Identifying the Sociodemographic and Environmental Risk Factors of Childhood Pneumonia in South Asia

Abstract

Background: Pneumonia is the leading infectious cause of mortality in children under five years old. Despite global progress in reducing pneumonia cases, South Asia continues to experience disproportionately high incidence and mortality rates. Purpose: This study aims to identify the sociodemographic and environmental risk factors contributing to childhood pneumonia morbidity and mortality across eight South Asian countries: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Methods: Six databases were searched for relevant studies: MEDLINE (Ovid), Global Health (Ovid), Embase, Web of Science, Emcare, and the Cochrane Library. Primary research studies focusing on sociodemographic and environmental risk factors for childhood pneumonia morbidity and mortality in children under five from eight South Asian countries were included. The review followed PRISMA guidelines, and data were extracted and analyzed using a DerSimonian and Laird random-effects meta-analysis model. Studies were assessed for quality using the Newcastle-Ottawa Scale, and pooled effect estimates were calculated to quantify the strength of associations between risk factors and pneumonia outcomes. Results: Higher age was associated with a lower risk of pneumonia morbidity (OR: 0.89). Male sex (OR: 1.15), preterm birth (OR: 2.53), and rural residence (OR: 2.03) significantly increased pneumonia risk. For mortality due to pneumonia, children under six months (OR: 3.78), children under one year (OR: 2.34), and low-weight-for-age children (OR: 6.07) had significantly higher risks, while females had a lower risk compared to males (OR: 0.58). Conclusion: The findings highlight the need for targeted public health interventions, particularly in rural areas and for vulnerable groups like preterm infants. Addressing these risk factors is essential for making progress toward reducing the childhood pneumonia burden in South Asia and achieving global health goals aimed at lowering under-five mortality.