Acute lower respiratory tract infection in hospitalized children in Zimbabwe

Abstract

A descriptive study was undertaken to document clinical and socio-demographic features and also to identify risk factors for mortality in children hospitalized with acute lower respiratory tract infection (ALRI). A total of 704 children aged from 1 month to 5 years admitted to Harare Central Hospital were studied. The peak age group was between 1 and 6 months. Seventy per cent of the children were found to have normal nutrition and 12% severe malnutrition. Seventy-eight per cent had severe and the remainder moderate ALRI (WHO classification). Clinical HIV infection was diagnosed in 219 (31%) children. One hundred and four children died, an overall case fatality rate (CFR) of 15%. In the clinically HIV-infected children, a CFR of 28% occurred, which constituted 60% of the overall ALRI mortality. A much lower CFR of 9% was found in the clinically non-HIV-infected children. Malnutrition, severe ALRI, age of 1 to 6 months, concurrent diarrhoea, duration of cough > or = 14 days and previous history of admission for ALRI were significant risk factors for mortality in ALRI. Low birthweight was not found to be a risk factor in this study. The impact of HIV infection on mortality in children with ALRI is of major concern in Zimbabwe and should be an important component of the national ALRI programme.

Childhood asthma in low income countries: an invisible killer?

“…Acute respiratory infection treatment failures were predominantly seen in cases with cough of >14 days before admission or prior admissions for acute respiratory infection 10 or cases with very fast breathing, hypoxia, but without fever, 11,54 which are typical features of severe asthma rather than bacterial pneumonia which is characterised by fever >38.5°C. 30,31 Secondly, mortality data from low-income countries showed that RSV is an important cause of respiratory death in childhood.…”

“…51 Moreover, several comparative studies showed equivalent treatment results between different types, doses, and administration forms of antibiotics in children with IMCI-defined pneumonia. [52][53][54] Treatment failures of serious pneumonia were primarily related to infants (3-11 months) with very fast breathing, chest indrawings and hypoxia 10,11,53 and long-term cough, 10 but were not associated with fever, 10,11,54 raising questions concerning the diagnosis of bacterial pneumonia according to BTS guidelines.…”

“…79 Malnutrition and acute respiratory infection/pneumonia are interrelated health problems affecting children in developing countries, 80,81 and malnutrition is often an underlying cause of recurrent and fatal pneumonia. 10,11 Underlying asthma causing malnutrition may therefore contribute to fatal pneumonia/ respiratory infection.…”

“…[1][2][3][4][5][6] ARI and pneumonia are often used synonymously although ARI is an umbrella term for several respiratory diseases. 8,9 The case fatality rate from pneumonia in hospitalised under-5s remains at 11-15%, 4,7,[10][11][12] but it can be as high as 30%. 13 Mortality in under-5s is particularly high in Sub-Saharan Africa.…”

Serum IgG subclasses levels in paediatric patients with pneumonia

“…It is now established that IgG2 type antibodies are the most effective against encapsulated bacteria such as Streptococcus pneumoniae, particularly in young children.s It would appear that children with low IgG2 levels would have correspondingly low levels of IgG2-type antibodies Bacterial pneumonia is the commonest cause of morbidity and mortality in Zimbabwe. 1 The children most at risk are those infected with HIV. [2][3][4] We reported, in a recent study2 that the great majority of children admitted to hospital with pneum onia have hypergam m aglobulinaem ia in immunoglobulins A (IgA), G (IgG) and M (IgM).…”