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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

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

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.

Suggested Citation

  • Michela Sonego & Maria Chiara Pellegrin & Genevieve Becker & Marzia Lazzerini, 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," PLOS ONE, Public Library of Science, vol. 10(1), pages 1-17, January.
    • Handle: RePEc:plo:pone00:0116380
    DOI: 10.1371/journal.pone.0116380
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    1. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    2. Eric D McCollum & Bejoy Nambiar & Rashid Deula & Beatiwel Zadutsa & Austin Bondo & Carina King & James Beard & Harry Liyaya & Limangeni Mankhambo & Marzia Lazzerini & Charles Makwenda & Gibson Masache, 2017. "Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-17, January.
    3. Alan da Silveira Fleck & Margaux L. Sadoine & Stéphane Buteau & Eva Suarthana & Maximilien Debia & Audrey Smargiassi, 2021. "Environmental and Occupational Short-Term Exposure to Airborne Particles and FEV 1 and FVC in Healthy Adults: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 18(20), pages 1-19, October.
    4. Juwel Rana & Jalal Uddin & Richard Peltier & Youssef Oulhote, 2019. "Associations between Indoor Air Pollution and Acute Respiratory Infections among Under-Five Children in Afghanistan: Do SES and Sex Matter?," IJERPH, MDPI, vol. 16(16), pages 1-13, August.
    5. Nipuni Nilakshini Wimalasena & Alice Chang-Richards & Kevin I-Kai Wang & Kim N. Dirks, 2021. "Housing Risk Factors Associated with Respiratory Disease: A Systematic Review," IJERPH, MDPI, vol. 18(6), pages 1-24, March.
    6. Qingyun Tang & Ke Gong & Li Xiong & Yuanxiang Dong & Wei Xu, 2022. "Can El Niño–Southern Oscillation Increase Respiratory Infectious Diseases in China? An Empirical Study of 31 Provinces," IJERPH, MDPI, vol. 19(5), pages 1-17, March.
    7. Shruti Murthy & Myron Anthony Godinho & Vasudeva Guddattu & Leslie Edward Simon Lewis & N Sreekumaran Nair, 2019. "Risk factors of neonatal sepsis in India: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-26, April.

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