Title: Observational study of comparison for outcome, clinical and radiological profile of pneumonia among malnourished and normal nourished children of 6-59 month of age
Authors: L.Gopalia, M.Shah, H. Kharadi, B.Vyas
DOI: https://dx.doi.org/10.18535/jmscr/v9i6.39
Abstract
Background: Pneumonia is a very common preventable and treatable disease in childhood. It still remains as the leading cause of under five childhood fatality representing an estimated 1.4 Million out of total 7.6 Million deaths in globe in 2010. The risk of fatal outcome is high when children with pneumonia having malnutrition as high as 15 times compared to those who did not have malnutrition.
Objective: To compare outcome, clinical and radiological profile of pneumonia among malnourished and well nourished children between 6 months to 59 months of age at G. G. Hospital Jamnagar.
Methodology: An observational study was conducted in G.G. Hospital, Jamnagar over a period of 12 months. Institutional Ethical clearance taken.After written consent taken from parents, total 100 patients taken in the age group 6 months to 59 months of pneumonia as per inclusion criteria. Anthropometric examination was carried out and patients divided into normal SAM and MAM categories as per WHO guidelines Detailed history of the illness and clinical examination, blood and radiological investigations were carried out among malnourished (as per WHO criteria) and normal nourished children. Comparison of clinical and radiological profile and outcome analysed by statistical tests.
Results: Out of 100 patients of pneumonia, 62 (62%) were malnourished and 38 (38%) patients were normal nourished. Out of total 62 malnourished children, 20 (32.2%) have very severe pneumonia while out of 38 normal nourished children , only 4 (16.6%) have very severe pneumonia. P value is 0.047 which suggest that association between severity of pneumonia and malnutrition is significant. Death rate in malnourished children with pneumonia is 10 (17.5%) and in normal children with pneumonia 4 (11.1%). Cough was found in 99% of patients, fast breathing (99%), fever (95%), inability to feed (23%). Most common sign was tachypnea (99%), respiratory distress (37%) and hypoxia(34%).X-ray finding of bronchopneumonia (32%), Lobar and Interstitial pneumonia (19%), hilar lymphadenopathy (11%), Pleural effusion (9%) and 3% were with normal X-ray. Most common age group of presentation of pneumonia is 1 to 3 years (50%). Male to female ratio is 1.5:1. 59% patients from rural area and 85% of patients from lower socio economic class. 33% of cases were fully immunized as per their age.
Conclusion: As clinical features and radiological profile of pneumonia in malnourished children remain subtle so they are prone to develop more complications leading to poor outcome in comparison with well nourish children.
References
- Liu L, Johnson H, Cousens S, Perm J, Scott S, Lawn J et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since The Lancet. 2012;379(9832):2151-2161.
- Black R, Cousens S, Johnson H, Lawn J. Global, Regional and National causes of child moratlity in 2008: a systemic analysis. Lancet. 2010;375(9730):1969-87.
- Nair H, Sim Ses E, Rudan I, Gessner B, Azziz-Baumgartner E, Zhang J et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. The Lancet. 2013;381(9875): 1380-1390.
- Chisti M, Ahmed T, Faruque A, Abdus Salam M. Clinical and Laboratory features of radiologic Pneumonia in severely malnourished infants attending an urban diarrhea treatment center in Bangladesh. The Pediatric Infectious Disease Journal. 2010;29(2): 174-177.
- Chisti M, Duke T, Robertson C, Ahmed T, Faruque A, Bardhan P, La Vincente S, Salam M. Co-morbidity: exploring the clinical overlap between pneumonia and diarrhoea in a hospital in Dhaka, Bangladesh. Annals of Tropical Paediatrics. 2011 ;31 (4):311-319.
- Chisti M, Tebruegge M, La Vincente S, Graham S, Duke T. Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Tropical Medicine & International Health. 2009;14(10): 1173-1189.
- Adegbola, S. K. Obaro R. Diagnosis of childhood pneumonia in the tropics. Annals of Tropical Medicine and Parasitology. 2000;94(3): 197-207.
- Dale H. WHO Pocket Book of Hospital Care for Children - Guidelines for the Management of Common Illnesses with Limited Resources WHO Pocket Book of Hospital Care for Children - Guidelines for the Management of Common Illnesses with Limited Resources. Nursing Standard. 2006;20(44):36-36.
- Falade A, Adegbola R, Mulholland E, Greenwood B. Respiratory rate as a predictor of positive lung aspirates in young Gambian children with lobar pneumonia. Annals of Tropical Paediatrics: International Child Health. 2001;21(4):293-297.
- Adegbola R, Falade A, Sam B, Aidoo M, Baldeh I, Hazlett D et al . The etiology of pneumonia in malnourished and well-nourished Gambian children. The Pediatric Infectious Disease Journal. 1994; 13(11):975-982.