The impact of HIV infection and trimethoprim-sulphamethoxazole prophylaxis on bacterial isolates from children with community-acquired pneumonia in South Africa

The aim of this study was to compare the type and antimicrobial resistance patterns of bacteria cultured from blood or respiratory tract secretions by HIV status and the use of trimethoprim-sulphamethoxazole (TMP-SMX) prophylaxis in children hospitalized with community-acquired pneumonia. During a 1-year prospective study in Cape Town, South Africa, 250 children [median aged 6 (3-16) months] hospitalized with pneumonia were enrolled; 151 (60.4 per cent) were HIV-infected. The incidence of bacteremia [35 of 244 cultures (14.3 per cent)] did not differ by HIV status. Bacteria were cultured in 17 of 32 (53 per cent) bronchoalveolar lavage specimens (BAL), 128 of 210 (61 per cent) induced sputa and 166 of 231 (71 per cent) nasopharyngeal specimens (NPAs). The type and number of bacteria in respiratory secretions did not differ by HIV status, except for a higher rate of Staphylococcus aureus in sputum or BAL [22 of 146 (15 per cent) vs. 3 of 96 (3 per cent), p = 0.003] and NPAs [41 of 135 (30 per cent) vs. 9 of 96 (9 per cent), p < 0.001] of HIV-positive children. The use of TMP-SMX prophylaxis in HIV-infected children was associated with an increased nasopharyngeal carriage of S. aureus [22 of 51 (43 per cent) vs. 17 of 79 (22 per cent), p = 0.009]. The rising prevalence of HIV infection and the use of TMP-SMX prophylaxis may alter the spectrum of colonizing and pathogenic bacteria in children in developing countries.     

Paediatric HIV infection in a rural South African district hospital

The objective of this study was to determine the prevalence, clinical spectrum, and outcome of paediatric HIV infection in 281 consecutive children admitted to hospital in rural South Africa between October 1996 and January 1997. HIV infection was defined as two positive ELISAs in those aged > 12 months; a positive ELISA plus a positive IgG3 in those aged 6-12 months; and a positive ELISA plus positive p24 antigen or PCR in those aged 0-5 months. In all, 72 (26 per cent) children were HIV infected. Age-specific HIV prevalence was at least 25 per cent in all 1-5 year age groups. HIV-infected children were more likely to have been previously admitted (46 per cent vs. 23 per cent; p = 0.0002), and were more likely to have severe malnutrition (52 per cent vs. 17 per cent; p < 0.0001). Both HIV-infected and HIV-uninfected most frequently presented with diarrhoeal disease (51 per cent vs. 32 per cent), acute respiratory infection (13 per cent vs. 23 per cent), and malnutrition (18 per cent vs. 11 per cent). Satisfactory response to antibiotic therapy was less likely among the HIV-infected (56 per cent vs. 73 per cent; p = 0.02), and mortality was higher among the HIV-infected (21 per cent vs. 7 per cent; p = 0.005). It is concluded that HIV-infected children present with disease syndromes common to this setting, but do so more frequently and with worse outcome than their uninfected counterparts. The high burden of paediatric HIV disease in this setting poses a substantial challenge for health resources.     

Bacterial aetiology and anti-microbial resistance of childhood diarrhoea in Yemen.

In a 12-month period, 561 stool cultures from Yemeni children aged 1-60 months and presenting with diarrhoea, were analysed to identify the bacterial aetiology and their anti-microbial resistance to the commonly used antibiotics. A total of 190 (33.9 per cent) were positive for bacterial culture. Most of the positive cultures (58 per cent) were from children aged 1-12 months. The majority of the positive cultures were enteropathogenic Escherichia coli (58.4 per cent) Salmonella spp., and Shigella spp. (20 per cent each). Campylobacter were found to be an extremely uncommon agent of childhood diarrhoea making only 1.6 per cent of the positive cultures. The majority of the Salmonella were group C (60.5 per cent) and group B (29 per cent). Of the Shigella isolates, 13 (34 per cent) were S. flexneri, and seven (18 per cent) S. dysentrea. More than two-thirds of the Salmonella isolates were resistant to nalidixic acid, chloramphenicol, co-trimoxazole, gentamicin, and amoxycillin, while 42 per cent were resistant to cefotaxime. Most of the Shigella isolates were susceptible to nalidixic acid and cefotaxime, and resistant to the other antibiotics. All the tested enteropathogenic E. coli isolates were resistant to amoxycillin, 83 per cent were resistant to co-trimoxazole, 62 per cent to chloramphenicol, and 54 per cent to gentamicin, while only 16 and 6 per cent were resistant to nalidixic acid and cefotaxime, respectively. This study, the first in Yemen, draws attention to the urgent need of a national surveillance system, essential for the containment of anti-microbial resistance.     

