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Mukherjee A, Jat KR, Lodha R, Goyal JP, Bhatt JI, Das RR, Ratageri V, Vyas B, Kabra SK. Feasibility of establishing acute respiratory infection treatment units (ATU) for improvement of care of children with acute respiratory infection. BMC Pediatr 2022; 22:189. [PMID: 35395777 PMCID: PMC8991474 DOI: 10.1186/s12887-022-03240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Acute respiratory infections (ARI) are the leading cause of morbidity and mortality in children below 5 years of age. Methods This multisite prospective observational study was carried out in the Pediatrics’ out-patient departments of 5 medical colleges across India with an objective to assess the feasibility of establishing Acute Respiratory Infection Treatment Unit (ATU) in urban medical college hospitals. ATU (staffed with a nurse and a medical officer) was established in the out-patient areas at study sites. Children, aged 2–59 months, with cough and/ breathing difficulty for < 14 days were screened by study nurse in the ATU for pneumonia, severe pneumonia or no pneumonia. Diagnosis was verified by study doctor. Children were managed as per the World Health Organization (WHO) guidelines. The key outcomes were successful establishment of ATUs, antibiotic usage, treatment outcomes. Results ATUs were successfully established at the 5 study sites. Of 18,159 under-five children screened, 7026 (39%) children were assessed to have ARI. Using the WHO criteria, 938 were diagnosed as pneumonia (13.4%) and of these, 347 (36.9%) had severe pneumonia. Ambulatory home-based management was done in 6341 (90%) children with ARI; of these, 16 (0.25%) required admission because of non-response or deterioration on follow-up. Case-fatality rate in severe pneumonia was 2%. Nearly 12% of children with ‘no pneumonia’ received antibiotics. Conclusions Setting up of ATUs dedicated to management of ARI in children was feasible in urban medical colleges. The observed case fatality, and rate of unnecessary use of antibiotics were lower than that reported in literature.
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Affiliation(s)
- Aparna Mukherjee
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | - K R Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Javeed Iqbal Bhatt
- Pediatrics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vinod Ratageri
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubbali, Karnataka, India
| | - Bhadresh Vyas
- Department of Pediatrics, MP Saha Medical College, Jam Nagar, Gujrat, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months. Indian Pediatr 2021. [PMID: 34837361 DOI: 10.1007/s13312-021-2367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Ralston ME, de Caen A. Teaching Pediatric Life Support in Limited-Resource Settings: Contextualized Management Guidelines. J Pediatr Intensive Care 2017; 6:39-51. [PMID: 31073424 PMCID: PMC6260263 DOI: 10.1055/s-0036-1584675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
Of the estimated 6.3 million global annual deaths in children younger than the age of 5 years, nearly all (99%) occur in low- to middle-income countries (LMIC). Existing management guidelines for children with emergency conditions as taught in a variety of current pediatric life support courses are mostly applicable to high-income countries with a different disease range and full resources compared with LMIC. A revised curriculum with evidence-based application to limited-resource settings would expand their potential for reducing pediatric mortality worldwide. This review provides a supplemental curriculum of standards for selected pediatric emergency conditions with attention to the context of disease range and level-specific resources in LMIC. During training sessions, contextualized management guidelines create the framework for realistic and fruitful case simulations.
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Affiliation(s)
- Mark E. Ralston
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Allan de Caen
- Division of Pediatric Critical Care Medicine, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
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Yadav KK, Awasthi S. The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review. Ther Adv Infect Dis 2016; 3:83-97. [PMID: 27536353 PMCID: PMC4971591 DOI: 10.1177/2049936116652326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour.
