Evaluation the Effectiveness of Interventions to Prevent Acute

Respiratory Infection (Pneumonia) among Children under Five Year

A Systematic Review

Ayudiah Uprianingsih

, Budi Utomo

and Retno Indarwati

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Faculty of Medicine Universitas Airlangga,Dharmahusada, Surabaya, Indonesia

Keywords: Pneumonia, Intervention, Prevention, Children Under Five Year.

Abstract: Pneumonia accounted for 15% of the 6.3 million deaths among children under the age of five years. It kills

children more than any other illness. Each year, over 2 million children die from pneumonia, accounting for

1 in 5 under-five deaths worldwide. A variety interventions to prevent and to reduce pneumonia are

available. This systematic review was carried out in order to inform and to know some interventions that

can prevent pneumonia among children under five year. Methods : We identified articles through databases

searching:, Proquest, Science Direct, SpringerLink, and Ebsco Host, published between (2002-

2017). Results: Ten articles were analysed and selected from 1271. Conclusions: The studied evaluated that

the integration of the interventions such as hand washing, vaccination, exclusive breastfeeding, giving zinc

supplement potentially be more cost-effective, efficient and sustainable. Other interventions that may be

effective involve providing health education to family or caregivers to raise awareness about this forgotten

killer disease of children and to reduce child deaths from pneumonia.

1 BACKGROUND

Pneumonia is a severe form of acute lower

respiratory infection responsible for high

preventable morbidities and mortality among under-

five year child. According to WHO estimates. It

persist the leading killer of young children around

the world. Pneumonia is killing 1 million children

under the age of five years accounting for more

young deaths annually than AIDS, malaria and

measles combined each every year. This loss of life

is especially tragic because pneumonia can be

prevent and be treat. (International Vaccine Acces

Centre, 2015).

In 2015, the 10 countries that contributed most to

the global burden of child pneumonia were consist

of India, Nigeria, Pakistan, Democratic Republic of

Congo, Angola, Ethiopia, Indonesia, Chad,

Afghanistan, Niger (WHO, 2015).

A variety interventions to prevent and to reduce

pneumonia are available. These intervention can

plausibly prevent pneumonia. Considering the

worldwide high burden of ARI, preventing and

reducing pneumonia in children is an crucial aspect

of a strategy to reduce child mortality.This

systematic review aimed to evaluate the

effectiveness of interventions to prevent pneumonia.

2 METHODS

We identified the articles according to the Cochrane

group’s recommendations. In addition, we actively

searched articles through databases searching:

Proquest, Science Direct , and EbscoHost, published

between (2005-2017). The keywords used to search

the articles included prevention, pneumonia, Acute

Respiratory Infection, Children.

We found ten articles that suitable with our

Inclusion Criteria. Our inclusion criteria are all kind

of intervention in preventing and reducing

pneumonia of children under five year old. All

articles using the English language were included.

We excluded the articles if the target population

focused on adults or elderly.

174

Uprianingsih, A., Utomo, B. and Indarwati, R.

Evaluation the Effectiveness of Interventions to Prevent Acute Respiratory Infection (Pneumonia) among Children under Five Year.

DOI: 10.5220/0008322201740177

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 174-177

ISBN: 978-989-758-336-0

3 RESULTS

Ten articles that have been collected, analyzed and

scored, obtained the following results.

Research conducted by Luby et al (2005) aimed

to know the effect of hand washing on acute

respiratory-tract infections in prevention of

pneumonia. Study result that children under 5 years

in households that received plain soap and

handwashing promotion had a 50% lower incidence

of pneumonia than the children in controls.

Research conducted by Mortimer et al (2017)

was to compare the effects of a cleaner burning

biomass-fuelled cookstove intervention to

continuation of open fire cooking on pneumonia in

children living in two rural district show that thre is

no evidence that an intervention can prevent and

reduced the risk of pneumonia in children. The study

suggest that Effective strategies to reduce the

adverse health effects of household air pollution are

needed.

Research conducted by Gabida et al (2013)

aimed to evaluate communities with village health

workers who received training in cIYCF and the

distribution of educational materials (newsletter) to

mothers in promotion of exclusive breastfeeding

using a cluster randomized controlled trial. Result

showed that combination of intervention with village

health worker and distribution of a newsletter to

mothers on promotion of exclusive breastfeeding

can prevent and reduce the pneumonia compared to

non combine intervention.

