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International Journal of Medical Research &

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ISSN No: 2319-5886 Health Sciences, 2018, 7(4): 60-68
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Risk Factors of Pneumonia Among Children Under 5 Years at a Pediatric

Hospital in Sudan
Siham M.O. Gritly1, Mohamed Osman Elamin2, Hatim Rahimtullah1, Abdikani Y. Haji
Ali , Abdi Hassan Dhiblawe Yabarow 1, Ebtihal A. Mohamed1 and Hamed Ademola Adetunji2*
1

Faculty of Public Health, University of Bahri, Khartoum, Sudan

1

2
Faculty of Public Health and Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
*Corresponding e-mail: hamed.tunji@gmail.com

ABSTRACT
Introduction: Pneumonia is major cause of mortality among acute respiratory infections, killing up to 5 million of
children below the age of 5 years annually in developing countries. Total 50% out-patients cases in Sudan are children
while 30% of children admissions are due to pneumonia. Every year, the number of deaths in infant and children
below the age of 5 years is reported to be 12 million. Objectives: The aim of this study is to find out the pneumonia
risks in Sudan among children <5 years and to establish a baseline data and statistical information about pneumonia
in the age group for future use. Study design and Setting: A hospital based descriptive study was conducted among
children <5 years at Mohamed Al-Amin Hamid Pediatric Hospital in February 2017. Methods: Parents of 40 children
<5 years admitted to the hospital during the study period completed the constructed questionnaire after obtaining
informed consents from each of them. Data was then analyzed. Results: Children in this study consisted of 27 (57.50%)
males and 13 (42.5%) females. Factors found to have association with pneumonia include low socio-economic status
and low educational level of mothers. Conclusion and Recommendations: The study concluded that the pneumonia
is more prevalent in children less than one year. Factors found to have association with pneumonia include low socio-
economic status and low educational level of mothers admitted to Mohamed Al-Amin pediatric hospital in Omdurman
locality. It was recommended to have an early diagnosis and treatment of pneumonia. Community health education
and completion of the immunization program are recommended to decrease the infection.
Keywords: Pneumonia, Developing countries, Immunization programs, Surveys and questionnaires

INTRODUCTION
Sudan is considered as one of the developing countries that faces increased morbidity and mortality rate due to
pneumonia among children <5 years due to the low standard of living and low socio-economic status. In Sudan, every
year about 1 million children suffer from pneumonia and about 50% of out-patients are children under 5 years, and
30% of hospital admissions are attributed to pneumonia. According to the latest WHO data published in May 2014,
influenza and pneumonia deaths in Sudan reached 37,775 (14.50%) of total deaths. Pneumonia kills up to 5 million
children under the age of 5 years annually in developing countries [1].
Every year, 12 million children die before their fifth birthday, many during the first year of life. Seven in ten of these
deaths are due to acute respiratory infections mostly due to pneumonia. Mortality rates of children under the age of
five years in most developing countries ranges from 60 to 100 per 1000 live births, one fifth of these deaths are due
to pneumonia and these mortalities due to childhood pneumonia is strongly linked to poverty-related factors such as
under nutrition, lack of safe water and sanitation, indoor air pollution and inadequate access to health care. Pneumonia
is the lower respiratory tract infection that exclusively affects the lung. While it attacks every person, children under
the age of five years are particularly prone to pneumonia. A range of both bacterial and viral pathogens have been
recognized to cause pneumonia in children with Streptococcus pneumonia accountable for most of the cases.
Also, 1 in every 5 knew the two indicative symptoms of pneumonia: fast breathing and difficult breathing. Previous
research has shown that in low resource settings, risk factors for pneumonia in children have included malnutrition,

