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ORIGINAL CONTRIBUTION |
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| Year : 1999 | Volume
: 53
| Issue : 6 | Page : 249-253 |
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Acute respiratory infection in children a survey in the rural community
MP Tambe1, C Shivaram2, Y Chandrashekhar3
1 Department of Preventive & Social Medicine, B.J. Medical College, Pune 411 001., India
2 Department of 4Community Medicine, Sri M.S. Ramaiah Medical College. Bangalore, India
3 Department of Communiyt Medicine, Sri Siddhartna Medical College, Tumkur., India
Correspondence Address:
M P Tambe
Department of Preventive & Social Medicine, B.J. Medical College, Pune 411 001.
India
PMID: 10776505
How to cite this article:
Tambe M P, Shivaram C, Chandrashekhar Y. Acute respiratory infection in children a survey in the rural community. Indian J Med Sci 1999;53:249-53 |
Acute Respiratory Infections (ARI) are among the most important causes of death in all age groups particularly in children under 1 year of age. [1] It has been estimated that about 2.2 million deaths occur from AR-1 throughout the world. [2] According to Registrar General's published figures, ARI accounts for 13-20 percent mortality during infancy and childhood in India. [3] It is estimated that AR] accounts for 630,000 deaths annually among pre-school age group. [4] The magnitude of ARI morbidity and it's impact on health services can be measured by the proportion of outpatient attendance due to ARI. As high as 20-40% of children brought to outpatient department and 12-35% of children admitted to hospital may have ARI. [5],[6] There is a need to undertake periodic surveys in various parts of the country to determine the incidence of ARI associated morbidity and mortality in children in order Plan, organise and evaluate the health services. The Government of India in it's policy document of Health For All By 2000 A.D. recommends the ARI control programme to reduce infant and pre-school child mortality.
| ¤ Material and Methods | |  |
The study was conducted in the rural area of Ballary district, in the northern Karnataka. Total population of the study area is 2,54,055. Literacy rate is 35.9% (female literacy = 24.4%). 40 percent of the total population is below poverty line. Agriculture is the main occupation. Nearly half are living in mud houses. The typical huts have a small floor area of 50 to 79 sq. ft and in this small area 6-8 persons stay together. Most of the huts have no windows. All the 30 clusters were identified randomly by the standard 30 cluster sampling technique, recommended by the World Health Organisation (WHO). For the purpose of the study any child under the age of 5 years, who had an attack of ARI either at the time of the survey or during the previous 15 days was considered.
ARI were defined as sudden onset of signs and symptoms resulting from infection of any part of the respiratory tract including paranasal sinuses, middle ear and pleural cavity'. ARI episodes were classified into mild, moderate and revere as follows [7] : MILD: cough + respiratory rate less than 50 per minute. MODERATE : cough + respiratory rate more than 50 per minute. SEVERE: cough + respiratory rate more than 50 per minute + chest indrawing/inability to drink.
It is seen that the point prevalence of ARI was 7.6 percent among children below 5 years, (833 episodes out of 10951 children surveyed). It may be noted that a total of 965 ARI episodes were seen during the study period of 15 days. The estimated annual incidence of ARI was worked out to be 2.6 episides/child/year.
It can be seen from [Table 1] that the prevalence of ARI was highest 6 months-2 years age group. As the age advanced, th prevalence of ARI decreased.
The more common symptoms among children with ARI were cough, fever, incessant cry and refusal to feed. Ear pain/ discharge, grunting, wheeze and fits were present occassionally. [Table 2]. Out of the total 965 API episodes, majority (86.2%) were mild in nature while 12.1% episodes were moderate and only 1.7% episodes were severe in nature.
[Table 3] shows that the treatment received depended on the sex of the child which was significant statisically also.
It was observed that there was no association between the severeity of ARI episodes and the treatment received as is evident from the statistical test (in [Table 5]). Far distance of the hospital (33.3%) was the main reason for not taking treatment followed by the ignorance (28.1%), family problem (16.7%) lack of faith (12.6%) and other reasons. Absence of doctor accounted for 6.1 % of no taking the treatment.