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Affiliation(s)
| | - Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
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Lanaspa M, Valim C, Acacio S, Almendinger K, Ahmad R, Wiegand R, Bassat Q. High reliability in respiratory rate assessment in children with respiratory symptomatology in a rural area in Mozambique. J Trop Pediatr 2014; 60:93-8. [PMID: 24072556 DOI: 10.1093/tropej/fmt081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early recognition of severe medical conditions is often based on clinical scores and vital sign measurements such as the respiratory rate (RR) count. We designed this study to determine the reliability of RR assessment counted three times during a full minute by independent observers in children in a developing country setting. A total of 55 participants were enrolled in the study. Participant ages ranged from 10 days to 7 years (median 22 months). Agreement for RR count was high (intraclass correlation coefficient of 0.95; 95% confidence interval: 0.93-0.97). Agreement for presence of tachypnea was also high (Kappa coefficient of 0.83, p < 0.001). However, a single reading would have misclassified 5-11% of the participants as non-tachypneic. Repeated RR counts offer reliable results if done during a full minute. Patients not fulfilling tachypnea criterion but with a high RR count should have the measurement repeated.
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Affiliation(s)
- Miguel Lanaspa
- Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Ralston ME, Day LT, Slusher TM, Musa NL, Doss HS. Global paediatric advanced life support: improving child survival in limited-resource settings. Lancet 2013; 381:256-65. [PMID: 23332963 DOI: 10.1016/s0140-6736(12)61191-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nearly all global mortality in children younger than 5 years (99%) occurs in developing countries. The leading causes of mortality in children younger than 5 years worldwide, pneumonia and diarrhoeal illness, account for 1·396 and 0·801 million annual deaths, respectively. Although important advances in prevention are being made, advanced life support management in children in developing countries is often incomplete because of limited resources. Existing advanced life support management guidelines for children in limited-resource settings are mainly empirical, rather than evidence-based, written for the hospital setting, not standardised with a systematic approach to patient assessment and categorisation of illness, and taught in current paediatric advanced life support training courses from the perspective of full-resource settings. In this Review, we focus on extension of higher quality emergency and critical care services to children in developing countries. When integrated into existing primary care programmes, simple inexpensive advanced life support management can improve child survival worldwide.
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Affiliation(s)
- Mark E Ralston
- Department of Pediatrics, Naval Hospital, Oak Harbor, WA 98278, USA
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Fontoura MSH, Matutino AR, Silva CC, Santana MC, Nobre-Bastos M, Oliveira F, Barreto BB, Araujo-Neto CA, Andrade SC, Brim RV, Cardoso MRA, Nascimento-Carvalho CM. Differences in evolution of children with non-severe acute lower respiratory tract infection with and without radiographically diagnosed pneumonia. Indian Pediatr 2011; 49:363-9. [PMID: 22080618 DOI: 10.1007/s13312-012-0085-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 08/02/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify differences in the evolution of children with non-severe acute lower respiratory tract infection between those with and without radiographically diagnosed pneumonia. DESIGN Prospective cohort study. SETTING A public university pediatric hospital in Salvador, Northeast Brazil. PATIENTS Children aged 2-59 months. METHODS By active surveillance, the pneumonia cases were prospectively identified in a 2-year period. Each case was followed-up for changes in various clinical symptoms and signs. Demographic, clinical and radiographic data were recorded in standardized forms. Exclusion was due to antibiotic use in the previous 48 hours, signs of severe disease, refusal to give informed consent, underlying chronic illness, hospitalization in the previous 7 days or amoxicillin allergy. Chest X-ray (CXR) was later read by at least 2 independent pediatric radiologists. MAIN OUTCOME MEASURES Radiographic diagnosed pneumonia based on agreed detection of pulmonary infiltrate or pleural effusion in 2 assessments. RESULTS A total of 382 patients receiving amoxicillin were studied, of whom, 372 (97.4%) had concordant radiographic diagnosis which was pneumonia (52%), normal CXR (41%) and others (7%). By multivariate analysis, age (OR=1.03; 95% CI: 1.02-1.05), disease > 5 days (OR = 1.04; 95% CI: 1.001-1.08), reduced pulmonary expansion (OR = 3.3; 95% CI: 1.4-8.0), absence of wheezing (OR = 0.5; 95% CI: 0.3-0.9), crackles on admission (OR = 2.0; 95% CI: 1.2-3.5), inability to drink on day 1 (OR = 4.2; 95% CI: 1.05-17.3), consolidation percussion sign (OR = 7.0; 95% CI: 1.5-32.3), tachypnea (OR = 2.0; 95% CI: 1.09-3.6) and fever (OR = 3.6; 95% CI: 1.4-9.4) on day 2 were independently associated with pneumonia. The highest positive predictive value was at the 2nd day of evolution for tachypnea (71.0%) and fever (81.1%). CONCLUSION Persistence of fever or tachypnea up to the second day of amoxicillin treatment is predictive of radiographically diagnosed pneumonia among children with non-severe lower respiratory tract diseases.
