Prevalence and associated factors of pneumonia among under-fives with acute respiratory symptoms: a cross sectional study at a Teaching Hospital in Bushenyi District, Western Uganda

Abstract

Objectives:
This study assessed the prevalence and associated factors of pneumonia among children under-five years presenting with acute respiratory symptoms.

Methodology:
This was a cross sectional study at the Pediatric Department of Kampala International University - Teaching Hospital, from the month of April to August 2019. The study included 336 children aged 2 to 59 months presenting with acute respiratory symptoms to the pediatric clinic. Pneumonia diagnosis was made according to the World Health Organization definition, modified by a chest radiograph. Structured questionnaires were used to collect data on socio-demographic, environmental and nutrition factors and multivariate logistic regression analysis using STATA version 13.0 was done to assess for the factors independently associated with pneumonia.

Results:
Of the 336 children with acute respiratory symptoms, eighty-six, 86 (25.6%) had pneumonia. Factors significantly associated with pneumonia included: age below 6 months (OR=3.2, 95%CI=1.17-8.51, p=0.023), rural residence (OR=5.7, 95%CI=2.97-11.05, p <0.001), not up-to-date for age immunization status (OR=2.9, 95%CI=1.05-7.98, p=0.039), severe acute malnutrition (OR=10.8, 95%CI=2.01-58.41, p=0.006), lack of exclusive breastfeeding during the first six months (OR=2.9, 95%CI=1.53-5.53, p=0.001) and exposure to cigarette smoke (OR=3.0, 95%CI=1.35-6.80, p=0.007).

Conclusion:
The prevalence of pneumonia in children under-five years was high. Most of the factors associated with pneumonia are modifiable; addressing these factors could reduce this prevalence.

Full text

Prevalence and associated factors of pneumonia among under-ves with
acute respiratory symptoms: a cross sectional study at a Teaching
Hospital in Bushenyi District, Western Uganda
Gloria Kiconco1, Munanura Turyasiima1, Andrew Ndamira1, 2, Ortiz Arias Yamile1,
Walufu Ivan Egesa1, Martin Ndiwimana1, Melvis Bernis Maren1
1. Department of Pediatrics, Kampala International University School of Health Sciences, Western Campus.
2. African Medical and Research Foundation (AMREF) Africa, Mbarara, Uganda.
Co-author details:
Yamile Arias Ortiz: yariasortiz@gmail.com, Tel: +256701728177; Andrew Ndamira: lionandrew411@gmail.com,
Tel:+256772456666; Turyasiima Munanura: tumiek2000@gmail.com, Tel: +256776505193; Walufu Ivan Egesa:
wiegesa@gmail.com, Tel: +256789766517; Melvis Bernis Maren: Email address: samuelramirez1201@gmail.com
Tel: +256704310238; Martin Nduwimana: Email address: docrmartin@yahoo.frTel: +256750969417
Abstract
Objectives: This study assessed the prevalence and associated factors of pneumonia among children under-ve years pre-
senting with acute respiratory symptoms.
Methodology: This was a cross sectional study at the Pediatric Department of Kampala International University – Teaching
Hospital, from the month of April to August 2019. The study included 336 children aged 2 to 59 months presenting with
acute respiratory symptoms to the pediatric clinic. Pneumonia diagnosis was made according to the World Health Organi-
zation denition, modied by a chest radiograph. Structured questionnaires were used to collect data on socio-demographic,
environmental and nutrition factors and multivariate logistic regression analysis using STATA version 13.0 was done to
assess for the factors independently associated with pneumonia.
Results: Of the 336 children with acute respiratory symptoms, eighty-six, 86 (25.6%) had pneumonia. Factors signicantly
associated with pneumonia included: age below 6 months (OR=3.2, 95%CI=1.17-8.51, p=0.023), rural residence (OR=5.7,
95%CI=2.97-11.05, p <0.001), not up-to-date for age immunization status (OR=2.9, 95%CI=1.05-7.98, p=0.039), severe
acute malnutrition (OR=10.8, 95%CI=2.01-58.41, p=0.006), lack of exclusive breastfeeding during the rst six months
(OR=2.9, 95%CI=1.53-5.53, p=0.001) and exposure to cigarette smoke (OR=3.0, 95%CI=1.35-6.80, p=0.007).
Conclusion: The prevalence of pneumonia in children under-ve years was high. Most of the factors associated with pneu-
monia are modiable; addressing these factors could reduce this prevalence.
Keywords: Pneumonia, prevalence, under-ves.
DOI: https://dx.doi.org/10.4314/ahs.v21i4.25
Cite as: Kiconco G, Turyasiima M, Ndamira A, Yamile OA, Egesa WI, Ndiwimana M, et al. Prevalence and associated factors of pneu-
monia among under-ves with acute respiratory symptoms: a cross sectional study at a Teaching Hospital in Bushenyi District, Western Uganda.
Afri Health Sci. 2021;21(4):1701-10. https://dx.doi.org/10.4314/ahs.v21i4.25
Corresponding author:
Gloria Kiconco,
Pediatrics and child Health (2020),
Kampala International University Teaching
Hospital Ishaka Bushenyi.
Tel: +256779926658.
Email Address: littlebabygal@gmail.com
Introduction
Pneumonia is the most common infectious cause of
death in children accounting for 16% of all deaths of
under-ves worldwide, it is most prevalent in south Asia
and sub-Saharan Africa 1 and is the second leading cause
of under-ve in-patient mortality in Uganda 2. System-
atic review and meta-analysis of data on pneumonia
across East African countries, estimated the average
prevalence of pneumonia in under-ves at 34% 3. In
© 2021 Kiconco G et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution Li-
cense (https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work
is properly cited.
African
Health Sciences
African Health Sciences, Vol 21 Issue 4, December, 2021 1701

