Pneumonia_in_developing_countries

Pneumonia_in_developing_countries - Pneumonia in Developing...

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Unformatted text preview: Pneumonia in Developing Countries: Still Unresolved Problem Dr. Pushpa Raj Sharma Professor, Department of Child Health Institute of Medicine Kathmandu, Nepal This Presentation Epidemiology Risk factors Aetiological agents Clinical syndromes Investigations Treatment Future implications 4 months old One day history of excessive crying Sent home with the diagnosis of windy colic with anti- spasmodics Next day: Grunting, respiratory distress, fever. Admitted, IV ceftriaxone. A case: Case (contd) Second day: Mother felt child is better but continues to be tachypnoeic, chest indrawing, fever persisting. Vancomycin added with oxygen Case (contd) Third day Severe respiratory distress Pus drained through water seal drainage Antibiotics contd. Discharged after 2 wk. Strepto.pneumoniae isolated Total live births and surviving infants in South East Asia 200000 400000 600000 800000 1000000 1200000 1400000 1600000 1800000 1980 1990 2000 2001 2002 2003 2004 Live births Surviving infants Total populaliton Measles cases Worlds population prospects. 2004 Revision. New York, United Nations, 2005 Leading infectious causes of mortality, 2000 estimates Source WHO 0.5 1 1.5 2 2.5 3 3.5 4 Pneumonia AIDS Diarrhoea TB Malaria Measles > 5 years old < 5 years old Burden of Pneumonia Population of approximately 667 million Approximately 170 million infants and children, (about one-third of all the children in developing countries). South Asia 60240 135600 576480 82320 18240 ,1000 Unicef ( www.childinfo.org ) and Hyder et al ; Extrapolated from Black et al DISTRIBUTION OF DISEASE 16% 2.4% 6.1% 6.1% 3.7% 1.2% 7.4% 56.8% RESPIRATORY - 32 CNS - 9 CVS - 1 DIGESTIVE -5 HEMATOLOGY - 2 NEPHROLOGY - 3 RHEUMATOLOGY -2 MISCELLAN - 8 MONTH OF Feb. 2006 Hospital Admissions Then and Now 0% 10% 20% 30% 40% 50% 60% 1982 2006 Admission of ARI cases NEPAS J 1988; 7; 1-8 Age distribution of pneumonia in hospital 10 20 30 40 50 60 70 80 1 -12 m onths 1 - 5 years 5 - 10 years > 10 years Percentag Burden of Disease ARI episodes/child/year in U5: 5-9 Pneumonia in ARI: 1:30-50 (2-3% of all ARI). Most of these pneumonia are bacterial in developing countries. Deaths in ARI are mostly due to pneumonia Duration of illness who died from pneumonia: 3.5 days (Jumla Nepal) 0% 5% 10% 15% 20% 25% 30% Bangladesh Vietnam Benin Tanzania Poorest 20% Richest 20% Acute respiratory infection prevalence in under 5 children by socioeconomic status in selected countries Based on World Bank data 2000. Risk Factors In a multivariate analysis, the variables found to be most closely associated with mortality were breastfeeding, education of the father, the number of under-fives, family income and birth weight . Having a low weight-for-age was also strongly associated with mortality but the retrospective nature of the study makes this finding difficult to interpret....
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Pneumonia_in_developing_countries - Pneumonia in Developing...

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