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ORIGINAL CONTRIBUTION
Year : 1999  |  Volume : 53  |  Issue : 6  |  Page : 249-253
 

Acute respiratory infection in children a survey in the rural community


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
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PMID: 10776505

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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

How to cite this URL:
Tambe M P, Shivaram C, Chandrashekhar Y. Acute respiratory infection in children a survey in the rural community. Indian J Med Sci [serial online] 1999 [cited 2014 Oct 23];53:249-53. Available from: http://www.indianjmedsci.org/text.asp?1999/53/6/249/12226


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 Top


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 Top


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 Top


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 Top

1.Cockburn WC, Asaad F. Some observations on the communicable diseases as public health problem. Bull WHO 1973;.49:1-2.  Back to cited text no. 1    
2.World Health Organization. Clini­cal management of acute respira­tory infections in children. Butt WHO. 1981;59:707-716.  Back to cited text no. 2    
3.Office of the Register General of India. Mortality statistics of cau­ses of death. No. 9, 1982, New Delhi, India. P 69.  Back to cited text no. 3    
4.Narain JP. Epidemiology of Acute Respiratory Infections. Indian J Paediatr. 1987;54:153-160.  Back to cited text no. 4    
5.Manmohan, Bhargava SK. Acute Respiratory Infections, Indian Pediatr 1984;21:1-3.  Back to cited text no. 5    
6.Report of Technical Advisory Group of ARI. WHO/TRI/ARI: 1/83, WHO, 1983; P 24.  Back to cited text no. 6    
7.DGHS. Acute Respiratory Infec­tions in Children : Case Manage­ment - Doctors Manual. Ministry of Health & Family Welfare, Govt of India, New Delhi, 1986, P. 7.  Back to cited text no. 7    
8.Shivaram C. Acute Respiratory In-­Infections in children of Chitra­durga District. Dept. of PSM, Medi­cal College, Bellary. 1990, p 22.  Back to cited text no. 8    
9.Vijaykumar. Epidemiologic me­thods in ;acute respiratory infec­tions. Indian J Pediatr 1987;54: 205-211.  Back to cited text no. 9    
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.  Back to cited text no. 10    
11.WHO Scientific Working Meeting on Acute Respiratory Infections. SEA/CD/83 New Delhi 25-28 July 1983. P 18.  Back to cited text no. 11    
12.JP Narai.n. Epidemiology of Acute Respiratory Infections. Indian J Pediatr 1987;54:153-160.  Back to cited text no. 12    
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.  Back to cited text no. 13    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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