Mortality due to pneumonia in childhood is strongly associated with malnutrition, poverty, as well as inadequate access to health services. As a result of this, more than 98% of deaths caused by pneumonia in children occurred in 68 countries, of which progress in reducing under-five mortality was the most critical. The burden of pneumonia on families and health systems in low-resource countries exacerbates inequality; especially, children who are poor, hungry, and live in secluded areas most likely will be visited by this “forgotten killer”.1

Pneumonia still be a globally major cause of childhood mortality and morbidity. Accurate diagnosis and attribution of the cause of pneumonia are important for measuring the load of disease, implementing appropriate prevention and treatment strategies, and expand more effective interventions. Human adenovirus (HAdV) infection causes serious pneumonia in children, leading to significant morbidity and mortality rates. However, diagnostic biomarkers for HAdV-associated pneumonia are unavailable. Serum microRNAs (miRNAs/miRs) have been recently reported as diagnostic biomarkers for several diseases. The present study performed microRNA sequencing to identify potential biomarkers among serum exosomes miRNAs, with the aim of identifying candidate biomarkers for the diagnosis of pneumonia in adenovirus-infected children.2,3 Biomarkers are usually biological, chemical, or physical substances that can diagnose and examine various parts of the body such as blood and tissues. Biomarkers can show normal or pathological processes that occur in the body.4

Globally the proportion of childhood deaths that occur in the neonatal period is increasing. Since 1990 there has been a 47% reduction in deaths in children less than five years of age. Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women. Skilled care before, during, and after childbirth can save the lives of women and newborn babies. Only a small proportion of women in developing countries less than 30% receive adequate postpartum care. Culture is defined as passed down values, beliefs, attitudes, and behaviours, including knowledge, art, traditions, customs, abilities, and similar skills and habits that human beings gain as a member of society. The postpartum period lasts for approximately 6–8-weeks, starting from childbirth and ending with the restoration of the reproductive organs and other body systems to their pre-pregnancy state. In this period, significant physiological, social, and emotional changes occur in the woman. Thus, in many cultures, the postpartum period is considered as a sensitive period and various traditional practices are performed to protect the health of the mother and the baby.5,6

The WHO and Indian guidelines still recommend oral cotrimoxazole as an alternative to amoxicillin for outpatient treatment for CAP (community acquired pneumonia). All children aged 2 months to 5 years with WHO criteria for CAP were prospectively enrolled. Children on antibiotics or having received antibiotics within the previous 2 weeks.7,8

Pneumonia remains the leading cause of death in children outside the neonatal period, despite advances in prevention and management. Over the last 20 years, there has been a substantial decrease in the incidence of childhood pneumonia and pneumonia-associated mortality.4 Pneumonia is the biggest cause of deaths in young children in developing countries, but early diagnosis and intervention can effectively reduce mortality. We aimed to assess the diagnostic value of clinical signs and symptoms to identify radiological pneumonia in children younger than 5 years and to review the accuracy of WHO criteria for a diagnosis of clinical pneumonia. WHO-approved signs age-related fast breathing (six studies; pooled sensitivity 0.62, 95% CI 0.26–0.89; specificity 0.59, 0.29–0.84) and lower chest wall indrawing showed poor diagnostic performance.12

In general, biomarkers are biological, chemical, or physical substances that can be detected and measured in various parts of the body, such as blood and tissues. Biomarkers can show normal or pathological processes that occur in the body. Biomarkers can be in the form of certain cells, molecules, genes, gene products, enzymes, or hormones. Biomarkers can be used for diagnostic purposes, disease processes, disease degree, disease prognosis (cancer biomarkers), and biomarkers to monitor clinical response to intervention.13

The results of research in Cambodian villages, for traditional beliefs, some postpartum women have modern medicine during childbirth and then use traditional medicine right away. Like drinking traditional medicine consisting of plants from leaves, bark, and roots. One explanation for this is that the mother doesn’t know what to care about, so will listen more to the older person, the mother. However, in the next pregnancy, she will have more confidence, knowledge, and experience so she will move in her own way towards modern medicine even though some traditional medicines may continue to be used. They still use traditional medicine to maintain this habit.5

The results of the study in Nepal, a country where income levels are low, pregnancy, and childbirth are socio-cultural events that have different meanings in different societies and cultures. This often translates into social expectations of what certain societies expect (or should not do) during pregnancy, birth, and/or the postnatal period. The study explores beliefs around childbirth, then establishes issues such as the period in which women were seen as polluted (or even dirty) after childbirth.10

Postpartum women in addition to maintaining the health of their babies also maintain their reproductive health. The role of culture in maintaining postpartum sexual abstinence in women in Swazi. The literature shows that periods of abstinence and resumption of sexual activity are influenced by many factors and variations from existing cultures.14,15

The culture of the Timorese people in the Timor Tengah Selatan district of NTT province is that mothers are required to give birth in a roundhouse (traditional house) and receive 40 days of care by a dukun or someone who is believed to have experience in caring for the mother. Treatment for postpartum mothers is usually in the form of baking a fire. This cultural event will adversely affect the mother and the baby who will roast the body over medium heat and also affect the faster healing of wounds after childbirth.

From the references we read, it was explained that the incidence of pneumonia is very risk disease in vulnerable group of infants and toddlers, so early prevention must be carried out. Pneumonia treatment intervention by examining biomarkers to determine the cause of pneumonia. The results of the biomarker examination are a marker of the case and prevention management will be carried out using existing cultural approaches.

The authors declare no conflict of interest.