Uganda, 80% of children under ve years that sought
treatment from a health worker had symptoms of an
acute respiratory infection 4. A study was done at Mu-
lago national Referral Hospital in Uganda and record-
ed a prevalence at 53.7% 5. Studies in different African
countries have estimated pneumonia prevalence among
under-ves between 16% and 33% 6, 7, 8.
The leading risk factors that contribute to pneumonia
incidence are lack of exclusive breastfeeding, under-nu-
trition, indoor air pollution, low birth weight, over
crowding lack of immunization and comorbid condi-
tions 9,10. Children with compromised immune systems
like malnutrition especially in infants not exclusively
breastfed are at higher risk of developing pneumonia
1, 9. The burden of child hood Pneumonia has declined
but the rate of decline is slow compared to other infec-
tious diseases in children 1.
The government of Uganda has implemented the strat-
egies adapted from Global Action Plan for Prevention
and Control of Pneumonia (GAPP) which includes a
combination of interventions to protect, prevent, and
to treat pneumonia for example vaccination, encourag-
ing exclusive breastfeeding for six months and access to
proper pneumonia treatment, however in Uganda we
are still below the national targets 4, 11, 12 which has con-
tributed to a high Under-ve mortality 4. This study de-
termined the prevalence of pneumonia and described
factors associated with pneumonia among children be-
tween 2 and 59 months with acute respiratory symptoms
attending to Kampala International Teaching Hospital
(KIU-TH) in Bushenyi district Western Uganda.
Methods and materials
Study design and participants: This study was a hospi-
tal based descriptive cross sectional and analytical study
in the Pediatric Department of Kampala International
University Teaching Hospital (KIU-TH), a private ter-
tiary hospital located in Ishaka-Bushenyi municipality
Bushenyi district Western Uganda. It serves as a refer-
ral center for hospitals and health centers around the
districts of Bushenyi, Sheema, Buhweju and Mitooma.
KIU-TH provides general and specialized services, has
outpatient and inpatient departments for each disci-
pline with an emergency wing and intensive care unit.
The Pediatric department has ve 5 sections: pediat-
ric ward, neonatal ward, Pediatric OPD and emergency.
The study was conducted in the pediatric ward, pediat-
ric OPD and emergency ward. According to KIU T-H
records in 2018, approximately 280 children under ve
years attend to KIU T-H per month and around 70%
present with acute respiratory symptoms and about one
child died of pneumonia every month.
Three hundred thirty-six (336) children aged between 2
and 59 months presenting with acute respiratory symp-
toms at the pediatric out patient, emergency and pedi-
atric ward were consecutively recruited into the study
from the months of April to August 2019.
Study procedure: All the children aged 2-59 months who
attended to KIU-TH with acute respiratory symptoms
(running nose, cough, fast breathing and/or difculty
in breathing) during the study period were consecutive-
ly recruited for the study. Children with acute respirato-
ry symptoms were identied from the presenting com-
plaint at outpatient clinic, Emergency ward or in the
pediatric ward. Consent ws obtained from the children’s
parents/caretakers after the primary reason for seeking
health care had been taken care of and any emergency
treatment (if required) given.
We excluded children with obvious clinical features of
acute aspiration (near drowning and acute foreign body
inhalation) since there was a known cause.
A structured questionnaire was used to capture com-
prehensive data on acute respiratory symptoms, so-
cio-demographic information, breast feeding history,
birth weight, immunization status, environmental fac-
tors and comorbid medical conditions like Human Im-
mune Virus infection (HIV), cerebral palsy and heart
disease that could be associated with pneumonia. Birth
weight was checked from the immunization cards and
by direct interview of parents/caretakers for those who
did not have the cards at the time of data collection.
Urban residence was referred to as cities, municipali-
ties and towns with a population over 2,000 persons 13.
Parental smoking as an environmental risk factor for
pneumonia applied only when the smoker stays in the
same environment with the child.
Physical examination was done for every child to docu-
ment nutritional status and clinical features of pneumo-
nia including: increased respiratory rate (according to
age), chest in drawing and crackles or added sounds on
chest auscultation. Chest radiographs were only done
for children with clinical features of pneumonia based
on World Health Organization Cough and/or difculty
in breathing with fast breathing and/or chest in draw-
ing).
African Health Sciences, Vol 21 Issue 4, December, 20211702