Clinical characteristics of respiratory syncytial virus infection in hospitalized healthy infants and young children in Qatar

To evaluate seasonal trends, clinical profile, and outcome of disease in previously healthy infants and young children hospitalized for respiratory syncytial virus (RSV) infection at Hamad Medical Corporation in the state of Qatar, we reviewed the records of 257 children admitted between 1 January 1996 and 31 December 1998. RSV epidemics occurred yearly during the winter months with peak hospitalizations occuring between November and February. Of the 257 admissions, 160 (62.3 per cent) were male and 97 (37.7 per cent) female. The mean age of all children was 5.7 months (range, 10 days to 32 months). The most common admitting diagnoses were bronchiolitis (59.9 per cent), pneumonia (17.5 per cent), bronchiolitis with pneumonia (8.9 per cent), possible sepsis (7.8 per cent), asthma (4.7 per cent) and apnea (1.2 per cent). A family history of asthma was quite common (63.8 per cent), although no statistical significant difference was noted in complication or length of stay. Treatment was supportive, the majority of the patients received oxygen therapy in 77.8 per cent of cases, bronchodilators in 85.4 per cent, and antibiotics therapy in 49.4 per cent. The median duration of hospital stay was 6 days (range, 1 to 29 days). Of the 14 (5.4 per cent) patients requiring intensive care, four (1.6 per cent) needed mechanical ventilation. No deaths were reported, but subjects aged < or = 12 months had a significantly higher oxygen requirement, intensive care unit admission, bronchodilators and antibiotics therapy than those > 12 months old. Within 1-2 years after admission with RSV infection, 63 of the 257 patients attended for recurrent episodes of wheezy chest. These results indicate that, during the season of infection, RSV is an important pathogen in infants and young children in the state of Qatar, highlighting the need for development of effective vaccines to ameliorate the impact of annual RSV epidemics in infants and young children.     

A prospective study of nosocomial enteric pathogen acquisition in hospitalized children in South India

Screening for enteric pathogens in stool samples from 249 children under the age of 36 months, admitted to hospital for non-gastrointestinal disorders, was positive at admission in 41 (16.4 per cent) in a prospective study of enteric pathogen acquisition and diarrhoea in hospitalized children. Infection with multiple organisms was found in 31/41 (75.6 per cent) children who were positive when screened at admission. Of 194 children who had no enteric pathogens on admission and could be followed up for 3 days after discharge, clinical or laboratory data showed nosocomial enteric infections in 39 (20.1 per cent). Presumed nosocomial infection with more than one organism was seen in only two patients and no pathogens were isolated in 14 (35.8 per cent). Children presenting to hospital may asymptomatically carry enteric pathogens and potentially act as a source of nosocomial infections. One in five children admitted into hospital without an enteric infection is at risk of developing a nosocomial gastrointestinal infection, with rotavirus being the most common aetiological agent.     

Anthropometric status, serum prealbumin level and immune response to measles vaccination in Mali children.

Protein energy malnutrition (PEM) is known to depress cell-mediated immunity. Its effect on humoral immunity is less clear-cut. The purpose of the study was to assess seroconversion following measles vaccination according to child nutritional status as assessed by anthropometry and serum thyroxine-binding prealbumin (TBPA). Prior to vaccination, 200 Malian children aged 8-22 months (mode: 9 months) and free of infection were weighed and measured. A venous blood sample was drawn for determination of serum TBPA by radial immunodiffusion and of measles specific immunoglobulins (Ig) by Enzyme-linked Immuno-Sorbent Assay (ELISA). IgG and IgM were again assayed 6 weeks post-vaccination after excluding pre-immune subjects. Seroconversion took place in 91 per cent of the children (95 per cent confidence interval: 86-96 per cent). Based on the NCHS standards, 30 per cent of the children were wasted (weight-for-height less than -2.0 SD) and 18 per cent were stunted (height-for-age less than -2.0 SD). Low serum TBPA (less than 10 mg/dl) was found in 38 per cent of them. TBPA was significantly correlated with weight-for-height and weight-for-age (P less than 0.001), but not with height-for-age. Seroconversion was not significantly related to age, anthropometric indices or TBPA. This study using sensitive methods for the assessment of protein status and of the immune response confirms that children should be vaccinated against measles irrespective of their nutritional status, and PEM was not shown to impair their antibody response.     

