Academic journal article Journal of Health Population and Nutrition

A Population-Based Study of Hospital Admission Incidence Rate and Bacterial Aetiology of Acute Lower Respiratory Infections in Children Aged Less Than Five Years in Bangladesh

Academic journal article Journal of Health Population and Nutrition

A Population-Based Study of Hospital Admission Incidence Rate and Bacterial Aetiology of Acute Lower Respiratory Infections in Children Aged Less Than Five Years in Bangladesh

Article excerpt

The research was carried out to study the rate of population-based hospital admissions due to acute lower respiratory infections (ALRIs) and bacterial aetiology of ALRIs in children aged less than five years in Bangladesh. A cohort of children aged less than five years in a rural surveillance population in Matlab, Bangladesh, was studied for two years. Cases were children admitted to the Matlab Hospital of ICDDR,B with a diagnosis of severe ALRIs. Bacterial aetiology was determined by blood culture. Antimicrobial resistance patterns of Haemophilus in fluenzae type b (Hib) and Streptococcus pneumoniae (Spn) isolates were determined using the disc-diffusion method. In total, 18,983 children aged less than five years contributed to 24,902 child-years of observation (CYO). The incidence of ALRI-related hospital admissions was 50.2 per 1,000 CYO. The incidences of ALRI were 67% higher in males than in females and were higher in children aged less than two years than in older children. About 34% of the cases received antibiotics prior to hospitalization. Of 840 blood samples cultured, 39.4% grew a bacterial isolate; 11.3% were potential respiratory pathogens, and the rest were considered contaminants. The predominant isolates were Staphylococcus aureus (4.5%). Hib (0.4%) and Spn (0.8%) were rarely isolated; however, resistance of both these pathogens to trimethoprim-sulphamethoxazole was common. The rate of ALRI-related hospitalizations was high. The high rate of contamination, coupled with high background antibiotic use, might have contributed to an underestimation of the burden of Hib and Spn. Future studies should use more sensitive methods and more systematically look for resistance patterns of other pathogens in addition to Hib and Spn.

Key words: Acute lower respiratory infections; Child; Drug resistance, Microbial; Haemophilus influenzae; Hospitalization; Infant; Morbidity; Streptococcus pneumoniae; Bangladesh

INTRODUCTION

More than 10 million children die each year, most from preventable causes and most in poor countries (1). Acute lower respiratory infections (ALRIs) account for about 20% or more than two million of these deaths, making it the leading cause of deaths in children aged less than five years (2,3). Efficacious vaccines against Streptococcus pneumoniae (Spn) and Haemophilus influenzae type b (Hib), the two important causes of ALRI in developing countries, are available (4,5). However, these vaccines are not routinely used in most developing countries because of their high costs and lack of data documenting the burden of the disease. The World Health Organization (WHO) has developed a case-management strategy against ALRIs; this strategy has become the corner stone of national ALRI-control programmes in many countries to decrease mortality due to ALRIs. The strategy is based on diagnosis of ALRIs in children with cough or difficult breathing using easily-discernible signs (tachypnea and chest in-drawing), followed by empiric antimicrobial therapy. The successes of this approach depend on the selection of an antimicrobial agent that is effective against the pathogens most likely to cause fatal ALRIs.

In Bangladesh, about 25% of deaths of children aged less than five years and 40% of deaths in infancy are associated with ALRIs (6). A community-based cohort study in children, aged less than two years, in rural Matlab, observed an annual ALRI incidence of 30/100 child-years (7). A hospital-based study conducted in the Dhaka Hospital of ICDDR,B during 1986-1988 investigated 401 ALRI cases in children aged less than five years for respiratory pathogens. A respiratory pathogen was identified in 30% of patients. The most common pathogen isolated was respiratory syncytial virus (14.4%); Spn and Hib were isolated from 7% and 3% of the cases respectively. The case-fatality rates were 14% due to bacterial pneumonia and 3% due to viral pneumonia (8).

Data on population-based incidence of hospital admissions, aetiology, and antimicrobial resistance are generally scarce and not available from Bangladesh. …

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