Pneumonia denition: In this study pneumonia was
dened as presence Cough and/or difculty in breath-
ing with fast breathing and/or chest in drawing 14. These
symptoms also present in other many acute respiratory
conditions. Therefore the denition was modied with
presence of positive chest X-ray ndings of pneumonia
which included one of the following: inltrates, consol-
idation, pleural effusion, and empyema indicated pneu-
monia 15
However, children who had clinical features of pneu-
monia using WHO/IMCI criteria but with normal
chest X-ray and had no other identied respiratory fo-
cus of infection like pharyngitis, tonsillitis, and otitis
media were considered to have pneumonia. This was
because a normal chest X-ray might not rule out pneu-
monia since sensitivity is around 83.3% 16. Children with
identied respiratory focus of infection and had no fea-
tures of pneumonia on chest Radiograph were given
other respective diagnoses according to the examina-
tion ndings
Severe pneumonia: Was dened as presence of pneu-
monia plus one or more of the danger signs (lethar-
gy, dehydration, cyanosis, vomiting everything, failure
to feed, convulsions, oxygen saturation <90%, axillary
temperature > 39.5degrees centigrade, severe chest
in-drawing) 14.
Nutritional status: Nutritional status was assessed ac-
cording to the WHO nutritional charts 17 and classied
as normal nutritional status, moderate acute malnutri-
tion (MAM) and severe acute malnutrition (SAM).
Weight was measured using a weighing scale (salter type
baby weighing scale for infants and those who could
not stand) and digital electric weighing scale when the
child completely undressed and rounded to the nearest
0.1kg. The body length/height was measured using a
Stadiometer and length measuring board and recorded
in centimeters, Mid-upper arm circumference (MUAC)
was measured using a MUAC tape and recorded in cen-
timeters.
Fig 1: Flow chart showing summery of the study procedure
Managed for their
respective diagnoses
Children presenting
to the hospital
Initial history (age and
presenting complaint)
Acute foreign body
inhalation or near-drowning
- excluded
Aged 2-59 mo without acute
respiratory symptoms –
managed for their respective
conditions
Aged 2-59 mo with
acute respiratory
symptoms – consent
for the study
No clinical features of
pneumonia
(WHO criteria)
Associated factors for
pneumonia
Detailed history and
examination
Managed according to
the diagnosis
Chest X-ray
Chest X-ray
features of
pneumonia
Clinical features of
pneumonia
(WHO criteria)
Pneumonia
Has identified
respiratory focus of
infection
Has no identified respiratory
focus of infection
(pharyngitis, tonsillitis, otitis
media, etc)
No chest X-ray
findings of pneumonia
African Health Sciences, Vol 21 Issue 4, December, 2021 1703

