Background. Lower Respiratory Tract Infections including pneumonia are the fourth cause of death globally. In Ethiopia, pneumonia is the leading cause of death for children under five. However, so far, only a few studies that used longitudinal design and time dependent covariates determined the significant factors of pneumonia. This study sought to determine whether respiratory rate changes differed for under five-year-old pneumonia patients who had been receiving different treatments over time and whether the change was effected by time dependent and independent covariates. Methods. A longitudinal study design involving marginal Poisson regression models and conditional Poisson regression models was used. After comparing the two, the final interpretation was made using a conditional Poisson regression model owing to its relative powerfulness. Results. Four hundred and fifty-three under five pneumonia patients were included, of which 44.37% were female. It is found that, compared to rural children, urban children had an estimated mean respiratory rate decrease of 3%. It is also found that, compared to children whose mother practiced only exclusive breastfeeding in the first six months, children whose mother practiced both breastfed and complementary were more likely to be exposed to pneumonia. The estimated mean respiratory rate of children having asthma was 1.073 times that of children who had diarrhea. Conclusions. In northwest Ethiopia, weight, residence, previous disease history, breastfeeding and temperature are significant factors of pneumonia among children under five. The effectiveness of treatments was dependent on the number of times children visited the hospital. A significant variation of baseline pneumonia status among under five pneumonia patient children was noted in the hospital.
___
1. Unicef’s report of pneumonia 2019: 1-5. Available at: https://data.unicef.org/topic/child-health/ pneumonia/ (Accessed on January28, 2020).
2. Gupta D, Mishra S, Chaturvedi P. Fast breathing in the diagnosis of pneumonia-a reassessment. J Trop Pediatr 1996; 42: 196-199.
3. Tong N. Priority Medicined for Europe and the World. A Public Health Approach to Innovation. Background Paper 6.22 Pneumonia, 2013. Available at: https://www.who.int/medicines/areas/priority_ medicines/BP6_22Pneumo.pdf (Accessed on May 16, 2021).
4. Gebru HB, Gahse FE, Kahsay AB. Risk factors of community acquired pneumonia among adults in Tigray, Ethiopia: a case-control study. J Clin Diagn Res 2018; 12: LG01-LG05.
5. Beletew B, Bimerew M, Mengesha A, Wudu M, Azmeraw M. Prevalence of pneumonia and its associated factors among under five children in East Africa: a systematic review and meta-analysis. BMC Pediatr 2020; 20: 254
6. Karki S, Fitzpatrick AL,Shrestha S. Risk factors for pneumonia in children under 5 years in a teaching hospital in Nepal. Kathmandu Univ Med J 2014; 12: 247-252.
7. UNICEF reports of pneumonia in Ethiopia 2014: 2-10. https://unicefethiopia.org/2014/11/13/ inethiopia-pneumonia-is-a-leading-single-diseasekilling-under five-children/ (Accessed on December 28, 2019).
8. Victora CG, Fuchs SC, Flores JA, Fonseca W, Kirkwood B. Risk factors for pneumonia among children in a Brazilian metropolitan area. Pediatrics 1994; 93(6 Pt 1):977-985.
9. Markos Y, Dadi AF, Demisse AG, Ayanaw Habitu Y, Derseh BT, Debalkie G. Determinants of under five pneumonia at Gondar University Hospital, Northwest Ethiopia: an unmatched case-control study. J Environ Public Health 2019; 2019: 9790216.
10. Muro F, Mtove G, Mosha N, et al. Effect of context on respiratory rate measurement in identifying nonsevere pneumonia in African children. Trop Med Int Health 2015; 20: 757-765.
11. UNICEF annual report of pneumonia in Ethiopia 2017: 1-5. https://www.unicef.org/ about/ annualreport/files/Ethiopia 2017 COAR.pdf (Accessed on January, 2020).
12. Negash AA, Asrat D, Abebe W, et al. Bacteremic community-acquired pneumonia in Ethiopian children: etiology, antibiotic resistance, risk factors, and clinical outcome. Open Forum Infect Dis 2019; 6: ofz029.
13. Lema B, Seyoum K, Atlaw D. Prevalence of community acquired pneumonia among children 2 to 59 months old and its associated factors in Munesa district, Arsi Zone, Oromia Region, Ethiopia. Clin Mother Child Health 2019; 16: 334.
14. Lema KT, Murugan R, Tachbele E, Negussie BB. Prevalence and associated factors of pneumonia among under five children at public hospitals in Jimma zone, South West of Ethiopia 2018. J Pulmonol Clin Res 2018; 2: 25-31.
15. Strauß R, Ewig S, Richter K, König T, Heller G, Bauer TT. The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705,928 hospitalized patients in Germany from 2010-2012. Dtsch Arztebl Int 2014; 111: 503-508.
16. Molenberghs G, Verbeke G. Models for Discrete Longitudinal Data (Springer Series in Statistics). (Kindle ed) New York: Springer Science and Business Media, 2005.
17. Lalonde TL, Nguyen AQ, Yin J, Irimata K, Wilson JR. Modeling correlated binary outcomes with timedependent covariates. Data Sci J 2013; 11: 715-738.
18. Cai K, Wilson JRHow to use SAS® for GMM logistic regression models for longitudinal data with timedependent covariates. InProceedings of the SAS Global Forum Conference 2015: 1-8.
19. Guerra MW, Shults J, Amsterdam J, Ten-Have T. The analysis of binary longitudinal data with timedependent covariates. Stat Med 2012; 31: 931-948.