The Butajira Rural Health Project in Ethiopia: mothers' perceptions and practices in the care of children with acute respiratory infections

In Ethiopia, a social anthropologist, a pediatrician, and a nurse project supervisor interviewed 15 mothers living in Butajira district to learn about their current perceptions and practices in the care of children with acute respiratory infections (ARIs) in order to plan effective intervention programs for the Butajira Rural Health Project. All the mothers were familiar with measles and identified fever and rash as its major symptoms. Since they tended to believe that modern medication keeps the rash from appearing, which they thought necessary for recovery, many mothers thought that a child with measles should not go to a health facility. Mothers considered lentil and a cereal soup as necessary to bring out the rash. The only white-colored food allowed during measles is breast milk. Mothers would not allow a child with measles to be taken out of his or her house. All the mothers were familiar with whooping cough and its key feature--a chronic cough. None of the mothers knew that vaccination would prevent whooping cough. An acceptable treatment for whooping cough was use of leaves of Lippia adoensis and garlic or milk of a black donkey. The mothers considered infection of the uvula and/or the tonsils to be natural since all children develop these throat infections. Treatment consists of a traditional healer cutting the uvula with a wire or scratching the tonsils with the fingers. Herbs are applied to the resultant wounds. Only two mothers knew about pneumonia. They had taken their children to a health center, where they were told that their children had it. Even after the interviewers had thoroughly explained the symptoms of pneumonia, 10 mothers did not recognize it as an illness entity. Mothers did not know about the symptoms of fast breathing or chest indrawing. Only a few mothers would take their child with these symptoms to a health center. Traditional treatments would be used (e.g., massaging the chest with butter). Regardless of ARI, most mothers would take their child to the health center only as a last resort. Any interventions developed based on these findings should at least target harmful practices (e.g., cutting the uvula with nonsterile instruments).     

Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission

Acute lower respiratory tract infections are a common cause of morbidity and mortality in children in the less developed countries. Considering the urgent need for rational protocols for the management of these infections in children and how little is known about the clinical signs that might predict the need for antibiotic therapy in a primary health care setting, a prospective study of the clinical signs in 200 paediatric outpatients presenting with a cough, 100 age-matched controls without cough, and 50 children admitted to hospital with pneumonia was carried out.     

Acute lower respiratory illness in under-five children in Rio Grande, Rio Grande do Sul State, Brazil: prevalence and risk factors

This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9% presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.     

Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents’ homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m²). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI≥20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13–3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64–3.59), allergy (OR = 1.89, 95% CI: 1.34–2.66), and Environmental Tobacco Smoke (OR = 1.54, 95% CI: 1.05–2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43–1.00) when compared with children from households where coal or gas was used for home heating.     

Child health and child care in Okelele: an indigenous area of the city of Ilorin, Nigeria

This paper provides a detailed analysis of the survival rates and health problems of a cohort of children born during a 5-yr period in part of the city of Ilorin, Nigera. The findings are linked to a demographic and environmental study which indicates that the study area was relatively stable in terms of family structure and population turnover. Most people work in the informal sector, in trading, small scale crafts and service industries. At the time the survey began, in 1979, the provision of piped water supplies to the area was unreliable and sanitation provisions rudimentary. Most of the people had little or no formal education and were very poor. The study indicated that health status had improved over the 5-yr period, compared to a baseline study conducted in 1979. Common causes of child mortality and morbidity included diarrhea, acute respiratory infections, measles, and malaria. The infant mortality rate was 41.5/1000. The availability of clinic care at nominal cost, and the attendance of mothers at the clinic for checkups and immunization, resulted in a higher level of health for their children than otherwise would have been possible. Some problems of primary health care in the area are mentioned, in the light of Nigeria's current budgetary problems, and the utilization of existing strong social support networks to improve health care and environmental sanitation and water supply is suggested.     

Management of pneumonia in India and Indonesia

Although the death rates from neonatal tetanus have been lowered and the death rates from childhood diarrhoea are becoming lower in India and Indonesia, death rates from pneumonia have not yet begun to fall. Pneumonia has become the greatest killer of children and the most important cause of preventable death. The reason for this relative rise in significance may lie in the failure to realize that the majority of the most acute cases of respiratory illness are not viral but rather bacterial infections which rapidly respond to appropriate antibiotic therapy. This paper reviews recent research on the aetiology of pneumonia; it examines age distribution and regional variation in morbidity and mortality; and it concludes by suggesting appropriate pneumonia treatment and case management guidelines. The essential priority is to make procaine penicillin available to children presenting with cough and a respiratory rate over 50 breaths per minute. This alone would substantially reduce the number of child deaths in India and Indonesia.     

Evaluating children health conditions in a small community: the study of Itapirapuã, Ribeira Valley, SP

A household survey for evaluating the mortality, morbidity, nutritional status and health services utilization of children aged under five years was carried out in a rural village in Ribeira, S?o Paulo State. Most children belonged to families of rural laborers earning less than 80 US dollars per month and living under inadequate environmental conditions. The infant mortality rate was equal to 83 per thousand and 35% of the children were affected by moderate or severe stunting, rates which are well above those for the State. The main reasons for clinic attendances and hospital admissions were acute respiratory infections and diarrhea. The median duration of breastfeeding was 14.4 months, the highest reported for Brazil. Only 40% of the mothers had received antenatal care, and 56% delivered in a hospital - of whom 35% had a caesarean section. Vaccine coverage reached 65% of children aged 12 months or more. This survey revealed an enclave of high morbidity and mortality within Brazil's richest state. It also showed that with a limited budget and within a short time it is possible to obtain valuable information for planning child survival strategies.     

辽宁省农村5岁以下儿童急性呼吸道感染监测分析

我省从1991年开始进行急性呼吸道感染监测工作。新民县和黑山县为我省的全国监测点,自1992年1月～12月在上述2个县8个抽样乡中监测9217名5岁以下儿童。监测结果表明:急性呼吸道感染的发病率为629‰;感冒咳嗽使用抗生素率大幅度降低(仅3.7％);轻度肺炎患儿全部就地使用抗生素治疗;极重症、重度肺炎在首次使用抗生素和对症处理后,全部转县或县级以上医疗单位治疗,这些医院的治疗抢救条件较好,可降低肺炎的死亡率。