Immunization status: Child health cards were used
to assess the immunization status of children. Appro-
priate history about immunization using a checklist was
used for caretakers who did not have immunization
cards at the time of data collection. Children who had
not received all vaccinations expected for their age or
had never been immunized at all were labeled not up
to-date for age.
Data management: Data collection tools were pre-
tested to ensure reliability and validity, questionnaires
were translated into local language (Runyankole). Leg-
ibility was ensured by daily auditing of the question-
naires. Chest x-rays were taken by a radiologist and
interpreted properly. Radiographic lms were attached
to the respective questionnaires to avoid misplacement.
Privacy and condentiality were ensured by conduct-
ing interviews in the closed clinic and all data collected
kept in a lock and password protected computer. After
collection, data was arranged, coded and entered into
the computer using the EXCEL 2016 then imported to
STATA version 13.0 (Statacorp, College station, USA)
for analysis.
Data analysis: Data was analyzed using STATA ver-
sion 13.0 (Statacorp, College station, USA). The prev-
alence of pneumonia among children presenting with
acute respiratory symptoms was analyzed using fre-
quencies, percentages and corresponding 95% con-
dence interval (CI). Factors associated with pneumonia
were analyzed using univariate and multivariate logistic
regression. Factors with p-value ≤0.2 at univariate anal-
ysis qualied to be taken to multivariate analysis. Meas-
ures of effect were reported using odds ratios for both
crude and adjusted analysis, followed by corresponding
95% CI and p-value. At multivariate analysis, factors
with p-value ≤0.05 were considered statistically signi-
cant. The results were presented in tables.
Ethical considerations: Ethical approval was obtained
from the research ethics committee (REC) of Kampa-
la International University (Nr UG-REC-023/201902).
Informed consent was sought from parents/caretakers
of children and the purpose of the study well explained
before administering the questionnaire.
Study limitations: Some parents/caretakers had no
immunization cards at the time of recruitment in to the
study and were not clear with the information regarding
their immunization status and birth weight, however,
history on age and site at immunization based on the
UNEPI guidelines was used to help them recall though
a few of them could not recall at all.
Results
Participants’ socio-demographics characteristics
Among the 336 children aged 2 to 59 months present-
ing with acute respiratory symptoms; majority were of
age category 24-59 months, males were slightly more
than females. Most children were of rural residence and
their parents/caretakers had attained primary and sec-
ondary level of education. This is shown in table 1.
Participants’ medical and environmental charac-
teristics
Majority of the children had their immunization up-
to-date for their age, were exclusively breastfed up to
six months, had normal nutritional status, with no co-
morbidity and had normal weight at birth. Most of the
children came from families that cook from outside the
main house using biomass and their parents/caretakers
were non-smokers (Table 2).
African Health Sciences, Vol 21 Issue 4, December, 20211704

