the sputum. Vaccines to prevent certain types of pneumonia are available. Treatment depends on the underlying cause. Pneumonia presumed to be bacterial is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized.

Pneumonia remains the leading cause of death in children under 5 years in low and middle income countries despite the introduction of case management guidelines and the development of new preventative strategies including effective vaccines. It currently accounts for 18% of annual deaths in children under five worldwide, 20% in low income countries compared to only 4.3% in high income countries (Black et al., 2008). In children, many of these deaths occur in the newborn period. The World Health Organization estimates that one in three newborn infant deaths is due to pneumonia (Garenne et al., 1992). Over two million children under five die each year worldwide and it is estimated that up to 1 million of these (vaccine preventable) deaths are caused by the bacteria Streptococcus pneumoniae, and over 90% of these deaths take place in developing countries (WHO, 1999). After the neonatal period, the main causes of death in sub-Saharan African are pneumonia and malaria, both manifesting as acute febrile illness (Hildenwall et al., 2007).

Mortality from pneumonia generally decreases with age until late adulthood with increased mortality in the elderly. More cases of pneumonia occur during the winter months than during other times of the year. Individuals with underlying illnesses such as Alzheimer’s disease, cystic fibrosis, emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia (Almirall et al., 1999). These individuals are also more likely to have repeated episodes of pneumonia. People who are hospitalized for any reason are also at high risk for pneumonia. Pneumonia is common in malnourished children and frequently associated with fatal outcome (Bryce et al., 2005; Rice et al., 2000; Loeb & High, 2005; Nannan et al., 2007). Of children with malnutrition requiring hospital admission, up to two-thirds are diagnosed with pneumonia (Shimeles & Lulseged, 1994; Ahmed, 1999).

Typically, oral antibiotics, rest, fluids, and home care are sufficient for complete resolution. Caregivers’ home management is appropriate and is in conformity with family and community practices that promote child survival and development stipulated by household and community component of IMCI (UNICEF, 1999). Children with pneumonia should be encouraged to feed orally unless there are indications for nasogastric feeding/intravenous fluid infusions. If children are too distressed to take fluid and feeds orally, continuous enteral feeds via a nasogastric tube may be provided (Ashraf et al., 2010). People who are having trouble breathing, with other medical problems, and the elderly may need greater care. If the symptoms get worse, the pneumonia does not improve with home treatment, or complications occur, then hospitalization may be recommended. However, over the counter cough medicine has not been found to be helpful in pneumonia (Chang et al., 2007).

According to IMCI guidelines, mothers are advised to replace animal milk with increased breast-feeding or a fermented product such as yoghurt, or to replace half of the milk with a nutrient-rich semisolid complementary food (Gove, 1997). Exclusive and early breastfeeding in the first 6 months of an infant’s life has a significant protective effect against pneumonia and other diseases (Chisti et al., 2011). However, only 35% practice exclusive breastfeeding for six months (Bhutta et al., 2010).

Substantial gains have been made in improving the overall burden of childhood pneumonia. However, it is apparent that efforts must be focused on the available pneumonia interventions if the 90% immunisation target set by Global Action Plan for Prevention and Control of Pneumonia (GAPP) is to be met (Otczyk et al., 2013). Prioritizing the prevention and appropriate management of childhood pneumonia is essential to meet the Millennium Development Goal 4 of decreasing under 5 child mortality by two thirds from 1995 by 2015. Recognizing the significant impact that vaccines might have on morbidity and mortality caused by pneumonia, the World Health Organization (WHO) recommended in November 2006 and March 2007 that Hib and pneumococcal conjugate vaccines, respectively, be routinely used in the immunization schedules of all countries (WHO, 2007; WHO, 2006). In response to this the WHO and UNICEF have developed the Global Action Plan for Prevention and Control of Pneumonia (GAPP) to highlight pneumonia as a major cause of death in children and to assist in scaling up of interventions with proven benefit (WHO, 2009). As infants are not fully immunized until 6 months of age, community case management strategies such as the ‘Integrated Management of Childhood Illness’ (IMCI) have the potential to significantly reduce mortality from pneumonia (Theodoratou et al., 2010). Pneumococcal vaccine initiative was launched in Nigeria where it received the pneumococcal vaccines through a partnership with GAVI. The free vaccine is administered to all children under twelve months of age; protecting thousands of children across the country (UNICEF, 2011).

