Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma

Abstract

BackgroundPneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among “under-fives” with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital.MethodsWe enrolled 614 children aged 2–59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as “asthma syndrome” due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant’s case report post hoc and made a diagnosis according to the study criteria.ResultsOf the 614 children, 41.2% (95% CI: 37.3–45.2) had asthma syndrome, 27.2% (95% CI: 23.7–30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1–30.2) had viral pneumonia, while 5.1% (95% CI: 3.5–7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9–97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1–91.5) for bronchodilators and 43.1% (95% CI: 36.9–49.4) for steroids. ConclusionAlthough reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia in Uganda.

Perencanaan Pulang Efektif Meningkatkan Kemampuan Ibu Merawat Anak dengan Pneumonia Di Rumah

“…Pneumonia merupakan salah satu masalah kesehatan dan penyebab kematian anak usia di bawah lima tahun (balita) di dunia (Nantanda, Tumwine, Ndeezi, & Ostergaard, 2013). Di Indonesia, 23,8% kematian bayi disebabkan karena pneumonia dan 15,5% pada balita (Depkes RI, 2007), sehingga perlu upaya kesehatan dengan melibatkan keluarga dan masyarakat.…”

Pattern of Respiratory Diseases among Admitted Children in Pediatric Pulmonology Unit : A Tertiary Center Experiences

“…10 Prevalence of childhood asthma is substantial and asthma has often been treated as pneumonia and under-diagnosed in developing countries. 11 Bangladesh is no longer any exception of them with low prevalence. 12 Nevertheless, much of the data is extrapolated from geographical regions elsewhere with different demographics and there is paucity of epidemiological data on children admitted with respiratory complaints in the context of Bangladesh.…”

Automated methods for cough assessments and applications in screening paediatric respiratory diseases

“…This occurs because the symptoms used to screen in pneumonia (cough and rapid breathing) coexist in asthma [59,60]. A recent study in Uganda [59] showed that 95 percent of 253 children with asthma syndrome received antibiotic treatments meant for pneumonia. These results are in line with a study in [61] where 46 percent of 200 children diagnosed with pneumonia (according to WHO criteria) actually had asthma.…”

“…Currently, the diagnosis of pneumonia in resourcelimited settings relies on the guidelines developed by WHO and UNICEF, called the Integrated Management of Childhood Illness (IMCI) [55]. The implementation of IMCI revealed that asthma cases are often misdiagnosed as pneumonia [59,60]. The updated WHO guideline recommends the bronchodilator test to separate asthma from pneumonia; however, the test is costly, time consuming and rarely available in remote areas.…”

“…The implementations of IMCI guidelines are successful in sorting out pneumonia and asthma from other respiratory diseases [59][60][61]. However, the similarity of the symptoms between pneumonia and asthma makes it difficult to differentiate between these two diseases with the result that asthma patients are often over-diagnosed as having pneumonia and receive unnecessary antibiotic treatments.…”