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Affiliation(s)
- M-S H Fontoura
- Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil
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Abstract
Childhood pneumonias are an important cause of morbidity and mortality and annually contribute to over 2 million deaths among children under five years of age. To combat this, a standardized case management protocol developed by the World Health Organization has been adopted by the National programs in most high burden, resource constrained settings. This can detect patients with pneumonia early on and with ease at community level and also identify those who are at risk of dying due to a severe form of the disease if not referred or appropriately treated. However, as most deaths due to pneumonia occur in health facilities, it is equally important to standardise treatment at a facility level with pulse oximetry, regular monitoring for complications and the judicious use of antibiotics. The challenge is to identify other respiratory illnesses which mimic pneumonia resulting in under treatment with bronchodilators and over usage of antibiotics. This becomes particularly important in developing countries which have the dual burden of both the infectious and non-infectious illnesses. The strategy also needs refinement for diagnosing and treating pneumonia in severely under nourished and / or HIV co-infected children who are both at higher risk of disease as well as death due to it.
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Affiliation(s)
- Varinder Singh
- Department of Paediatrics, Lady Hardinge Medical College and assoc Kalawati Saran Children's Hospital, Bangla Sahib Marg, N Delhi 110001, India.
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Chisti MJ, Tebruegge M, La Vincente S, Graham SM, Duke T. Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health 2009; 14:1173-89. [PMID: 19772545 DOI: 10.1111/j.1365-3156.2009.02364.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To quantify the degree by which moderate and severe degrees of malnutrition increase the mortality risk in pneumonia, to identify potential differences in the aetiology of pneumonia between children with and without severe malnutrition, and to evaluate the validity of WHO-recommended clinical signs (age-specific fast breathing and chest wall indrawing) for the diagnosis of pneumonia in severely malnourished children. METHODS Systematic search of the existing literature using a variety of databases (Medline, EMBASE, the Web of Science, Scopus and CINAHL). RESULTS Mortality risk: Sixteen relevant studies were identified, which universally showed that children with pneumonia and moderate or severe malnutrition are at higher risk of death. For severe malnutrition, reported relative risks ranged from 2.9 to 121.2; odds ratios ranged from 2.5 to 15.1. For moderate malnutrition, relative risks ranged from 1.2 to 36.5. Aetiology: Eleven studies evaluated the aetiology of pneumonia in severely malnourished children. Commonly isolated bacterial pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The spectrum and frequency of organisms differed from those reported in children without severe malnutrition. There are very few data on the role of respiratory viruses and tuberculosis. Clinical signs: Four studies investigating the validity of clinical signs showed that WHO-recommended clinical signs were less sensitive as predictors of radiographic pneumonia in severely malnourished children. CONCLUSIONS Pneumonia and malnutrition are two of the biggest killers in childhood. Guidelines for the care of children with pneumonia and malnutrition need to take into account this strong and often lethal association if they are to contribute to the UN Millennium Development Goal 4, aiming for substantial reductions in childhood mortality. Additional data regarding the optimal diagnostic approach to and management of pneumonia and malnutrition are required from regions where death from these two diseases is common.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Clinical Science Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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10
