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    • Acute Respiratory Infection among Children aged 2 Month to 5 Years: Do Children with Initially “No Pneumonia” Progress to Pneumonia?

    		  

    Shahzad Munir
    Assistant Professor of Paediatrics
    The Children Hospital, PIMS, Islamabad

    Objective: To document the percentage of children ( aged 2 months to 5 years)  with initial diagnosis of “No pneumonia” progressing  to pneumonia and determine any risk factors involved.
    Study Design: Case series study.Place and Duration: Outpatients Department, Children hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad from November 2008 to March 2009.
    Materials and Methods: A total of 840 patients (aged 2 months up to 5 years) with acute respiratory tract infections were include in the study by convenience sampling technique. The patients were grouped as group I with age range of 2 months to < 12 months and Group II with age range of 12 months to 59 months. Date were collected using a structured proforma. Data entry and analysis were performed using EPI INFO ver. 6.04 software.
    Results:Total number of children enrolled in this study was 840, with an IMCI case definition diagnosis of “No pneumonia”. The age range was 2 months to 59 months with a mean of 13.783 (±12.06) months. There were 497 (59.16%) patients in group I and 343 (40.83%) in group II.  539 (64.2%) were male and 301 (35.8%) were female. Their duration of illness ranged from one day to 20 days with a mean of 4.5 (±3.10) days.  On follow-up after 2 days 112 (13.33%) patients were found to have developed Pneumonia. Age less than 12 months, clinically severe malnutrition and lack of breastfeeding were found to be risk factors for development of pneumonia.
    Conclusion:A significant proportion of children diagnosed with “No pneumonia” progress to develop pneumonia.  Age < 12 months, clinically severe malnutrition and lack of breast feeding are important risk factors for the development of pneumonia in these children.
    Key words: No pneumonia. WHO ARI guidelines,     Integrated Management of Childhood Illness. 

    Introduction

    Acute infections of the lower respiratory tract are an important cause of morbidity and mortality in developing countries. These are responsible for the death of more than two million children under the age of 5 years annually.1 World health organization (WHO) developed a case management strategy in the 1980s aiming to reduce pneumonia related deaths. This was a cornerstone of the acute respiratory infection (ARI) program and was later incorporated into the integrated management of childhood illness (IMCI) guidelines, which include primary care and hospital based case management.2 Respiratory tract infections are the most common reason for patients to consult in primary care with children consulting more than any other age group.3

    One in five children who consult for a respiratory tract infection returns during the same illness episode and many of these visits are unnecessary.4 Unnecessary re-consulting can increase the pressure on clinicians to prescribe antibiotics. Guidelines of the National institute for health and clinical excellence (NICE) recommend against the immediate use of antibiotics for most children who have respiratory tract infections, and promote efficient communication and information provision including an indication of the likely duration of illness.5  Prescribing for non-specific upper respiratory tract infections, which declined in the late 1990’s, is once again increasing.6 Unnecessary antibiotics use wastes the healthcare resources, encourages further consulting in the future for similar illnesses,7 contributes to the problem of antibiotic resistance and unnecessarily exposes patients to risk of adverse effects.8

    The present study was undertaken to establish which proportion of our children with an initial diagnosis of “No pneumonia” later progress to pneumonia during the same illness.

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