Understanding how locally recognized signs and symptoms relate to the clinical definition of pneumonia is important in constructing messages that families can understand and which they are likely to adhere to (Irimu et al., 2008). Mothers’ practices, knowledge of pneumonia, their perceptions of its causes, their ability to recognize the signs of pneumonia, and their behaviour if they were to have a child with the signs helps to build a better understanding of mothers’ reaction to child pneumonia (Muhe, 1996). Community health education is required to empower the caretaker with an understanding to appreciate and recognize signs and symptoms of pneumonia as well as understand the appropriate supportive care. This will enable the caretaker to perceive pneumonia disease for what it should be, and improve adherence to health care messages (Irimu et al., 2008). Mothers should be encouraged to seek medical help when a child has any of the signs of pneumonia, and particularly in the winter months when the problems are more acute (Galvez et al., 2002). However, financial constraints and perception that an illness is not serious have been described to be main reasons given for failure to seek health care outside home (Metlay et al., 1997). Effective Acute Respiratory Infection (ARI) health education needs to be based on understanding the prevailing knowledge, beliefs, and practices of the mothers which are appropriate for successful management of pneumonia (UNICEF, 1999).

With increased global interdependence there is need to develop country preparedness plans that take into consideration overall immunization plans, building capacity within countries to ensure appropriate and timely response to disease outbreaks that may involve among other steps vaccination, which is key to reducing mortality and associated morbidity (GAVI, 2008). Concurrent with the release of the GAPP and in support of its vision, a diverse group of advocacy, academic and service organizations joined forces in 2009 to form the Global Coalition against Child Pneumonia. Working together, the Coalition launched the first-ever World Pneumonia Day on November 2, 2009 (now observed annually on November 12) to raise awareness about the disease, promote interventions to protect against, prevent and treat pneumonia as called for in the GAPP, and generate action to combat the world’s leading killer of young children (International Vaccine Access Centre, 2012).

1.2 Statement of the Problem

Pneumonia remains the leading infectious cause of death among children under-five, killing nearly 2,600 children a day. Pneumonia accounts for 15 per cent of all under-five deaths and killed about 940,000 children in 2013 (UNICEF, 2015). It kills more children than any other illness (accounting for 19% of all under-five deaths), more than AIDS, malaria and measles combined which accounts for 8%, 4% and 3% of all under-five deaths respectively (UNICEF, 2006). Each year, more than 2 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, yet little attention is paid to this disease (UNICEF, 2006). Childhood pneumonia is a major public health issue for Nigeria. In 2008, pneumonia was the second leading cause of death among under fives, claiming over 30,000 childrens’ lives, equivalent to 16 % of child mortality in Nigeria (Black et al., 2010). Medical records further show that pneumonia is among the top three causes of hospital admissions and among the top five causes of infant and under five mortality in Nigeria (CBS, 2004).

So far, declines in child mortality are far too slow to achieve the fourth Millennium Development Goal (MDG) to reduce under five mortality by two thirds between 1990 and 2015 in most countries (Murray et al., 2007). Inappropriate and harmful health practices such as over the counter medication are detrimental by drawing mothers into a false sense of security and delay of appropriate health seeking with timely management. Poor nutritional practices and cultural practices by mothers due to their literacy level may also be fatal (Muhe, 1996). The findings of this study are intended to find out causes and effect of pneumonia under five years old children.