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Acute Lower Respiratory Infections. NUTRITION AND HEALTH IN DEVELOPING COUNTRIES 2008. [PMCID: PMC7122747 DOI: 10.1007/978-1-59745-464-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality in children worldwide. Appropriate management depends on accurate assessment of disease severity, and for the majority of children in developing countries the assessment is based on clinical signs alone. This article reviews recent evidence on clinical assessment and severity classification of pneumonia and reported results on the effectiveness of currently recommended treatments. METHODS Potential studies for inclusion were identified by Medline (1990-2006) search. The Oxford Center for Evidence Based Medicine criteria were used to describe the methodologic quality of selected studies. RESULTS In the included studies the sensitivity of current definitions of tachypnea for diagnosing radiologic pneumonia ranged from 72% to 94% with specificities between 38% and 99%; chest indrawing had reported sensitivities of between 46% and 78%. Data provide some support for the value of current clinical criteria for classifying pneumonia severity, with those meeting severe or very severe criteria being at considerably increased risk of death, hypoxemia or bacteremia. Results of randomized controlled trials report clinically defined improvement at 48 hours in at least 80% of children treated using recommended antibiotics. However, a limitation of these data may include inappropriate definitions of treatment failure. CONCLUSION Particularly with regard to severe pneumonia, issues that specifically need to be addressed are the adequacy of penicillin monotherapy, or oral amoxicillin or alternative antibiotics; the timing of introduction of high-dose trimethoprim-sulfamethoxazole in children at risk for or known to be infected by HIV and the value of pulse oximetry.
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Affiliation(s)
- Philip Ayieko
- Kenya Medical Research Institute/Wellcome Trust Collaboration, Nairobi, Kenya.
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Van den Bruel A, Bruyninckx R, Vermeire E, Aerssens P, Aertgeerts B, Buntinx F. Signs and symptoms in children with a serious infection: a qualitative study. BMC FAMILY PRACTICE 2005; 6:36. [PMID: 16124874 PMCID: PMC1215482 DOI: 10.1186/1471-2296-6-36] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 08/26/2005] [Indexed: 11/17/2022]
Abstract
Background Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables. Methods Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital. Results 18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact. The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent. Conclusion behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study.
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Affiliation(s)
- Ann Van den Bruel
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium
| | - Rudi Bruyninckx
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium
| | - Etienne Vermeire
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium
- Department of General Practice, Universtaire Instelling Antwerpen, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Peter Aerssens
- Department of Pediatrics, Virga Jesseziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Bert Aertgeerts
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium
| | - Frank Buntinx
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium
- Department of General Practice, Universiteit Maastricht, Postbus 616, 6200 MD Maastricht, The Netherlands
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Kahigwa E, Schellenberg D, Schellenberg JA, Aponte JJ, Alonso PL, Menendez C. Inter-observer variation in the assessment of clinical signs in sick Tanzanian children. Trans R Soc Trop Med Hyg 2002; 96:162-6. [PMID: 12055806 DOI: 10.1016/s0035-9203(02)90290-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We assessed the inter-observer agreement in identification of a range of 24 clinical signs associated with disease presentation in 327 children aged < 5 years admitted to hospital in January-June 1999 in Ifakara, southern Tanzania. Children with diagnoses of malaria, pneumonia, diarrhoea, anaemia and malnutrition were examined independently by 2 clinical officers. Findings were recorded on a standard proforma. The Kappa-statistic was used to assess inter-observer agreement for each sign. Physical signs were more likely to be agreed upon by clinicians if they involved inspection than if they involved auscultation. The signs included in the Integrated Management of Childhood Illness (IMCI) algorithm were found to be largely appropriate (Kappa-scores > 0.41) although there was only fair agreement (Kappa-score 0.21-0.40) in the detection of neck stiffness and chest indrawing and slight agreement in the detection of dehydration (Kappa-score 0.199). All objective neurological signs were less reliably assessed in infants than in older children. The difficulties surrounding the diagnosis of impaired consciousness in young children should increase vigilance in the diagnosis and management of neurological complications of illnesses in infancy.