Nutritional and clinical status of children admitted to the malnutrition ward, Maputo central hospital: a comparison of data from 2001 and 1983

Malnutrition is the fourth commonest reason for hospital admission to the paediatric department of the Central Hospital, Maputo and has the second highest death rate (20 per cent). A study from 1995 into mortality at this paediatric department, suggested an increase in severe malnutrition. Recent studies have shown that the global burden of undernutrition in the world is declining; however, data for Eastern Africa shows a deterioration. The current study was aimed at describing and comparing the patients on the malnutrition ward, in 2001 and 1983. The study gathered indices of nutritional status and secondary diagnoses from the notes of all children (aged between 6 months and 5 years) discharged from the malnutrition ward for a period of l year (January-December 2001), and from data (collected in January-December 1983) for the malnutrition ward. Data was entered and analysed using Epi-Info 6 and SPSS statistics package. The ethics committee of the hospital approved the study. Data was collected for 558 children in 2001 and 833 in 1983. There was no gender difference, average age was 21.7 months in 2001 and 23.8 months in 1983 and the average hospital stay was 13.1 and 14.3 days, respectively. In 2001, 33 per cent had kwashiorkor, 26 per cent marasmus, and 28 per cent marasmic kwashiorkor. Three hundred and twenty children (82 per cent) were <2 Z-scores below the median weight-for-age and 252 children (65 per cent) were <3 Z-scores. Forty per cent had malaria, 65 per cent anaemia, 53 per cent bronchopneumonia, 14 per cent TB, 36 per cent diarrhoea, and 12 per cent HIV/AIDS. In 1983, 49 per cent had kwashiorkor, 17 per cent marasmus, and 11 per cent had marasmic kwashiorkor. A total of 494 children (81 per cent) were <2 Z-scores below the median weight-for-age and 335 children (55 per cent) were <3 Z-scores. Eighteen per cent had malaria, 37 per cent anaemia, 28 per cent bronchopneumonia, 6 per cent TB, 8 per cent diarrhoea, and 4.4 per cent measles/post-measles. A comparison between the clinical status of 1983 with that of 2001 shows little difference in age, gender or length of stay. There were fewer admissions in 2001, although a higher percentage of severely underweight children and the 2001 group had more secondary infections, especially malaria, bronchopneumonia and anaemia. Clinical malnutrition at a referral hospital level, in spite of the remarkable Mozambican economic growth, shows signs of following the depressing pattern for much of Eastern Africa. A prospective study including HIV tests and anthropometric data for this and the city's other hospitals is warranted. Discussion needs to be prompted on a local level about malnutrition and the use of guidelines.     

Varicella zoster seroprevalence in children less than 5 years old

This study was designed to evaluate the age-specific varicella-zoster virus (VZV) seroprevalence in children less than 5 years old who presented at a healthy child outpatient clinic and to compare the results with the data from other countries. The study was a cross-sectional study determining the prevalence of serum IgG against VZV in children who presented to the Healthy Child Outpatient Clinic of the Gazi University Medical Faculty and who were aged between 9 months and 5 years, in the 3rd--97th percentile as regards height and weight, not suffering from any disease, and without a history of vaccination against varicella. The information on the children was obtained from a questionnaire, by physical examination, and from patient files. Serum samples were obtained from babies and children at 9, 15, 24, 36, 48, and 60 months. The 295 serum samples were kept at --20 degrees C following centrifugation until used for serologic analysis (ELISA). The 292 children of the study group consisted of 168 males (57.5 per cent) and 124 females (42.5 per cent). VZV antibodies were found to be positive in 65 children aged between 9 months and 5 years (22.3 per cent); 22.0 per cent in males and 22.6 per cent in females with no statistically significant difference between the sexes (p>0.05). The VZV seroprevalence was highest at the 48th and 60th months and this difference was statistically significant (p=0.000).     

