Meta-Analysis: Effects of Exposure to Tobacco Smoke and Malnutrition on the Risk of Pneumonia in Children


  • Atika Dwi Minawati Masters Program in Public Health, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret
  • Hanung Prasetya Study Program in Acupuncture, Health Polytechnics, Ministry of Health Surakarta



Background: Exposure to tobacco smoke (ETS) and poor nutritional status affect the risk of pneumonia in children. The purpose of this study was to analyze and estimate the effect of exposure to tobacco smoke and nutritional status in children on the risk of pneumonia.

Subjects and Method: The meta-analysis was carried out using the PRISMA flowchart and the PICO model. Population: children under five. Intervention: exposure to tobacco smoke and poor nutritional status. Comparison: no exposure to tobacco smoke and no malnutrition status. Outcome: Pneumonia. The online databases used are Google Scholar, PubMed, and Scient Direct with the keywords “Pneumonia” AND “Exposure to tobacco smoke” AND “Poor nutritional status” AND “Children under five years” AND “Multivariate” AND “Cross-sectional”. The inclusion criteria were full-text, cross-sectional study, and published in English. The data were analyzed by RevMan 5.3.

Results: A meta-analysis included 14 cross-sectional studies from Hong Kong, Nepal, Mongolia, Morocco, Uganda, Cameroon, Ethiopia, Nigeria, Egypt, and China. The total sample was 52,863 children under five. The results of the meta-analysis showed that exposure to tobacco smoke was 2.08 times more at risk of developing pneumonia than children under five who were not exposed (aOR=2.08; Cl 95%=1.30 to 3.32; p= 0.002). The presence of poor nutritional status is 2.00 times more at risk of experiencing pneumonia than children under five with no malnutrition status. (aOR=2.00; 95% Cl=1.31 to 3.06; p= 0.001).

Conclusion: Exposure to tobacco smoke and poor nutritional status in toddlers can increase the risk of pneumonia.

Keywords: exposure to tobacco smoke, poor nutritional status, children under five years pneumonia.

Atika Dwi Minawati. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: Mobile: +625212613303.


Akinyemi J, Morakinyo O (2018). Household environment and symptoms of childhood acute respiratory tract infections in Nigeria, 2003-2013: a decade of progress and stagnation. BMC Infect Dis. 18(1):1–12. doi: 10.1186/s12879-018-3207-5.

Aziza T, Dewi Y, Pamungkasari E (2020). Contextual effect of integrated health post on nutritional status among children age 6-59 months in Surabaya, East Java. J Matern Child Health. 5(1): 78-86. doi: 10.26911/thejmch.2020.0.01.09.

Dagvadorj A, Ota E, Shahrook S, Olkhanud P, Takehara K, Hikita N, Bayuusuren B, et al (2016). Hospitalization risk factors for children’s lower respiratory tract infection: a population-based, cross-sectional study in Mongolia. Sci Rep. 6(04):1–7.

Dai S, Chan K (2020). Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong. Tob. Induc.Dis. 18(01):1–9. doi: 10.18332/tid/114461.

Debela D, Mubarik M, Manyazewel T (2020). Severe pneumonia and risk factors among hospitalized children under five in Adama, Ethiopia. Res Sq. 1-19. doi:10.21203/rs.3.rs2497107/v1.

Demis S, Mekonnen N (2023). Prevalence and associated factors of pneumonia among (2-59) month’s children at public health facilities in Hulet Ejju Enesie District, Northcentral Ethiopia: Multi facility based study. PAMJ One Health. 7(9). doi: 10.11604/pamjoh.2022.7.9.32023.

Dharel S, Shrestha B, Basel P (2023). Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal multiple indicator cluster survey. BMC Public Health. 23(1): 1–9. doi: 10.1186/s12889-022-14839-6.

