Low Birth Weight and Childhood Pneumonia in Sumatra, Indonesia: A Cross-Sectional Analysis of the 2023 Indonesian Health Survey
DOI:
https://doi.org/10.22437/jkmj.v10i1.55484Keywords:
Low birth weight, Pneumonia, Children under five, Household air pollution, Cooking fuelAbstract
Low birth weight (LBW) is a well-established early-life biological risk factor for respiratory infections; however, subnational evidence examining its role in childhood pneumonia in Indonesia remains limited. This study aimed to examine the association between low birth weight and pneumonia among children aged 12–59 months in Sumatra, Indonesia, while accounting for demographic, health service, and environmental factors. A cross-sectional study was conducted using data from the 2023 Indonesian Health Survey (IHS). The analysis included 21,466 children aged 12–59 months residing in Sumatra. Pneumonia status and low birth weight were defined according to the SKI standard definitions. Multivariable logistic regression analyses were performed using sampling weights to account for the complex survey design. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. The prevalence of pneumonia among children aged 12–59 months in Sumatra was 1.0%. Children with a history of low birth weight had markedly higher odds of pneumonia compared with those born with normal birth weight (aOR 14.9; 95% CI 9.2-24.1). Household cooking fuel use was identified as a confounding factor, but not as an interaction. Other factors, including vitamin A supplementation, immunization status, and area of residence, were not identified as confounding or interacting factors. Low birth weight is a strong determinant of pneumonia among children aged 12–59 months in Sumatra. Reducing childhood pneumonia requires integrated strategies addressing both early-life biological vulnerability and modifiable household environmental exposures.
References
1. UNICEF. Pneumonia in Children Statistics [Internet]. UNICEF. 2024 [cited 2026 Jan 20]. Available from: https://data.unicef.org/topic/child-health/pneumonia/
2. Odoom A, Opoku-Asare B, Donkor ES. The Burden of Hospitalization Due to Klebsiella pneumoniae–Associated Pneumonia in Children Under 5 Years in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Heal Sci Reports. 2025;8(11). https://doi.org/10.1002/hsr2.71395
3. World Health Organization. Pneumonia In Children [Internet]. World Health Organization. 2022 [cited 2026 Jan 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/pneumonia
4. Wang M. Clinical characteristics of pediatric pneumonia: a retrospective study. Am J Transl Res. 2025;17(6):4642–50. https://doi.org/10.62347/NMGN1230
5. Kifle M, Yadeta TA, Debella A, Mussa I. Determinants of pneumonia among under-five children at Hiwot Fana specialized hospital, Eastern Ethiopia: unmatched case-control study. BMC Pulm Med. 2023;23(1):1–11. https://doi.org/10.1186/s12890-023-02593-3
6. Langefeld K. Pneumonia Remains Leading Cause of Child Mortality [Internet]. Global Initiative for Chronic Obstructive Lung Disease - GOLD. 2025 [cited 2026 Jan 20]. Available from: https://goldcopd.org/pneumonia-remains-leading-cause-of-child-mortality/
7. The Lancet Respiratory Medicine. Pneumonia: a neglected global threat. Lancet Respir Med. 2025;13(4):289. https://doi.org/10.1016/S2213-2600(25)00087-6
8. Keleb A, Sisay T, Alemu K, Ademas A, Lingerew M, Kloos H, et al. Pneumonia remains a leading public health problem among under-five children in peri-urban areas of north-eastern Ethiopia. PLoS One. 2020;15(9):e0235818. https://doi.org/10.1371/journal.pone.0235818.
9. Sutriana VN, Sitaresmi MN, Wahab A. Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia. Clin Exp Pediatr. 2021;64(11):588–95. https://doi.org/10.3345/cep.2020.00339
10. Ministry of Health Republic of Indonesia. National Action Plan for Pneumonia and Diarrhea Control 2023-2030. Jakarta; 2023.