Utility of clinically-directed selective screening to diagnose HIV infection in hospitalized children in Bombay,India

The increasing prevalence of HIV infection in urban India together with limited financial resources necessitates judicious HIV testing. This prospective study was undertaken to determine the utility of selective screening for HIV infection based on five clinical risk factors reported in African children. The study was conducted at the Departments of Paediatrics and Microbiology, LTMG Hospital, Bombay, India between September 1998 and 2000. The children were enrolled after taking informed consent from their parents. The HIV seroprevalence rate was determined in children (aged 1 month to 12 years) consecutively admitted with severe malnutrition, serious pyogenic infections (pneumonia, pyogenic meningitis, septicaemia), disseminated tuberculosis, chronic diarrhoea and oral candidiasis, present either singly or in combination. Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests. In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection. Of a total 204 children (110 male, 94 female) screened, 24 (11.8 per cent) were diagnosed as HIV-infected. The HIV seropositive rate was highest in children having oral candidiasis (40.6 per cent), followed by chronic diarrhoea (18.2 per cent), disseminated tuberculosis (16.2 per cent), severe malnutrition (14.4 per cent), and serious pyogenic infections (11.2 per cent). Only the presence of oral candidiasis was a significant independent risk factor for predicting HIV infection (p < 0.0001). However, as the number of risk factors concomitantly present increased, the chances of the child being infected with HIV also increased significantly (p < 0.001). Our study shows that clinically-directed selective screening does have a practical role in diagnosing HIV infection in a resource-poor setting.     

Changing spectrum of sporadic acute viral hepatitis in Indian children

From August 1997 to January 2000, 172 children (< or = 14 years) with acute viral hepatitis were studied. Their clinical features, investigations and outcome were noted. Viral markers (IgM anti-HAV, IgM anti-HEV, HBsAg and anti-HCV) were measured by ELISA using commercial kits. The mean age of these children was 5.6 +/- 2.9 (range, 4 months to 14 years) with a male to female ratio of 120:52. Prodromal symptoms were present in 161 (94 per cent) and icteric hepatitis was diagnosed in 168 (98 per cent) cases. Splenomegaly was noted in 53 (31 per cent), ascites in 52 (30 per cent) and encephalopathy (ALF) in 56 (32.6 per cent) cases. Sixteen (31 per cent) children with ascites had spontaneous bacterial peritonitis (SBP). Fifteen (27 per cent) children with encephalopathy died. Viral markers were positive in 166 (96.5 per cent) and they were: A in 111 (64.5 per cent), E in 28 (16.3 per cent), B in 13 (7.6 per cent), A + E in 12 (7 per cent), A + E + C and A + C in one each. Mortality in acute liver failure was more when associated with SBP (100 per cent) than without (20 per cent) (p < 0.001). We conclude that HEV is the second most common cause of sporadic acute viral hepatitis in children. Atypical presentations, such as splenomegaly, ascites, and SBP were present in virtually one-third of cases. In cases of ALF, the presence of ascites and SBP depicts a worse outcome.     

Persistent rhinorrhoea in rural Indian children: prevalence and consequences

To determine whether persistent rhinorrhoea constitutes a significant problem requiring intervention, 17 rural day care centres (Balwadis) in Tamilnadu, India, were visited. Among 414 children in the Balwadis 92 (22 per cent) children with persistent rhinorrhoea (15 days duration or longer) were identified. Demographic and clinical data and nasopharyngeal swabs for bacterial culture were obtained from 56 such children and 91 age-matched controls from the same Balwadi. Type of housing or nutritional status did not appear to be significant risk factors. There was a significantly higher number of children aged 5-15 years in the household of cases as compared to controls (1.23 +/- 1.08 vs. 0.83 +/- 0.95, p = 0.02). Other illnesses were noted in 25 (44.6 per cent) cases and seven (7.7 per cent) controls (OR 11.5; CI, 4.13-33.4; p < 0.00001). Notably, chronic ear discharge was noted in 6 (11.7 per cent) cases but in none of the controls (p = 0.007). Streptococcus pneumoniae was isolated from nasopharyngeal swabs in 42/49 (85.7 per cent) cases and 44/80 (55 per cent) controls (p < 0.001) and H. influenzae from seven cases and five controls; S. pneumoniae was isolated in all children with chronic ear discharge and H. influenzae from one child. Serotypes of pneumococci commonly associated with otitis media, i.e., types 6, 14, 19, and 23 were isolated from 25 (51 per cent) cases and 16 (20 per cent) controls (OR 4.17; 95% CI, 1.78-9.85; p < 0.001). Persistent rhinorrhoea, presumably due to pneumococcus, is a common condition among rural Indian children and appears to be associated with chronic otitis media.     