The study by Rodriguez et al (2005) aims to

evaluated the effect of a moderate dose of vitamin A

treatment on the duration of respiratory signs in

children with pneumonia. Result show there is no

effect of a moderate dose of vitamin A

supplementation on the duration of pneumonia in

underweight or normal-weight children under 5 year

old.

Research conducted by Fortunato et al (2015)

aimed to assessed effectiveness of PCVs in

preventing severe pneumococcal pneumonia in

children. Result showed that PCVs program has a

significant impact on reduction of pneumonia in

children aged under 5 years both at a national level

and in those regions with a longer vaccination

history, with nearly a 40% reduction of

hospitalizations for both outcomes.

Research by Mackenzi et al (2017 )the results of

the study aimed to measure the impact of the

introduction of vaccines on pneumonia incidence.

Result show that there is substantial reduction of

cases of pneumonia in hospital.

Research by Smith et al (2011) aimed to

investigated whether an intervention to lower indoor

wood smoke emissions would prevent and reduce

pneumonia in children. Result show that the

intervention did not significantly reduce physician-

diagnosed pneumonia for children younger than 18

months. However the study suggest that stove or fuel

interventions producing lower average exposures

than these chimney stoves might be needed to

substantially reduce pneumonia in populations

heavily exposed to biomass fuel air pollution.

The research by Brooks (2005) aimed to examine

whether giving zinc weekly could prevent clinical

pneumonia in children younger than 2 years. Result

showed that 70 mg of zinc weekly could reduces

pneumonia and mortality in young children.

Research by Shah et al (2014) aims to evaluate

the benefits of zinc gluconate supplementation for 2

months period compared to placebo in reducing

respiratory morbidity in acute lower respiratory

infected children up to 5 years of age The final

analysis showed that the number of episodes of

acute lower respiratory infections and severe acute

lower respiratory infections were significantly lower

in zinc group compared to placebo group (20.8% vs.

45.8% (P ¼ 0.009) and 21.7% vs. 58.3% (P <

0.001), respectively)

Gupta et al (2016) conducted a randomized

double-blind, placebo-controlled trial aimed to

evaluate the efficacy of single oral mega-dose of

Vitamin D3 for treatment and prevention of

pneumonia in under five children. Result show there

was no significant effect of vitamin D

supplementation on IgA and IgG and in reducing

pneumonia.

4 DISCUSSION

This systematic review aimed to identify the articles

around prevention of pneumonia specifically in

children under five year. The reasons for conducting

this systematic review are related to pneumonia as

major killers of young children and we need to know

what kind of interventions that we could use to

prevent this disease.

This systematic review identified and evaluated

several of the interventions that can prevent and

reduce pneumonia rates such as exclusive

breastfeeding, vaccination, reducing indoor air

pollution, giving Vitamin A, Zinc, Vitamin D, and

also health education intervention. Some of that are

effective but the others are not. This could indicate

Evaluation the Effectiveness of Interventions to Prevent Acute Respiratory Infection (Pneumonia) among Children under Five Year

175

the need for a more research to prove the

effectiveness of each intervention.

From the articles we know that hand washing,

vaccination, exclusive breastfeeding, giving zinc

supplement intervention are effective in preventing

and reduce pneumonia in several settings. While

other interventions such as reducing indoor air

pollution, cleaner burning biomass-fuelled cook

stove, giving vitamin A showed non significant

effect to prevent pneumonia. Actually we couldn’t

say that we should leave the intervention behind, it

indicates that there is a need for further research to

prove it. The result may differ in other setting and it

usually effect by length of study, participant number

and research design so we needed to fully

investigate these intervention.

The studied evaluated that the integration of

interventions potentially be more effective, efficient

and sustainable. Other interventions that may be

effective involve providing health education to

family or caregivers to raise awareness about this

neglected disease and to reduce child deaths from

pneumonia.

5 CONCLUSION

The studied evaluated that the integration of the

interventions such as hand washing, vaccination, exclusive

breastfeeding, giving zinc supplement intervention

potentially be more cost-effective, efficient and

sustainable. Other interventions that may be effective

involve providing health education to family or caregivers

to increase apprehension about this forgotten killer disease

of children and to reduce child deaths from pneumonia..

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