Table 1: Participants’ socio-demographic characteristics
Characteristic
Frequency, n (%)
Age (months)
2-5
6-11
12-23
24-59
54 (16.1)
69 (20.5)
39 (11.6)
174 (51.8)
Sex
Male
Female
179 (53.3)
157 (46.7)
Residence
Urban
Rural
154 (45.8)
182 (54.2)
Parental/care taker’s education
No education
Primary
Secondary
Tertiary
21 (6.3)
141 (42.0)
99 (29.5)
75 (22.3)
Marital status
Married
Single
304 (90.5)
32 (9.5)
Religion
Catholic
Anglican
Muslim
Pentecostal
143 (42.6)
127 (37.8)
32 (9.5)
34 (10.1)
Tribe
Banyonkole/Bakiga
Baganda
Others
308 (91.7)
17 (5.1)
11 (3.3)
Table 2: Participant’s medical and environmental characteristics
Characteristic
Frequency, n (%)
Medical characteristics
Immunization status
Up-to-date for age
Not up-to-date
309 (92.0)
27 (8.0)
Nutritional status
Normal nutrition
Moderate acute malnutrition
Severe acute malnutrition
238 (95.2)
10 (4.0)
2 (0.8)
Exclusive breast feeding for 6months
No
Yes
71 (21.1)
265 (78.9)
Comorbidity
No
Yes
327 (97.3)
9 (2.7)
Birth weight
2.5-3.99
<2.5
4+
Unknown
251 (74.7)
15 (4.5)
27 (8.0)
43 (12.8)
Environmental Characteristics
Place of cooking
Indoor
Outdoor
112 (33.3)
224 (66.7)
Parental/care taker smoking
No
Yes
301 (89.6)
35 (10.4)
African Health Sciences, Vol 21 Issue 4, December, 2021 1705

Prevalence of pneumonia among children aged
2 to 59 months presenting with acute respiratory
symptoms
Eighty-six (25.6%) children under-ve years had pneu-
monia; 24 (27.9%) of these had the severe form. Pneu-
monia was more prevalent in children below 6 months
of age and affected more of males than females (Table
3).
Table 3: Prevalence of pneumonia by age and sex
Prevalence
N
n
%
p-value
Overall
336
86
25.6
Age specific
2-5
6-11
12-23
24-59
54
69
39
174
20
13
11
42
37.0
18.8
28.2
24.1
0.127
Gender specific
Male
Female
179
157
47
39
26.3
24.8
0.767
Factors associated with pneumonia among chil-
dren aged 2 to 59 months presenting with acute
respiratory symptoms
Age of the child, place of residence, parental education,
religion, parental smoking, immunization status, nutri-
tional status, exclusive breast feeding and having co-
morbidity were associated with pneumonia at univariate
analysis. After adjusting for confounders at multivari-
ate analysis; children who were aged below 6 months,
not immunized up-to-date for age, severely malnour-
ished, not exclusively breastfed and exposed to cigarette
smoke were more likely to suffer from pneumonia (Ta-
ble 4).
African Health Sciences, Vol 21 Issue 4, December, 20211706