RMPs were the main source of treatment for ARIs followed by health worker and MBBS doctors. Doctorss (MBBS) had achieved as higher cure rate as compared to o her sources of treatment. The highest case faality rate of 7.7% was observed in traditional healers.
| ¤ Discussion | | |
The prevalence of acute respiratory infections was 7.6% in underfive children. This prevalence was a little higher as compared to earlier studies in Chitradurga district [8] and Chandigarh. [9] Most of the children affected were below 2 years of age. ARI most commonly occur in the 6 months - 2 years of life. In a study in urban Delhi, [10] the incidence was 81 per 1000 months during first year of life and decreased to 68, 67, 56 and 31 per 1000 months during the subsequent four years. The lower incidence during the first six months of life is probably related to feeding mode and less exposure in the first few months of life. In rural Haryana, [11] however an opposite pictlre was seen with an attack rate of 2.2 per year during infancy, increasing to 3.9 per year during 13-24 months and 42 per year in 25-36 months of age. All the ARI episodes presented with cough. Other major symptoms were fever, ear pain/ discharge, running nose, etc. These are similar to the findings of earlier studies. [8],[9] Most of the ARI episodes were mild in nature (86.8%). The earlier workers have reported 62.5%, episodes as mild and 37.5% as moderate to severe in nature. [9] Though majority of the episodes were treated, still a substantial number (27.2%) were left untreated. The preferential treatment given to male children has been observed in the previous studies also. [12] And also the fact remains that there was no association between the severity of ARI episode and the treatment received i.e., the parents failed to recognise the signs of severe ARI. The delay in receiving medical care is considered to be an important reason for the high mortality related to ARI in the developing countries. [13] Far distance of the hospital was the main reason for not receiving treatment, followed by ignorance, family problems, etc. These reasons may force the parents to seek treatment from other alternate sources. The rural medical practitioners are often not institutionally qualified and hence are frequently not able to select and use appropriate antibiotics in adequate dosage for proper duration for the treatment of ARI, making, the outcome unfavourable in many children. [13] In the present study the outcome was batter in those episodes treated by a qualified MBBS doctor. But RMP was the main source of treatment for ARI in the community rather than the qualified MBBS doctor, which calls for involving the RMP doctors in the ARI control programme.
| ¤ Summary | | |
The prevalence of Acute Respiratory Infections was 7.6% in a total of 10951 children below 5 yrs surveyed. The annual incidence was estimated to be 2.6 episodes per child. The prevalence was highest in the 6 months - 2 yrs of age. Majority of the episodes were mild in nature (86.2%), while only 1.7% episodes were severe in nature. A substantial number of episodes (27.3%) did not receive any treatment. There was no association between the severity of ARI episodes and the treatment received. Registered medical practitioners were the main source of treatment. Far distance of the hospital was the reason for not receiving any treatment among untreated cases. The outcome was better in those episodes treated by a qualified MBBS doctor, as compared to other sources of treatment.[Table 4]
| ¤ References | | |
| 1. | Cockburn WC, Asaad F. Some observations on the communicable diseases as public health problem. Bull WHO 1973;.49:1-2.  |
| 2. | World Health Organization. Clinical management of acute respiratory infections in children. Butt WHO. 1981;59:707-716. |
| 3. | Office of the Register General of India. Mortality statistics of causes of death. No. 9, 1982, New Delhi, India. P 69. |
| 4. | Narain JP. Epidemiology of Acute Respiratory Infections. Indian J Paediatr. 1987;54:153-160. |
| 5. | Manmohan, Bhargava SK. Acute Respiratory Infections, Indian Pediatr 1984;21:1-3. |
| 6. | Report of Technical Advisory Group of ARI. WHO/TRI/ARI: 1/83, WHO, 1983; P 24. |
| 7. | DGHS. Acute Respiratory Infections in Children : Case Management - Doctors Manual. Ministry of Health & Family Welfare, Govt of India, New Delhi, 1986, P. 7. |
| 8. | Shivaram C. Acute Respiratory In-Infections in children of Chitradurga District. Dept. of PSM, Medical College, Bellary. 1990, p 22. |
| 9. | Vijaykumar. Epidemiologic methods in ;acute respiratory infections. Indian J Pediatr 1987;54: 205-211. |
| 10. | Bhargava SK, Banerjee SK, Choudhary P, Kumari S. A longitudinal study of morbidity and mortality pattern from birth to six years of age in infants of varying birth weights. Indian Pediatr 1987;24:53-60. |
| 11. | WHO Scientific Working Meeting on Acute Respiratory Infections. SEA/CD/83 New Delhi 25-28 July 1983. P 18. |
| 12. | JP Narai.n. Epidemiology of Acute Respiratory Infections. Indian J Pediatr 1987;54:153-160. |
| 13. | Kumar V, Kumar L, Mand M, Mittal M, Datta N. Child care practices in the management of acute respiratory infections. Indian Pediatr 1984:21:15-20. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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