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inadequate paternal education, bad ventilated living room, and smoking habits of parents, age, and sex of the child and
widely vary across the regions of the world [2].
Objective
To identify main risk factors of pneumonia among children under five years admitted to Mohamed Al-Amen Hamid
pediatric Hospital in Omdurman.
Specific Objectives
• To identify nutritional status in relation to pneumonia among children under the age of 5 years.
• To examine standard of living among families of child with pneumonia.
• To establish baseline data and statistical information about pneumonia under five years of age for the future
use.
METHODS AND METHODS
It is a descriptive cross-sectional hospital-based study. This study was carried out on children less than five year of
age at Mohamed Al-Amin Hamid Pediatric Hospital at Omdurman city of Sudan.
Study Design
The main aim of this study was to determine the risk factors contributing to pneumonia among children under five
of age. Data was collected using a questionnaire. The questionnaire gathered information regarding background
information on mother and child, (breastfeeding, weaning and immunization). It also gathered information regarding
the socio-economic information and educational level of the mother and fathers, as well as determined the water and
hygiene information.
Study Area and Period
This study was carried at Omdurman city in the period between February 2017 to March 2017 in Mohamed Al-Amin
Hamid Pediatric Hospital at Khartoum state, Omdurman locality. The hospital is located in the east of Omdurman
with total area of 7200 m2 with length 120 meter and width 60 meter. This hospital was established in 1986 by
Mohammed Al-Amin Hamid.
Sample Size
The total sample size was 40 children, and the data was collected within two weeks. All the samples were chosen
which included all pneumonia cases of children under five years of age, whose mother, father, or family member had
admitted to the hospital during this period of the study at Mohamed Al-Amin Hamid pediatric hospital.
Inclusion Criteria
All pneumonic children aged between 0-60 months who attended Mohamed Al-Amin Hamid pediatric hospital
Khartoum state at Omdurman locality with their mother.
Exclusion Criteria
Severely ill children and mothers who have hearing impairments or talking problem.
Data Collection and Technique
Data were collected from mothers, fathers or any family member of children who was in attendance with the admitted
children in the hospital at the time of study. Questionnaire was used to collect data. The questionnaire was designed
to match the objectives of this study. Questions included child gender, child age, and educational level of parents,
socio-economic status, anthropometric measures, and nutrition information. Anthropometric measures were used to
identify the different stages of malnutrition. These measurements were obtained from the hospital reports at time of
interviews.
Data Analysis
Statistical analysis was carried out by using the statistical package for the social science (SPSS) version 20 program.

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Ethical Considerations
Ethical clearance was obtained from the Ministry of Health and University of Bahri. Verbal consents from parents and
care takers of children were obtained and the objective of the study was explained to them. Privacy, and confidentiality
of collected information was ensured at all level.
RESULTS
Table 1 shows that 23 (57.50%) children were males, while 17 (42.50%) were females. Majority of them (57.50%)
were less than one year while 17 (42.50%) were found 1-4 years of age.
Table 1 Distribution of study population according to child gender and age (N=40)

Gender Frequency (N) Percent

Male 23 57.50%
Female 17 42.50%
Total 40 100%
Age Frequency (N) Percent
Less than one year 23 57.50%
1-4 years 17 42.50%
Total 40 100%
Table 2 indicated that majority of families had children less than five years of age 26 (65.0%) and had more than
three children, while 14 (35.0%) families had 1-2 children. The number (1-3 children) of children in the family was
22 (55.0%).
Table 2 Frequencies of children distribution among families (N=40)

Number of children less than five years Frequency (N) Percent

One child 5 12.50%
Two children 9 22.50%
Three children 9 22.50%
More than 3 children 17 42.50%
Total 40 100.00%
The number of children in the family Frequency (N) Percent
1-3 22 55.00%
4-6 18 45.00%
Total 40 100%
Table 3 describes father’s occupation where 27 (67.50%) were labor (worker), while 1 (2.50%) un-employment
and 7 (17.50%) were trader. Twenty-two father’s educations (55.0%) was basic, while 5 (12.50%) were secondary
education and 1 (2.50%) was graduated from the university and 10 (25.0%) were illiterate.
The family income of 26 (65.0%) fathers were less than 150 SDG (Sudanese Pound), while 12 (30.0%) earned 150-
300 SDG and 2 (5.00%) had more than 600 SDG.
Table 3 Socioeconomic characteristics of the families (N=40)

Father's occupation Frequency (N) Percent

Un-employment 1 2.50%
Trader 7 17.50%
Other 5 12.50%
Workers 27 67.50%
Total 40 100.00%
Father's education Frequency (N) Percent
Illiterate 10 25.00%
Basic 22 55.00%
Secondary 5 12.50%
University 1 2.50%