11. Badan Kebijakan Pembangunan Kesehatan. Indonesia Health Survey (IHS) 2023 [Internet]. BKPK Kemenkes. 2023 [cited 2026 Jan 20]. Available from: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/
12. Gelagay AA, Azale T, Gezie LD, Tigabu Z, Alemu K. High proportion of pneumonia morbidity and risk factors in sick under-five children, northwest Ethiopia: a health facility based cross-sectional study. Sci Rep. 2026;16(1):7039. https://doi:10.1038/s41598-026-37920-1
13. Shi H, Wang T, Zhao Z, Norback D, Wang X, Li Y, et al. Prevalence, risk factors, impact and management of pneumonia among preschool children in Chinese seven cities: a cross-sectional study with interrupted time series analysis. BMC Med. 2023;21(1):1–14. https://doi.org/10.1186/s12916-023-02951-2
14. Purnama TB, Wagatsuma K, Pane M, Saito R. Effects of the Local Environment and Nutritional Status on the Incidence of Acute Respiratory Infections Among Children Under 5 Years Old in Indonesia. J Prev Med Public Heal. 2024;57(5):461–70. https://doi.org/10.3961/jpmph.24.246
15. Lu Y. Determinants of childhood pneumonia: a retrospective hospital-based analysis. Front Med. 2025;12(October):1–10. https://doi.org/10.3389/fmed.2025.1709403
16. M S, Vaithilingan S. Childhood Pneumonia in Low- and Middle-Income Countries: A Systematic Review of Prevalence, Risk Factors, and Healthcare-Seeking Behaviors. Cureus. 2024;16(4). https://doi.org/10.7759/cureus.57636
17. Abubakar FI, Oche OM, Kaoje AU, Garba BI, Abubakar MJ, Ahmed HK. Prevalence and associated risk factors of acute respiratory tract infections among under-five children in a tertiary hospital in Nigeria. BMC Pediatr. 2025;25(1). https://doi.org/10.1186/s12887-025-06193-4
18. Polo-Pucho DA, Gonzales-Carrillo JJ, Arce-Huamani MA. Factors Associated with Acute Respiratory Infections in Children Under Five Years Old: Analysis of the Demographic and Family Health Survey. Children. 2025;12(9):1–16. https://doi.org/10.3390/children12091242
19. Xu X, Deng Y, Han J, Wang J, Huang R, Zhao X. Analysis of risk factors contributing to neonatal pneumonia in low birth weight neonates. Front Pediatr. 2025;13(September):1–8. https://doi.org/10.3389/fped.2025.1620077
20. Karmany PAW, Rahardjo SS, Murti B. Effect of Low Birth Weight on the Risk of Pneumonia in Children Under Five: Meta-Analysis. 2020;57126. https://doi.org/10.26911/the7thicph.01.61
21. Puspamaniar VA, Setyoningrum RA, Susanti D. Low Birth Weight as Risk Factor of Pneumonia Child in Primary Health Care of Surabaya. JUXTA J Ilm Mhs Kedokt Univ Airlangga. 2019;10(2):61. https://doi.org/10.20473/juxta.V10I22019.61-63
22. Wilkes C, Bava M, Graham HR, Duke T. What are the risk factors for death among children with pneumonia in low and middle-income countries? A systematic review. J Glob Health. 2023;13. https://jogh.org/2023/jogh-13-05003/
23. To MM, Nguyen TQN, Phi DL, Khuc VL, Le NQ, Dang KL, et al. Burden of neonatal pneumonia and risk factors for severe disease in low – and middle – income country. Infez Med. 2025;33(4):435–44. http://dx.doi.org/10.53854/liim-3304-8
24. Wang, K.C.W., James, A.L., Donovan, G.M. and Noble PB. Prenatal Origins of Obstructive Airway Disease: Starting on the Wrong Trajectory? Comprehensive Physiology. Am Physiol Soc. 2024;14(5):5729–62. https://doi.org/10.1002/j.2040-4603.2024.tb00804.x
25. Ma Y, Fan S, Xi JS. Recent updates regarding the management and treatment of pneumonia in pediatric patients: a comprehensive review. Infection. 2025;53(6):2341–59. https://doi.org/10.1007/s15010-025-02605-w
26. Pike K, Pillow JJ, Lucas JS. Long term respiratory consequences of intrauterine growth restriction. Semin Fetal Neonatal Med. 2012;17(2):92–8. https://doi.org/10.1016/j.siny.2012.01.003
