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Meta-Analysis
. 2015 Jan 30;10(1):e0116380.
doi: 10.1371/journal.pone.0116380. eCollection 2015.

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  1 , Maria Chiara Pellegrin  2 , Genevieve Becker  3 , Marzia Lazzerini  3
Affiliations
Meta-Analysis

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 et al. PLoS One. .

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 10,655 papers retrieved, 77 studies from 39 countries (198,359 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart for bibliographic search.
Figure 2
Figure 2. Location of the 77 included studies.
Figure 3
Figure 3. Association between comorbidity with chronic diseases and death from ALRI.
Figure 4
Figure 4. Association between HIV/AIDS and death from ALRI.
Figure 5
Figure 5. Association between mother’s low educational level and death from ALRI.
Figure 6
Figure 6. Association between low socioeconomic status and death from ARLI.
See this image and copyright information in PMC

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