Table 4: Results of bivariate and multivariate analysis for factors associated with pneumonia
Variable
No
pneumonia
n (%)
Pneumoni
a
n (%)
Unadjusted OR
(95% CI)
Adjusted OR (95%
CI)
p-value
Age (months)
2-5
6-11
12-23
24-59
34 (13.6)
56 (22.4)
28 (11.2)
132 (52.8)
20 (23.3)
13 (15.1)
11 (12.8)
42 (48.8)
2.5 (1.12-5.74)
1.0
1.7 (0.67-4.26)
1.4 (0.68-2.75)
3.2 (1.17-8.51)
1.0
3.0 (0.96-9.54)
2.2 (0.91-5.17)
0.023
-
0.058
0.081
Sex
Male
Female
132 (52.8)
118 (47.2)
47 (54.6)
39 (45.4)
1.0
0.9 (0.57-1.52)
Residence
Urban
Rural
139 (55.6)
111 (44.44)
15 (17.4)
71 (82.6)
1.0
5.9 (3.22-10.91)
1.0
5.7 (2.97-11.05)
-
<0.001
Parental/caretaker ed
ucation
No education
Primary
Secondary
Tertiary
12 (4.8)
98 (39.2)
76 (30.4)
64 (25.6)
9 (10.5)
43 (50.0)
23 (26.7)
11 (12.8)
4.4 (1.49-12.79)
2.6 (1.23-5.32)
1.8 (0.80-3.89)
1.0
Marital status
Married
Single
227 (90.8)
23 (9.2)
77 (89.5)
9 (10.5)
1.0
1.2 (0.51-2.60)
Religion
Catholic
Anglican
Muslim
Pentecostal
110 (44.0)
95 (38.0)
28 (11.2)
17 (6.8)
33 (38.4)
32 (37.2)
4 (4.7)
17 (19.8)
1.0
1.1 (0.64-1.96)
0.5 (1.56-1.46)
3.3 (1.53-7.25)
Tribe
Banyankole/B
akiga
Baganda
Others
228 (91.2)
13 (5.2)
9 (3.6)
80 (93.0)
4 (4.7)
2 (2.3)
1.0
0.9 (0.28-2.77)
0.6 (0.13-2.99)
Place of cooking
Indoor
Outdoor
82 (32.8)
168 (67.2)
30 (34.9)
56 (65.1)
1.0
0.9 (0.54-1.53)
Parental/caretaker
smoking
No
Yes
231 (92.4)
19 (7.6)
70 (81.4)
16 (18.6)
1.0
2.8 (1.36-5.69)
1.0
3.0 (1.35-6.80)
-
0.007
Immunization status
Up-to-date
for age
Not up-to-
date for age
235 (94.0)
15 (6.0)
74 (86.0)
12 (14.0)
1.0
2.5 (1.14-5.67)
1.0
2.9 (1.05-7.98)
-
0.039
Exclusive breast
feeding
No
Yes
41 (16.4)
209 (83.6)
30 (34.9)
56 (65.1)
2.7 (1.57-4.76)
1.0
2.9 (1.53-5.53)
1.0
0.001
-
Nutritional status
Normal
nutrition
MAM
SAM
238 (95.2)
10 (4.0)
2 (0.8)
70 (81.4)
8 (9.3)
8 (9.3)
1.0
2.7 (1.03-7.15)
13.6 (2.82-
65.52)
1.0
2.9 (0.99-8.64)
10.8 (2.01-58.41)
-
0.052
0.006
MAM: moderate acute malnutrition, SAM: severe acute malnutrition
African Health Sciences, Vol 21 Issue 4, December, 2021 1707

