Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: A systematic review and meta-analysis of observational studies

Michela Sonego, Maria Chiara Pellegrin, Genevieve Becker, Marzia Lazzerini

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Objective: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. Design: Systematic review and meta-analysis. Study selection: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. Data sources: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014 Risk of bias assessment: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. Results: Out of 10655 papers retrieved, 77 studies from 39 countries (198359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37-13.92); age below two months (5.22, 1.70-16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67-8.61), chronic underlying diseases (4.76, 3.27-6.93); HIV/AIDS (4.68, 3.72-5.90); and severe malnutrition (OR 4.27, 3.47-5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03-3.31); low maternal education (1.43, 1.13-1.82); low socio-economic status (1.62, 1.32-2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11-4.31). Immunisation (0.46, 0.36-0.58) and good antenatal practices (0.50, 0.31-0.81) were associated with decreased odds of death. Conclusions: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

Original languageEnglish
Article numbere0116380
JournalPLoS One
Volume10
Issue number1
DOIs
Publication statusPublished - Jan 30 2015

Fingerprint

systematic review
observational studies
meta-analysis
Respiratory Tract Infections
Observational Studies
Meta-Analysis
income
risk factors
Mortality
death
infection
Economics
chronic diseases
education
Chronic Disease
Education
Indoor air pollution
Indoor Air Pollution
Immunization
Pneumocystis carinii

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries : A systematic review and meta-analysis of observational studies. / Sonego, Michela; Pellegrin, Maria Chiara; Becker, Genevieve; Lazzerini, Marzia.

In: PLoS One, Vol. 10, No. 1, e0116380, 30.01.2015.

Research output: Contribution to journalArticle

@article{a6639043323a4b3488a701c79307c11d,
title = "Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: A systematic review and meta-analysis of observational studies",
abstract = "Objective: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. Design: Systematic review and meta-analysis. Study selection: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. Data sources: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014 Risk of bias assessment: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. Results: Out of 10655 papers retrieved, 77 studies from 39 countries (198359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95{\%} confidence interval 6.37-13.92); age below two months (5.22, 1.70-16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67-8.61), chronic underlying diseases (4.76, 3.27-6.93); HIV/AIDS (4.68, 3.72-5.90); and severe malnutrition (OR 4.27, 3.47-5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03-3.31); low maternal education (1.43, 1.13-1.82); low socio-economic status (1.62, 1.32-2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11-4.31). Immunisation (0.46, 0.36-0.58) and good antenatal practices (0.50, 0.31-0.81) were associated with decreased odds of death. Conclusions: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.",
author = "Michela Sonego and Pellegrin, {Maria Chiara} and Genevieve Becker and Marzia Lazzerini",
year = "2015",
month = "1",
day = "30",
doi = "10.1371/journal.pone.0116380",
language = "English",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "1",

}

TY - JOUR

T1 - Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries

T2 - A systematic review and meta-analysis of observational studies

AU - Sonego, Michela

AU - Pellegrin, Maria Chiara

AU - Becker, Genevieve

AU - Lazzerini, Marzia

PY - 2015/1/30

Y1 - 2015/1/30

N2 - Objective: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. Design: Systematic review and meta-analysis. Study selection: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. Data sources: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014 Risk of bias assessment: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. Results: Out of 10655 papers retrieved, 77 studies from 39 countries (198359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37-13.92); age below two months (5.22, 1.70-16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67-8.61), chronic underlying diseases (4.76, 3.27-6.93); HIV/AIDS (4.68, 3.72-5.90); and severe malnutrition (OR 4.27, 3.47-5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03-3.31); low maternal education (1.43, 1.13-1.82); low socio-economic status (1.62, 1.32-2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11-4.31). Immunisation (0.46, 0.36-0.58) and good antenatal practices (0.50, 0.31-0.81) were associated with decreased odds of death. Conclusions: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

AB - Objective: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. Design: Systematic review and meta-analysis. Study selection: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. Data sources: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014 Risk of bias assessment: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. Results: Out of 10655 papers retrieved, 77 studies from 39 countries (198359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37-13.92); age below two months (5.22, 1.70-16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67-8.61), chronic underlying diseases (4.76, 3.27-6.93); HIV/AIDS (4.68, 3.72-5.90); and severe malnutrition (OR 4.27, 3.47-5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03-3.31); low maternal education (1.43, 1.13-1.82); low socio-economic status (1.62, 1.32-2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11-4.31). Immunisation (0.46, 0.36-0.58) and good antenatal practices (0.50, 0.31-0.81) were associated with decreased odds of death. Conclusions: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

UR - http://www.scopus.com/inward/record.url?scp=84961288747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961288747&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0116380

DO - 10.1371/journal.pone.0116380

M3 - Article

C2 - 25635911

AN - SCOPUS:84961288747

VL - 10

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 1

M1 - e0116380

ER -