El-Koofy N, El-Shabrawi M, El-alim, Zein M, Badawi N (2022). Patterns of respiratory tract infections in children under 5 years of age in a low–middle-income country. J Egypt Public Health Assoc. 97(1). doi: 10.1186/s42506-022-0011-8-0.

Hailemariam B, Legesse T, Alemu K (2018). Effect of nutritional status and associated factors on pneumonia treatment outcome among under-five children at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Int. J. Child Health Nutr. 7(4): 195. doi: 10.6000/19294247.2018.07.04.9.

Jroundi I, Mahraoui C, Benmessaoud R, Moraleda C, Tliguli H, Seffar M, Kettani S., et al (2014). Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco. Int J Infect Dis. 28: 164–170. doi: 10.1016/j.ijid.2014.07.027.

Keleb A, Sisay T, Alemu K, Ademas A, Lingerew K, Kloos H, Mekonnen T., et al (2020). Pneumonia remains a leading public health problem among under-five children in periurban areas of north-eastern Ethiopia. PLoS ONE. 15(9): 1–15. doi:10.1371/journal.pone.0235818.

Kiconco G, Turyasiim M, Ndamira A, Ya-mile O, Egesa W, Ndiwimana M, Ma-ren M., et al (2021). Prevalence and associated factors of pneumonia in toddlers with acute respiratory symptoms: a cross-sectional study at Tea-ching Hospital in Bushenyi District, Western Uganda. Afr. Health Sci. 21: 1701–1710. doi: 10.4314/ahs.v21i4.25.

Lestari N, Salimo H, Suradi (2017). Role of biopsychocial factors on the risk of pneumonia in children under-five years old at Dr. Moewardi Hospital, Surakarta. J Matern Child Health. 2(2): 162-175. doi: 10.26911/thejmch.2017.02.02.07.

Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M., et al (2017). Checklist for analytical cross sectional studies. Joanna Briggs Institute Reviewer's Manual: 1-7.

Oqui M, Wulandari N, Santos T, Leite A, Putri A (2022). Knowledge about The Dangers of Smoking and Smoking Behavior of Students in Septembro Unamet 4th High school Dili, Timor Leste. J. Nurs midwifery res. 9(2):162–167. doi: 10.26699/

Picauly I, Manongga S, Adar D, Liufeto F (2022). Stunting Determinant Analysis in the East Mainlan Province of East Nusa Tenggara for the Period of 2017-2021. J Matern Child Health. 07(06): 711-719. doi: 10.26911/thejmch.2022.07.06.09.

Sutriana V, Sitaresmi M, Wahab A (2021). Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia. Clin Exp Pediatr. 64(11): 588–595. doi: 10.3345/CEP.2020.00339.

Suzuki M, Thiem V, Yanai H, Matsubaya-shi T, Yoshida L, Tho L, Minh T (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. doi: 10.1136/thx.2008.106385.

Tazinya A, Halle-Ekane G, Mbuagbaw L, Abanda M, Atashili J, Obama M (2018). Risk factors for acute respiratory infections in children under five years attending the Bamenda Regional Hospital in Cameroon. BMC Pulm. Med. 18(1): 1–8. doi: 10.1186/s12890-018-0579-7.

Tesfaye A, Hiko D, Kabeta (2019). Prevalence and Associated Factors of Pneumonia among Children 2 – 59 Months of Age in Gumay District, Jimma Zone, Southwest Ethiopia. Res Sq. doi: 10.21203/rs.2.11138/v1.

Zhuge Y, Qian H, Zheng X, Huang C, Zhang Y, Li B, Zhao Z (2020). Effects of parental smoking and indoor tobacco smoke exposure on respiratory outcomes in children. Sci Rep. 10(1):1-9.




How to Cite

Minawati, A. D., Murti, B., & Prasetya, H. (2023). Meta-Analysis: Effects of Exposure to Tobacco Smoke and Malnutrition on the Risk of Pneumonia in Children. Journal of Epidemiology and Public Health, 8(4), 457–468.




Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 > >>