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Other 2 5.00%
Family income Frequency (N) Percent
Less than 150 SDG 26 65.00%
150-300 SDG 12 30.00%
More than 600 SDG 2 5.00%
Total 2 5.00%
Table 4 shows that, most of the children 29 (72.50%) whose mothers were interviewed breastfed their children.
Majority of child weaning 22 (55.50%) were gradually, while 3 (7.50%) weaned suddenly.
Table 4 Frequency distribution of feeding practices among children under five years of age (N=40)

The child breast feeding Frequency (N) Percent

Yes 29 72.50%
No 11 27.50%
Total 40 100.00%
The child is weaned Frequency (N) Percent
Gradually 22 55.00%
Suddenly 18 45.00%
Table 5 indicated child weight, majority of them 23 (57.50%) were 6.0-10.99 kg. Majority of children mid-arm
circumference 27 (67.50%) were found 10.0-14.99 cm, while 9 (22.50%) were found 15.0-19.99 cm, and 4 (10.0%)
were found 5.0-9.99 cm.
Table 5 Frequency distribution of anthropometric measurement of children under five years of age (N=40)

Child weight (kg) Frequency (N) Percent

1.00-5.99 7 17.50%
6.00-10.99 23 57.50%
11.00-15.99 6 15.00%
16.00-20.99 4 10.00%
Total 40 100.00%
Child mid arm circumference (cm) Frequency (N) Percent
5.00-9.99 4 10.00%
10.00-14.99 27 67.50%
15.00-19.99 9 22.50%
Total 40 100.00%
Table 6 describes that majority of study participants 26 (65.0%) used tap water while only 14 (35.0%) used well and
river. Most of the study participants (mothers) 19 (47.50%) used zeer pot fridge for drinking water and storage. While
18 (45.0%) used barrels and jerry cans.
Table 6 Frequency distribution of water safety among families (N=40)

Main source of drinking water supply for household Frequency (N) Percent
Tap water 26 65.00%
Well 6 15.00%
River 8 20.00%
Total 40 100.00%
Equipment's used for drinking water Frequency (N) Percent
Barrels 9 22.50%
Zeer pot fridge 19 47.50%
Jerry cans 9 22.50%
Barrels and zeer pot fridge 3 7.50%
Total 40 100.00%
Figure 1 indicates majority of mothers 27 (67.50%) attended health care center, while 13 (32.50) did not attended
health care center.

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32%

68%

Did not attend healthcare centre Attended healthcare centre

Figure 1 Frequency of attending child health care center (N=40)

Figure 2 shows majority of mothers 28 (70.0%) were given traditional treatment to their sick children, while 12
(30.0%) were given medical treatment to their sick children.

Figure 2 Frequency of kind of treatment that child takes (N=40)

Figure 3 indicates that majority of mothers 20 (50.0%) were using gas, while 20 (50.0%) used coal and wood.

Figure 3 Frequency of fuel used for cooking (N=40)

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Figure 4 shows that majority of 27 (67.50%) were not cigarette smokers among family members, while 13 (32.50%)
were cigarette smokers.

Figure 4 Frequency of cigarette smoking among family members (N=40)

Figure 5 describes the majority of study participants (mothers) 24 (60.0%), their house was poorly ventilated, while
16 (40.0%) were well ventilated.

Figure 5 Houses ventilation status (N=40)

Figure 6 shows the mothers 30 (75.0%) were using traditional pit latrines, while only 10 (25.0%) used ventilated
improved pit latrines.

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Figure 6 Toilets types used (N=40)