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Affiliation(s)
- E Kahigwa
- Ifakara Health Research and Development Centre, P.O. Box 53, Ifakara, Tanzania
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Palafox M, Guiscafré H, Reyes H, Munoz O, Martínez H. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child 2000; 82:41-5. [PMID: 10630911 PMCID: PMC1718193 DOI: 10.1136/adc.82.1.41] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate whether sensitivity and specificity of tachypnoea for the diagnosis of pneumonia change with age, nutritional status, or duration of disease. METHODS Diagnostic testing of 110 children with acute respiratory infection, 51 of whom presented with tachypnoea. The gold standard was a chest roentgenogram. Thirty five children had a radiological image of pneumonia; 75 were diagnosed as not having pneumonia. Sensitivity, specificity, and percentage of correct classification of tachypnoea, by itself or in combination with other clinical signs for all children, by age groups, nutritional status, and disease duration were calculated. RESULTS Tachypnoea as the sole clinical sign showed the highest sensitivity (74%) and a specificity of 67%; 69% of cases were classified correctly. Sensitivity was reduced when other clinical signs were combined with tachypnoea, and there was no significant increase in correct classification, although specificity increased to 84%. In children with a disease duration of less than three days, tachypnoea had a lower sensitivity and specificity (55% and 64%, respectively), and a lower percentage of correct classification (62%). In children with low weight for age (< 1 Z-score), tachypnoea had a sensitivity of 83%, a specificity of 48%, and 60% correct classification. Sensitivity and specificity did not vary with age groups. CONCLUSIONS Tachypnoea used as the only clinical sign is useful for identifying pneumonia in children, with no significant variations for age. In children with low weight for age, tachypnoea had higher sensitivity, but lower specificity. However, during the first three days of disease, the sensitivity, specificity, and percentage of correct classification were significantly lower.
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Affiliation(s)
- M Palafox
- Research Unit on Epidemiology and Health Services, Mexican Social Security Institute, Centro Médico Nacional Siglo XXI, Unidad de Congresos, Bloque B, 4o. Piso, Avenida Cuauhtémoc 330, Col. Doctores, Mexico 06725 DF
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Rajesh VT, Singhi S, Kataria S. Tachypnoea is a good predictor of hypoxia in acutely ill infants under 2 months. Arch Dis Child 2000; 82:46-9. [PMID: 10630912 PMCID: PMC1718185 DOI: 10.1136/adc.82.1.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the respiratory rate as an indicator of hypoxia in infants < 2 months of age. SETTING Pediatric emergency unit of an urban teaching hospital. SUBJECTS 200 infants < 2 months, with symptom(s) of any acute illness. METHODS Respiratory rate (by observation method), and oxygen saturation (SaO(2)) by means of a pulse oximeter were recorded at admission. Infants were categorised by presence or absence of hypoxia (SaO(2) </= 90%). RESULTS The respiratory rate was >/= 50/min in 120 (60%), >/= 60/min in 101 (50. 5%), and >/= 70/min in 58 (29%) infants. Hypoxia (SaO(2) </= 90%) was seen in 77 (38.5%) infants. Respiratory rate and SaO(2) showed a significant negative correlation (r = -0.39). Respiratory rate >/= 60/min predicted hypoxia with 80% sensitivity and 68% specificity. CONCLUSION These results indicates that a respiratory rate > 60/min is a good predictor of hypoxia in infants under 2 months of age brought to the emergency service of an urban hospital for any symptom(s) of acute illness.
