The study was conducted at Debre Tabor General Hospital Under-five OPD which is found in Debre Tabor town 720 km far from the capital of Ethiopia in North West direction. The hospital gives referral service for nearly 3 million population who are living in South Gondar zone. Estimated number of under five children in this zone are about 196,529. According to the new health tier system of Ethiopia it is secondary health care unit with the capacity of 254 beds at different departments and 40 beds in pediatric ward. From total staffs of 402 at this hospital, 102 are administrative staffs, and 300 are clinical staffs.
Study design and period
Institutional based cross-sectional study was conducted from January 3 to February 10 /2019 to determine the institution-based proportion of under-five pneumonia and associated factors at Debre Tabor General Hospital under five OPD.
Source of Population
All 2 -59 months old children visiting under-five OPD at Debre Tabor General Hospital.
The study populations were all selected 2-59 months old babies who visited under five OPD at Debre Tabor General Hospital during data collection period
Inclusion and exclusion criteria
All under five Children 2-59 months of age with mother / care giver visiting under five OPD at Debre Tabor General Hospital during data collection period.
Severely sick child need life treating intervention and/or mothers or caretakers who are severely ill and less than two months age infants.
Sample size and sampling procedure
Sample Size Determination
The sample size was determined using single population proportion formula. Prevalence of pneumonia among under-five (28.1%) in Jima Zone Public Hospitals was taken (7). By considering 95% confidence interval (CI) and 5% marginal error the, sample size was calculated as follows;
Where n = (Zα/2)2 p (1-p)
n = Sample size
p = Prevalence of pneumonia in Jima=28.1%
α = Probability to reject true null hypothesis
d = Margin of error
Z α/2 = Standard normal of value of normal distribution at α/2
n= (1.96)2 (0.281) (0.719)
For those participants who were not volunteer to participate 10% non-response rate was added on the calculated sample size. Then, the final total sample size was 342.
Systematic random sampling technique was used to select the study participants. To determine sampling fraction (K) and skip interval (Kth). A total of 3362 2-59-month-old children visiting Debre Tabor General Hospital under five OPD for the last six consecutive months was used. Thereafter, average monthly visit of 560 was divided by total sample size 342 gave K value of 2. Then the first participant was selected by lottery method to select 342 participants. To avoid the cyclic pattern new under five OPD visits were sampled.
Socio-economic factors: - Age of the child, sex of the child, residence of the child, educational level parents, and occupation of parents
Environmental factors: - Indoor air pollution, Poor ventilation, over crowded, Tobacco smoke exposure
Nutritional factors: - Vaccination status, Breast feeding status
Co-morbid conditions of child: - Diarrhea, Measles, Asthma, HIV and Malaria
Under five children: Children age less than 59 months excluding under two months age.
Under five pneumonia: Objectively diagnosed cases of pneumonia by licensed clinician working at under five OPD
Data collection tool and procedure
Interviewer administered structured questionnaire was used to collect data from sampled mother or care giver who visiting under five OPD. The questionnaire has socio-demographic characteristics, environmental factors, and Co-morbid conditions. The tool was adapted from related study and modified (7). The English version was translated into Amharic language by language professionals. Three diploma nurse data collectors and one BSc nurse supervisor were involved in the data collection. Finally, medical charts were reviewed by the data collectors to collect clinical marker of the children.
Data Quality Control
Data was collected by well-trained data collectors using pretested questionnaire. Training was given for one day (including half day of pretest). Pretest was done on 10% percent of the total sample size at Addis Zemen Primary Hospital. Using pretest result sociodemographic variables were modified. One day training was given on the objective the study, confidentiality of information, respondent’s right, informed consent, techniques of interview and the elements of the questionnaires for data collectors and supervisor.
Data Processing and Analysis
After visually checking for completeness and cleaning, data was entered into Epi info version 7 and exported into SPSS version 22 for coding and analysis. All variables were used in the bivariable logistic regression, then variables with p-value ≤0.2 were further considered for multivariable logistic regression to incorporate more candidate variables. The result was summarized and presented using descriptive statistics. Multivariable logistic regression was done to minimize confounders. Variables in the final model predict 57.4% of the outcome with Hosmer and Lemishow test result of 0.574. Finally, statistical association was declared using Adjusted Odds Ratio (AOR) at 95% confidence level and p-value≤0.