Association between nutritional status and exclusive breastfeeding and the incidence of pneumonia in toddlers: a-case control study

Abstract

Pneumonia remains the leading infectious cause of death in children under five worldwide. Nutritional status and exclusive breastfeeding (EBF) are recognized risk factors, yet evidence on their association with childhood pneumonia in the Indonesian context remains inconsistent. This study aimed to examine the relationship between nutritional status, EBF, and the incidence of pneumonia among under-fives (aged 12–59 months). A case-control study was conducted using retrospective medical record data. Children aged 12–59 months were enrolled via purposive sampling: cases were under-fives with a confirmed diagnosis of pneumonia, and controls were non-pneumonia inpatients matched 1:1. Nutritional status was assessed using the Weight-for-Age (W/A) index per national standards, and EBF status was ascertained from medical records. Fisher's Exact Test was used for bivariate analysis. A total of 28 participants were enrolled (14 cases, 14 controls). Most children in both groups had a normal nutritional status (26 children, 92.9%) and had received EBF (26 children, 92.9%). The distribution of both exposure variables was identical across case and control groups. No statistically significant association was found between nutritional status and pneumonia (p = 0.759), nor between EBF and pneumonia (p = 0.759). These findings are likely attributable to methodological limitations, particularly the small sample size. Larger, prospective, multivariable studies are needed to more definitively characterize risk factors for childhood pneumonia in this setting.