1.3 Objectives of the Study

The overall aim of this study is to examine causes and effect of pneumonia under five years old children. Hence, the study will be channeled to the following specific objectives;

Ascertain the prevalence of pneumonia among under five years old children.
Find out the causes of pneumonia among under five years old children.
Determine the effect of pneumonia among under five years old children.

1.4 Research Question

The following questions are formulated inline with the study objectives;

What is the prevalence of pneumonia among under five years old children?
What are the causes of pneumonia among under five years old children?
What are the effect of pneumonia among under five years old children?

1.5 Research Hypothesis

Ho: The prevalence of pneumonia among under five years old children is low.
Ha: The prevalence of pneumonia among under five years old children is high.

1.6 Significance of the Study

The findings of this study are intended to provide information on how mothers perceive and respond to pneumonia as well as the main factors that affect care-seeking for children with signs of pneumonia

This study is also critical as its findings could inform hospital-based policy formulation and/or review of interventions required to minimize pneumonia related pediatric readmissions in the country.

The findings of this study are useful in providing background information for planning strategic interventions that will help address pneumonia morbidity in the study area and in efforts to meet the Millennium Development Goal of reducing child mortality

1.7 Scope of the Study

The scope of this study boarders on the causes and effect of pneumonia under five years old children. The study will be carried out in Owan West local government of Edo State.

1.8 Limitation of the Study

This research project, like all human endeavors, had some challenges that threatened to derail the study’s completion. One of the reasons is that the time allotted for this work was so limited that the researcher did not have enough time to complete the task thoroughly. During data collection, the researcher also had to put forth extra effort to understand the respondents’ interview schedules, several of whom fell into the incomprehensible age group. Also, there were financial and transportation constraints to deal with. Insufficient funds tend to impede the efficiency of the researcher in sourcing the relevant materials, literature, or information and in the process of data collection (internet, questionnaire, interview).

1.9 Definition of Terms

Pneumonia:

Refers to an inflammation of1 the lung parenchyma caused by various infectious agents, including bacteria, viruses and fungi.

Pneumococcus:

Is a bacterium of1 the genus Streptococcus that is the most common cause of bacterial pneumonia.

Pneumococcal Conjugate Vaccine:

Is a vaccine used to protect infants and young children against disease caused by the bacterium Streptococcus pneumonia (pneumococcus).

Incidence of Pneumonia:

Refers to the number of1 people in a given community that develop pneumonia over a defined time period.

1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the causes and effect of pneumonia under five years old children using Owan West local government of Edo State as a case study. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was to examine the causes and effect of pneumonia under five years old children using Owan West local government of Edo State as a case study. The study specifically was aimed to ascertain the prevalence of pneumonia among under five years old children, find out the causes of pneumonia among under five years old children, and determine the effect of pneumonia among under five years old children.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 141 responses were validated from the enrolled participants where all respondents are parents residing in Owan West local government of Edo State.

5.3 Conclusions

Based on the findings of this study, the researcher made the following conclusion.

The prevalence of pneumonia among under five years old children is high.
The causes of pneumonia among under five years old children includes: virus, bacteria, fungi and parasites.
The effect of pneumonia among under five years old children includes: restrictive or obstructive lung function deficits, increased risk of asthma, non-smoking related COPD, and bronchiectasis.

5.4 Recommendations

Based on the findings of the study, the following recommendations are proffered.

This study highlighted the need for health administrators and policy makers to implement measures that would significantly reduce pneumonia morbidity and mortality in this locality 
There is need for agencies to train, encourage and empower community health workers to provide continuous health education to mothers on pneumonia prevention and control and appropriate home management practices 
There is need to widely utilize media platforms like televisions and radios to run health education campaigns on pneumonia prevention and control mechanisms in efforts to sensitize more mothers 
The need for national and county governments to improve accessibility to healthcare facilities and adequate resourcing of healthcare systems for effective healthcare delivery.