Academic journal article Journal of Health Population and Nutrition

Aetiology and Clinical Presentation of Pneumonia in Hospitalized and Outpatient Children in Northeast Brazil and Risk Factors for Severity

Academic journal article Journal of Health Population and Nutrition

Aetiology and Clinical Presentation of Pneumonia in Hospitalized and Outpatient Children in Northeast Brazil and Risk Factors for Severity

Article excerpt

INTRODUCTION

Acute lower respiratory infections (ALRIs) are the main cause of mortality among children aged less than five years in developing countries, resulting in about 1.9 million deaths every year (1). Most of these deaths occur due to pneumonia (2). ALRIs are also a major cause of morbidity among children, resulting in a large proportion of clinic attendance and hospital admissions (3). The estimated median incidence rate of ALRIs is 0.45 episode per child per year in the developing world, although there is a considerable geographic variation in its occurrence (4).

At present, appropriate case management, as part of integrated management of childhood illness (IMCI), is the cornerstone of the control of mortality due to pneumonia (5,6). Immunizations against measles, diphtheria, and pertussis and, more recently, against Haemophilus influenzae type b are also a recognized strategy for the prevention of ARI due to these causes.

Data on aetiology, clinical presentation, and prognostic indicators of severity of pneumonia are relevant for designing and evaluating pneumonia-control strategies. Data on aetiology also enable more accurate modelling of the impact of new interventions, such as vaccines. However, there are few such data in developing countries. This report describes the clinical presentation and aetiology of pneumonia among 472 children admitted to or treated as outpatients at the Barao de Lucena Hospital, Recife, Northeast Brazil. This public hospital serves children mainly from the poor areas of the city. Pneumonia is the main cause of mortality among children aged 1-4 year(s) in Recife, and the estimated incidence rate is 0.26 episode per child per year (7). In this paper, we describe the distribution of aetiologic agents, clinical presentation, and evolution of pneumonia cases. We also examined the factors associated with duration of pneumonia episode and of hospital admission.

MATERIALS AND METHODS

The study was conducted during June 1994-June 1995 as part of a randomized, double-blind, placebo-controlled trial of vitamin Ain the treatment of childhood pneumonia; its detailed design has been described previously (8). In total, 472 consecutive children, aged 6-59 months, with clinically-diagnosed pneumonia, who were either admitted to or treated as outpatients at the study hospital, were included in the study. The study excluded children with clinical diagnoses of xerophthalmia, measles, septicaemia (with clear systemic organ involvement), meningitis, other active lung diseases, such as tuberculosis and asthma attacks, renal failure, and previous admission to hospital due to the current illness. Patients with bacteraemic pneumonia were included unless they had another criterion for exclusion. Children with wheezing were included only if lung involvement was confirmed by chest X-ray.

Written consent was obtained from all participants. The ethical committees of the London School of Hygiene & Tropical Medicine and Barao de Lucena Hospital granted ethical clearance.

Diagnosis and baseline evaluation

The experienced study paediatricians diagnosed pneumonia based on history and clinical examination and by chest radiography, following the guidelines of Barao de Lucena Hospital (9). At admission, baseline data on a large number of clinical, socioeconomic and biological variables relating to the outcome of pneumonia were obtained. All children had a chest X-ray in the posterior-anterior position, which was read by an experienced study radiologist, according to the WHO guidelines (10). Blood samples of the hospitalized children were also collected for routine haematological tests.

Aetiologic diagnosis

Aetiology was investigated using a combination of procedures, which were applied on admission and before initiation of antibiotic treatment in the hospital. A positive result in any of the tests applied was considered diagnostic for that particular aetiology. …

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