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Affiliation(s)
- V T Rajesh
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Escorihuela Esteban R, Fernández Merchán J, Millán Jiménez A, Carrión Mera T, del Río Camacho G, Gadea Gironés I. Uso de antibióticos en niños hospitalizados por infección respiratoria aguda. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)77309-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Miranda-Novales G, Solorzano-Santos F, Leãnos-Miranda B, Vazquez-Rosales G, Palafox-Torres M, Guiscafre-Gallardo H. Blood culture and respiratory syncytial virus identification in acute lower respiratory tract infection. Indian J Pediatr 1999; 66:831-6. [PMID: 10798147 DOI: 10.1007/bf02723847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Even though the incidence of pneumonia in developed and developing countries is similar, the mortality is five times higher in developing countries. This study aimed to determine the prevalence of bacteremia in children with acute lower respiratory tract infection (LRTI) and relative contribution of respiratory syncytial virus (RSV). One hundred and one children under five years of age who attended a primary care level clinic with diagnosis of acute LRTI, were enrolled. Diagnosis and management of pneumonia were done according to the WHO guidelines. Two blood cultures were drawn at the time of admission. A nasopharyngeal sample was taken for detection of RSV by indirect immunofluorescence. Blood cultures were positive for pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus) in three patients. The detection for RSV was positive in 24 patients (23.7%). The clinical and radiographic presentations were not significantly different between patients with and without RSV (p > 0.05). RSV is a common cause of LRTI in children younger than five years old. Blood cultures are not commonly positive in outpatients with acute LRTI. The practice of obtaining blood cultures in primary and secondary care clinics is not useful to guide the treatment of patients with community-acquired pneumonia.
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Smyth A, Carty H, Hart CA. Clinical predictors of hypoxaemia in children with pneumonia. ANNALS OF TROPICAL PAEDIATRICS 1998; 18:31-40. [PMID: 9691999 DOI: 10.1080/02724936.1998.11747923] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A prospective study to determine which clinical factors identified children with acute lower respiratory infection who were hypoxaemic and at risk of death was done over a 9-month period on children under 5 years of age admitted to a district hospital in rural Zambia. Of 158 children studied, 55 (35%) were found to be hypoxaemic and 23 (14.6%) died. For the subgroup of children under 1 year of age, a respiratory rate of > 70 was the only significant predictor of hypoxaemia (p < 0.001, sensitivity 63%, specificity 89%). In older children, only the presence of crepitations/bronchial breathing was predictive (p = 0.018, sensitivity 75%, specificity 57%). The likelihood of death was increased in those children with low oxygen saturation (p = 0.021) and poor nutrition (p = 0.007). It is concluded that, on the basis of raised respiratory rate, the WHO guidelines are likely to identify children under 1 year of age who are hypoxaemic. However, it may be necessary to include auscultatory findings in the guidelines to recognize hypoxaemia in older children in order to ensure that they receive appropriate treatment with oxygen. This study demonstrates that hypoxaemia and malnutrition are risk factors for death.
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Affiliation(s)
- A Smyth
- St Francis Hospital, Katete, Zambia
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Muhe L. Mothers' perceptions of signs and symptoms of acute respiratory infections in their children and their assessment of severity in an urban community of Ethiopia. ANNALS OF TROPICAL PAEDIATRICS 1996; 16:129-35. [PMID: 8790676 DOI: 10.1080/02724936.1996.11747815] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Standard case management strategy has been recommended to reduce the high mortality rate in children with acute respiratory infections (ARI). Appropriate case management has been shown to prevent such deaths, but only if families recognize signs of possible pneumonia and seek care promptly from a trained health worker. The purpose of the present study was to assess mothers' perception and interpretation of ARI signs and symptoms in relation to that of a physician in an urban community in Addis Ababa. Two hundred and twenty-two mothers who brought their children to hospital with cough or difficulty in breathing and an equal number of control mothers were studied. Most mothers did not recognize these signs, including the key signs of pneumonia-rapid breathing and chest indrawing. While it was shown that between two physicians there was good agreement on kappa values above 70% for most ARI signs, there was little agreement between physicians and mothers or between mothers whose children came for ARI problems and mothers of hospital controls. The few mothers who recognized these signs did not interpret them as serious. The study concludes by recommending intensive health education and further ethnographic studies on community beliefs about ARI in children, with particular emphasis on documentation of the terms, signs and symptoms by which families recognize the illness.
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Affiliation(s)
- L Muhe
- Department of Paediatrics and Child Health, Ethio-Swedish Children's Hospital, Addis Ababa, Ethiopia
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