Multilevel Analysis on the Biological, Social Economic, and Environmental Factors on the Risk of Pneumonia in Children Under Five in Klaten, Central Java
Abstract
Background: Pneumonia is one of the leading causes of death in children under five in the world, particularly in the developing countries including Indonesia. Imbalance between host, agent, and environment, can cause the incidence of pneumonia. This study aimed to examine the biological, social economic, and environmental factors on the risk of pneumonia in children under five using multilevel analysis with village as a contextual factor.
Subjects and Method: This was an analytic observational study with case control design. The study was conducted in Klaten District, Central Java, from October to November, 2017. A total sample of 200 children under five was selected for this study by fixed disease sampling. The dependent variable was pneumonia. The independent variables were birth weight, exclusive breastfeeding, nutritional status, immunization status, maternal education, family income, quality of house, indoor smoke exposure, and cigarette smoke exposure. The data were collected by questionnaire and checklist. The data were analyzed by multilevel logistic regression analysis.
Results: Birth weight ≥2.500 g (OR=0.13; 95% CI= 0.02 to 0.77; p= 0.025), exclusive breastfeeding (OR= 0.15; 95% CI= 0.02 to 0.89; p= 0.037), good nutritional status (OR=0.20; 95% CI= 0.04 to 0.91; p= 0.038), immunizational status (OR= 0.12; 95% CI= 0.02 to 0.67; p= 0.015), maternal educational status (OR= 0.18; 95% CI= 0.03 to 0.83; p= 0.028), high family income (OR= 0.25; 95% CI= 0.07 to 0.87; p= 0.030), and good quality of house (OR= 0.21; 95% CI= 0.05 to 0.91; p= 0.037) were associated with decreased risk of pneumonia. High indoor smoke exposure (OR= 8.29; 95% CI= 1.49 to 46.03; p= 0.016) and high cigarette smoke exposure (OR=6.37; 95% CI= 1.27 to 32.01; p= 0.024) were associated with increased risk of pneumonia. ICC= 36.10% indicating sizeable of village as a contextual factor. LR Test p= 0.036 indicating the importance of multilevel model in this logistic regression analysis.
Conclusion: Birth weight, exclusive breastfeeding, good nutritional status, immunizational status, maternal educational status, high family income, and good quality of house decrease risk of pneumonia. High indoor smoke exposure and high cigarette smoke exposure increase risk of pneumonia.
Keyword: pneumonia, biological, social economic, environmental factor, children under five
Correspondence: Nurul Ulya Luthfiyana, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: ulya.luthfiyana@gmail.com.
Journal of Epidemiology and Public Health (2018), 3(2): 128-142
https://doi.org/10.26911/jepublichealth.2018.03.02.03
References
Abbey M, Chinbuah MA, Gyapong M, Bartholomew LK, Borne B (2016). Community perceptions and practices of treatment seeking for childhood pneumonia: A mixed methods study in a rural district, Ghana. BMC Public Health, 16(1): 1–10.
Adesanya OA, Chiao C (2016). A multilevel analysis of lifestyle variations in symptoms of acute respiratory infection among young children under five in Nigeria. BMC Public Health, 16(1): 1–11.
Ahmadi (2008). Manajemen penyakit berbasis wilayah. Jakarta: PT. Kompas Media Nusantara.
Anwar A, Dharmayanti I (2014). Pneumonia pada anak balita di Indonesia. Jurnal Kesehatan Masyarakat Nasional, 8(8): 359–365.
Azab S, Sherief LM, Saleh SH, Elsaeed WF, Elshafie MA, Abdelsalam S (2014). Impact of the socioeconomic status on the severity and outcome of communityacquired pneumonia among Egyptian children: a cohort study. Infectious Diseases of Poverty, 14(3): 1–7.
Azhar K, Perwitasari D (2014). Kondisi fisik rumah dan perilaku dengan prevalensi TB paru di Propinsi Dki Jakarta, Banten dan Sulawesi Utara.Media Penelitian dan Pengembangan Kesehatan, 23(4): 172–181.
Bruce NG, Dherani MK, Das JK, Balakrishnan K, Adair RH, Bhutta ZA, Pope D (2013). Control of household air pollution for child survival: Estimates for intervention impacts. BMC Public Health, 13(3): 1–13.
Dinas Kesehatan Kabupaten Klaten (2016). Profil Kesehatan Kabupaten Klaten Tahun 2015. www.depkes.go.id/resources/download/profil/ profil_kab_kota_2015/3310_jateng_kab_klaten_2015. Diakses Maret 2017.
Fikri BA (2016). Analisis faktor risiko pemberian ASI dan ventilasi kamar terhadap kejadian pneumonia balita. The Indonesian Journal of Public Health, 11(1): 14–27.
Grant CC, Wall CR, Gibbons MJ, Morton SM, Santosham M, Black RE (2011). Child nutrition and lower respiratory tract disease burden in New Zealand: A global context for a national perspective. Journal of Paediatrics and Child Health, 47(8): 497–504.
Hadisuwarno W, Setyoningrum RA, Umiastuti P (2015). Host factors related to pneumonia in children under 5 years of age. Paediatrica Indonesiana, 55(5): 248–251.
Hanieh S, HaTT, Simpson JA, Thuy TT, Khuong NC, Thoang DD, Biggs BA (2015). Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: A prospective cohort study. BMC Public Health, 15(1): 1–10.
Hidayat S, Yunus F, Susanto AD (2012). Pengaruh polusi udara dalam ruangan terhadap paru. Continuing Medical Education, 39(1): 8–14.
Ibrahim M, Zambruni M, Melby C, Melby P (2017). Impact of childhood malnutrition on host defense and infection. Clinical Microbiology Reviews, 30(4): 919–971.