27. Frontera W, Spicer CM, Applegate A. Health Conditions and Impairments Associated with Low Birth Weight and Their Functional Implications - Low Birth Weight Babies and Disability. Low Birth Weight Babies and Disability. 2024. 1–246 p. https://www.ncbi.nlm.nih.gov/books/NBK605571/
28. Mwape RK, Barday M Al, Van Der Zalm MM, Verhagen LM. Overview of mucosal immunity and respiratory infections in children: A focus on Africa. Curr Opin Pediatr. 2025;37(2):137–44. https://doi:10.1097/MOP.0000000000001438
29. Has EMM, Efendi F, Wahyuni SD, Lailiah N, Mahendra RAP. Predictors of Survival in Under-Five Children with Low Birth Weight: A Population-Based Study in Indonesia. Nurs Reports. 2025;15(7):1–14. https://doi:10.3390/nursrep15070238
30. Widoyo R. Measles immunization and Vitamin A for prevention of pneumonia in Indonesia. Kesmas. 2016;11(1):46–50. https://doi:10.21109/kesmas.v11i1.841
31. Sidabutar E, Ansariad, Wahiduddin, Bustan N, Stang, Birawida AB. Analysis of risk factor for pneumonia in children less than five years in Makassar. J Educ Health Promot. 2024;13(1):1–6. https://doi:10.4103/jehp.jehp_727_23
32. Islam MZ, Chowdhury MRK, Kader M, Billah B, Islam MS, Rashid M. Determinants of low birth weight and its effect on childhood health and nutritional outcomes in Bangladesh. J Heal Popul Nutr. 2024;43(1):1–11. https://doi:10.1186/s41043-024-00565-9
33. Safiri S, Mahmoodpoor A, Kolahi AA, Nejadghaderi SA, Sullman MJM, Mansournia MA, et al. Global burden of lower respiratory infections during the last three decades. Front Public Heal. 2023;10. https://doi:10.3389/fpubh.2022.1028525
34. Sukmawati WD. The Relationship Between Low Birth Weight With Pneumonia Toddlers in West Java. J Berk Epidemiol. 2019;7(3):225. https://doi:10.20473/jbe.V7I32019.225-233
35. Lutpiatina L, Dwiyanti RD, Insana A. The Role of Biological and Environmental Factors in Infant Pneumonia : Findings from the 2023 Indonesian Health Survey. Trop Heal MedicalResearch. 2026;8(1):37–45. http://www.tropicalhealthandmedicalresearch.com/index.php/JAK/article/view/150
36. Vakalopoulos A, Dharmage SC, Dharmaratne S, Jayasinghe P, Lall O, Ambrose I, et al. Household air pollution from biomass fuel for cooking and adverse fetal growth outcomes in rural Sri Lanka. Int J Environ Res Public Health. 2021;18(4):1–11. https://doi:10.3390/ijerph18041878
37. Mortimer K, Lesosky M, Semple S, Malava J, Katundu C, Crampin A, et al. Pneumonia and Exposure to Household Air Pollution in Children Under the Age of 5 Years in Rural Malawi: Findings From the Cooking and Pneumonia Study. Chest. 2020;158(2):501–11. https:// doi:10.1016/j.chest.2020.03.064
38. Akbar H, Paundanan M, Reskiaddin LO, Studi P, Kesehatan I, Jambi U. The Relationship Between the Physical Home Environment and the Incidence of Pneumonia Among Under-Five Children in the Working Area of Plumbon Community Health Center. J Kesmas Jambi. 2021;5(2):1–8. https://doi:10.22437/jkmj.v5i2.14306
39. Kinney PL, Asante KP, Lee AG, Ae-Ngibise KA, Burkart K, Boamah-Kaali E, et al. Prenatal and Postnatal Household Air Pollution Exposures and Pneumonia Risk: Evidence From the Ghana Randomized Air Pollution and Health Study. Chest. 2021;160(5):1634–44. https://doi:10.1016/j.chest.2021.06.080
40. Mccracken JP, Mccollum ED, Steenland K, Nicolaou L, Kirby MA, Grajeda LM, et al. Exposure to Household Air Pollution From Biomass Cooking and Severe Pneumonia in Infants. JAMA Netw Open. 2025;8(10). https://doi:10.1001/jamanetworkopen.2025.38721
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