Discussion
The prevalence of pneumonia was at 25.6% in this
study. This prevalence is low compared to ndings in
a study at Mulago National Referral Hospital Uganda
which recorded prevalence of pneumonia in under-ves
at 53.7% 5. This could be because of the difference in
the study setting. Since Mulago Hospital is near the city,
children are likely to be affected by environmental pol-
lution, overcrowding and exposure to smoke due to in-
door cooking with biomass which predispose to pneu-
monia with a high odds of above 1.5 as found in some
studies 3, 7,18. Because most children under-ve years
visit hospitals due to symptoms of acute respiratory
infection 3, the prevalence of pneumonia in this study
is almost similar to the hospital based studies among
all under-ves (33.5%) in Ethiopia 7, 20.2%) in Sudan 19
and (21%) in Kenya 20.
Children of rural residence had 5.7 higher odd of
having pneumonia in this study compared to the ur-
ban residence, ndings are comparable with a study in
Ethiopia 6 that reported 4.5 higher odds of developing
pneumonia among children of rural residence. The dif-
ference could be explained by the low socioeconomic
status, low education level in rural areas that are associ-
ated with an increased risk of pneumonia 21. However,
some studies found an opposite with an increased risk
of pneumonia in urban than rural 19 with more children
in urban setting suffering from acute respiratory infec-
tions compared to those from rural setting 21. This is
because of exposure to factors like environmental air
pollution and overcrowding in urban areas which have
been found to be associated with pneumonia 7,16.
Children aged 2-6 months had 3.2 times higher odd of
suffering from pneumonia compared to older infants.
A study in Ethiopia 7 found that children who were aged
2-12 month were 2.5 times more likely to develop pneu-
monia as compared to children above 12 months. The
ndings can be attributed to the weak immune system
in these young infants that allows progression of upper
respiratory infection to the lungs causing pneumonia 8.
Children not exclusively breastfeed for six months, not
up to date immunized for their age according to nation-
al guidelines had almost 3 times odds of having pneu-
monia compared to the exclusively breast fed and im-
munized. The ndings were comparable with what was
found in a study in Brazil 22 where the odds of having
pneumonia was 2.4 times higher in children not exclu-
sively breast fed and 2.5 times among those who lacked
immunization compared to their counterparts. Exclu-
sive breast feeding and Immunization protects and
prevents children from pneumonia 1, this explains why
children who lacked these factors had a high chance of
developing pneumonia compared to their counterparts.
Children with severe acute malnutrition in this study
were 11 times more likely to have pneumonia than chil-
dren with good nutritional status. The ndings were
similar to related studies in southern Ethiopia 23, in dis-
trict hospitals of Malawi 24 and in a tertiary Care Centre
in Pradesh India 25. This is because malnutrition weak-
ens the immune system and increases the susceptibility
of children to acquire pneumonia 9
Having a co-morbidity for example HIV, asthma, cer-
ebral palsy and congenital heart disease was associated
with an increased odd of having pneumonia at bivar-
iate analysis. A case control study in eastern Kenya 26
found 3.8 odd of having pneumonia in children with a
comorbid condition. These comorbidities compromise
the immunity of children rendering them susceptible
to developing pneumonia following an upper respira-
tory tract infection. The results at multivariate analy-
sis did not show any statistical signicance and this is
because the number of children with co-morbidities in
this study was small.
Children who were exposed to cigarette smoke were
found to have 3 times higher odds of acquiring pneu-
monia compared to children who stayed in environment
free of cigarette smoke. These ndings were compara-
ble to the study in Ethiopia 7 which found that exposure
to cigarette smoke increased the odds of having pneu-
monia by 2.8 times. This is because smoke from the
cigarette damages the epithelial lining of the respiratory
tract and weakens the innate immune system which al-
lows easy colonization by the microorganisms. Howev-
er, another study in Ethiopia 6 did not nd association
between cigarette smoke exposure and pneumonia in
children under-ve years.
Conclusion
The prevalence of pneumonia among children present-
ing with acute respiratory symptoms is high at KIU-
TH in Bushenyi and most of the factors associated
with pneumonia are modiable and can be prevented.
Therefore emphasis should be put on Health Education
to sensitize the community about the preventive meas-
ures in addition to appropriate antibiotic treatment of
children who already have pneumonia. This is achieva-
ble when there is District Health Team Support Super-
vision to the lower health facilities and continued sen-
sitisation on timely routine immunisation of children,
African Health Sciences, Vol 21 Issue 4, December, 20211708

avoiding exposure to cigarette smoke, exclusive breast-
feeding, good nutrition practices and prompt antibiotic
treatment of children diagnosed with pneumonia
Acknowledgement
We acknowledge the radiology department of Kampa-
la International University Teaching Hospital for the
good work done in taking and interpretation of the
chest radiographs.
Conict of interest
The authors have no conict of interest associated with
material presented in this paper.
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