Jackson S, Mathews KH, Pulanic D,Falconer R, Rudan I, Campbell H, Nair H (2013). Risk factors for severe acute lower respiratory infections in children a systematic review and metaanalysis. Croatian Medical Journal, 54(2): 110–121.
Karsidi R (2008). Sosiologi pendidikan. Surakarta: UNS press.
Kelly MS, Wirth KE, Madrigano J, Feemster KA, Cunningham CK, Arscott T, Finalle R (2016). The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana. Int J Tuberc Lung Dis, 19(3): 349–355.
Kementerian Kesehatan RI. (2017). Data dan informasi profil kesehatan Indonesia 2016. Jakarta: Kementerian Kesehatan RI.
Lestari N, Salimo H, Suradi (2017). Role of biopsychosocial factors on the risk of pneumonia in children underfive years old at Dr. Moewardi Hospital Surakarta. Journal of Maternal and Child Health, 2(2): 162–175.
Machmud R (2009). Pengaruh kemiskinan keluarga pada kejadian pneumonia balita di Indonesia. Jurnal Kesehatan Masyarakat Nasional, 4(1): 36–41.
Murti B (2016). Prinsip dan metode riset epidemiologi. Surakarta: Yuma Pustaka.
Nguyen TKP, Tran TH, Roberts CL, Graham SM, Marais BJ (2017). Risk factors for child pneumonia focus on the Western Pacific Region. Paediatric Respiratory Reviews, 21: 102–110.
Nirmolia N, Mahanta TG, Boruah M, Rasaily R, Kotoky RP, Bora R (2017). Prevalence and risk factors of pneumonia in under fi ve children living in slums of Dibrugarh town. Clinical Epidemiology and Global Health, 196: 1- 4.
Oliwa JN, Marais BJ (2017). Vaccines to prevent pneumonia in children – a developing country perspective. Paediatric Respiratory Reviews, 22: 23–30.
Padmonobo H, Setiani O, Joko T (2013). Hubungan faktor-faktor lingkungan fisik rumah dengan kejadian pneumonia pada balita di wilayah kerja Puskesmas Jatibarang Kabupaten Brebes. Jurnal Kesehatan Lingkungan I, 11(2): 194–198.
Patel AB, Dhande L A, Pusdekar YV, Borkar JA, Badhoniya NB, Hibberd PL (2013). Childhood illness in households using biomass fuels in India: Secondary data analysis of nationally representative national family health surveys. International Journal of Occupational and Environmental Health, 19(1): 35–42.
Rao S, Kanade AN, Yajnik CS, Fall CHD (2009). Seasonality in maternal intake and activity influence off spring’s birth size among rural Indian mothers Pune Maternal Nutrition Study. International Journal of Epidemiology, 38(4): 1094–1103.
Rasyid Z (2013). Faktor-faktor yang berhubungan dengan kejadian pneumonia anak balita di RSUD Bangkinang Kabupaten Kampar. Jurnal Kesehatan Komunitas, 2(3): 136–140.
Sanbata H, Asfaw A, Kumie A (2014). Association of biomass fuel use with acute respiratory infections among under five children in a slum urban of Addis Ababa, Ethiopia. BMC Public Health, 14(1): 1–8.
Sari EL, Suhartono, Joko T (2014). Hubungan antara kondisi lingkungan fisik rumah dengan kejadian pneumonia pada balita di wilayah kerja Puskesmas Pati I Kabupaten Pati. Jurnal Kesehatan Masyarakat, 2(1): 56–61.
Sofia (2017). Environmental risk factors for the incidence of ARI in infants in the working area of the Community Health Center Ingin Jaya District of Aceh Besar. Aceh Nutrition Journal, 2(1): 43–50.
Stekelenburg J, Kashumba E, Wolffers I (2002). Factors contributing to high mortality due to pneumonia among underfives in Kalabo District, Zambia. Tropical Medicine and International Health, 7(10): 886–893.
Suzuki M, Thiem VD, Yanai H, Matsubayashi T, Yoshida LM, Tho LH, Ariyoshi K (2009). Association of environmental tobacco smoking exposure with an increased risk of hospital admissions for pneumonia in children under 5 years of age in Vietnam. Thorax, 64(6): 484–489.
Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA (2007). Socioeconomic and foodrelated physical characteristics of the neighbourhood environment are associated with body mass index. Journal of Epidemiology and Community Health, 61(6): 491–498.
WHO & UNICEF (2013). Ending preventable child deaths from pneumonia and diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). Geneva.
WHO & UNICEF (2015). Pneumonia The Deadliest Childhood Disease. https://data.unicef.org/topic/child health/pneumonia/. Diakses April 2017.
Wichmann J, Voyi KVV (2006). Impact of cooking and heating fuel use on acute respiratory health of preschool children in South Africa. The Southern African Journal of Epidemiology and Infection, 21(2): 48–54.
World Bank (2012). Indonesia: Health Impacts of Indoor Air Pollution. Australia.www.who.int/indoorair/health_impacts/en/. Diakses April 2017.
Wulandari E (2014). Faktor yang berhubungan dengan keberadaan Streptococcus di udara pada rumah susun Kelurahan Bandarharjo Kota Semarang Tahun 2013. Unnes Journal of Public Health, 3(4): 1–10.
Zairinayati, Udiyono A, Hanani Y (2013). Analisis faktor lingkungan fisik rumah yang berhubungan dengan kejadian pneumonia pada balita di wilayah kerja Puskesmas Sosial Kecamatan Sukarame Palembang. Jurnal Kesehatan Lingkungan, 1(2): 1-10.
Zar HJ, Madhi SA, Aston SJ, Gordon SB (2013). Pneumonia in low and middle income countries: Progress and challenges. Thorax, 68(11): 1052–1056.