DISCUSSION
This study was designed to investigate the main risk factors for pneumonia presenting at Mohamed Al-Amin Hamid
Pediatric hospital in Omdurman city. The specific objectives were to identify nutritional status in relation to pneumonia
among children under five years of age, to examine standard of living among families of child with pneumonia and
to establish baseline data and statistical information about pneumonia under five years of age for the future use.
This study consisted of 40 mothers who had brought their sick children under five years of age with pneumonia to
Mohamed Al Amin Hamid pediatric hospital in Omdurman city.
The findings of this study showed that the numbers of male children were 23 (57.50%) and female children were
17 (42.50%). The gender distribution indicated that pneumonia was more prevalent in male children than in female
children, which revealed that a relation existed between gender and pneumonia. This finding agrees with the study of
Almirall, et al., who found that pneumonia occurs more commonly in males than females [3]. In several community-
based studies, boys appear to be more frequently affected by pneumonia than girls [4]. The excess risk for boys was
confirmed in a pneumonia case control study in Brazil [5].
The study showed that 65.7% of the children less than two years of age were more affected with pneumonia than the
other age groups, this finding was supported from a case control study conducted in Pakistan, younger children were
found to be at increased risk of pneumonia compared to older children under the age of five years. Younger age of the
children (2-6 months) was found to be at a significant risk factor for pneumonia [6].
In this study, results indicated that pneumonia was higher among families who have lower income 26 (65.00%), and
there was relation between the family income and pneumonia. The study by Park in 2007, who reported that children
from low socio-economic status tend to have more risk to respiratory infections [7]. Also, this finding was supported
a study conducted in the Gambia by O’Dempsey, et al., in 1996 who founded that children of mothers with a personal
source of income are at a lower risk of pneumonia [8].
The majority 34 (85.0%) of pneumonia prevailed among children whose mothers were homemakers. This result
was supported by a report from case control study by Graham in 1990 which revealed that maternal occupation was
significantly associated with pneumonia in under five years of age [9]. This study showed that 40.0% of pneumonia
prevailed among children whose mothers had lower education.
Lack of ventilation might induce dampness and smell, which are risk factors of pneumonia. No significant association
between pneumonia in children and current smoking habits among family member were found in study. This is not
in line with the reports from WHO training package on health sector, where children whose parents smoke were 60%
more affected by pneumonia. Also, this finding is not supported by the scientific articles published in Miami and
Poland [10].

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Breast feeding the child exclusively during the first 6 months of child’s life was not found to be a significant factor
for pneumonia in children. This is not consistent with findings from a systematic review and meta-analysis done in
UNICEF report, 2011. The integrated action plan for prevention and control of pneumonia and diarrhea depend on
exclusive breast feeding which was one of the factors that could determine the incidence, prevalence, and mortality
of pneumonia in children [11].
CONCLUSION
The study concluded that pneumonia is more prevalent in children under one year of age, but it is still a health problem
among children under five years of age at Mohamed Amin Hamid hospital in Omdurman city of Sudan.
Low family income and low educational levels of mothers were found to be major risk factors of pneumonia among
children less than five years of age admitted to Mohamed Al-Amin pediatrics hospital in Omdurman locality.
Significantly, higher number of males presented with pneumonia than females in this study. The study had identified
a comparatively high prevalence of pneumonia in children less than five years of age. It also pointed out modifiable
risk factors of the pneumonia as diarrhea, measles and use of primitive latrines among families. Majority of studied
children under five years of age had history of diarrhea. So, the study indicated diarrhea associated with pneumonia
disease.
RECOMMENDATIONS
• Early diagnosis and treatment of pneumonia.
• Community health education programs on the disease
• Completion of the immunization program to be compulsory for all children under five years of age.
• Families should be sensitized on the importance of early detection of pneumonia.
• Breast feeding of infants and balanced nutrition for children.
• Health education programs should be introduced in MCH services in all health centers.
DECLARATIONS
Conflict of Interest
The authors have disclosed no conflict of interest, financial or otherwise.
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2016, http://www.who.int/mediacentre/factsheets/fs331/en/.
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children”. Unicef, 2006.
[3] Almirall, J., et al. “Risk factors for community-acquired pneumonia in adults: A population-based case–control
study.” European Respiratory Journal, Vol. 13, No. 2, 1999, pp. 349-55.
[4] Mahalanabis, D., et al. “Risk factors for pneumonia in infants and young children and the role of solid fuel for
cooking: a case-control study.” Epidemiology & Infection, Vol. 129, No. 1, 2002, pp. 65-71.
[5] Victora, Cesar G., et al. “Risk factors for pneumonia among children in a Brazilian metropolitan
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West Africa.” International Journal of Epidemiology, Vol. 25, No. 4, 1996, pp. 885-93.
[9] Graham, Neil M. “The epidemiology of acute respiratory infections in children and adults: a global
perspective.” Epidemiologic Reviews, Vol. 12, 1990, pp. 149-78.

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[10] Smith, Kirk R., et al. “Effect of reduction in household air pollution on childhood pneumonia in Guatemala
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[11] UNICEF, WHO. “Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children.” 
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