Acute bacterial meningitis in The Gambia: a four-year review of paediatric hospital admissions

Over a 4 year period, 1991 to 1994, 420 patients with acute bacterial meningitis were admitted to a tertiary urban hospital in The Gambia. Organisms were isolated from the cerebrospinal fluid in 64 per cent of cases. In the neonatal period Streptococcus pneumoniae was the single most common organism isolated. Amongst infants and children the two major pathogens were Haemophilus influenzae and S. pneumoniae. In the first year of life, children with S. pneumoniae meningitis were younger than those with H. influenzae infection (median age 3 months versus 6 months, p < 0.00003) and they had a higher case fatality rate (37 per cent versus 17 per cent, p = 0.002). In view of the high case fatality rate, there is a need to review overall case management. This will include a review of more effective antibiotics, the possible role of dexamethasone, and the inclusion of efficacious vaccines against H. influenzae and S. pneumoniae disease.     

Persistent diarrhoea: associated infection and response to a low lactose diet

Children aged 4-23 months with persistent diarrhoea received a low lactose diet, multivitamins, minerals and antibiotics for infection. Sixty-one (57 per cent) children improved with low lactose diet while 46 (43 per cent) failed. Children who failed were younger (8.9 +/- 3.5 vs. 11.3 +/- 4.4 months), had higher initial purging rate (146 +/- 102 vs. 109 +/- 102 g/kg/day) and consumed more ORS (138 +/- 77 vs. 95 +/- 79 g/kg/day). A higher proportion of children in the failure group needed unscheduled intravenous fluid (48 vs. 20 per cent) and lost body weight (24 vs. 0 per cent). Single and multiple stool pathogen were isolated from 44 and 45 per cent cases, respectively. Diarrhoeagenic Escherichia coli (66 per cent) was the most common pathogen isolated. Half of all pathogens including Campylobacter, rotavirus, cholera and non-typhoidal Salmonella were nosocomially acquired. Sixty four per cent of children had extraintestinal infections including acute lower respiratory infection (50 per cent), urinary tract infection (29 per cent) and septicaemia (11 per cent). The presence of extraintestinal infections were significantly associated with failure. Overall, 91 per cent of children had either intestinal and/or extraintestinal infections.     

Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting

Few large studies have evaluated risk factors for mortality among children hospitalized for pneumonia and this may contribute to suboptimal case management efficiency. To identify useful screening criteria for mortality among children hospitalized for pneumonia in a developing country setting, we conducted a population-based hospital cohort study among children less than 2 years of age admitted for pneumonia during 1999-2001 at one of three major hospitals on Lombok Island, Indonesia. Of 4351 children admitted for pneumonia, 12 per cent died before discharge. Case fatality proportions were seasonal, with peaks occurring immediately after peaks in the proportion of cases positive for respiratory syncytial virus. Children with an oxygen saturation < or = 85 per cent or age younger than 4 months were 5.6 times more likely to die than children with none of these predictive factors (95 per cent CI, 4.5-7.1); 83 per cent of children who died had one of these two risk factors. For children < 4 months old, mortality increased at an oxygen saturation < 88 per cent compared with < 80 per cent for older children. Laboratory, physical examination, and radiological findings were not associated with or did not contribute substantially to mortality prediction. Among children hospitalized for pneumonia, age less than 4 months and hypoxia were identified with those at high risk of death. Age influences cut-off levels for hypoxia.     

Survival of childhood acute lymphoblastic leukemia: experience in Chennai

The object of this study was to evaluate the treatment outcome in children with acute lymphoblastic leukemia (ALL) in Chennai. The problems inherent in a developing country which affect outcome are analyzed. The importance of prognostic factors especially immunotyping is assessed. The period of study was from June 1991 to December 1995. A total of 135 children were studied. Pre B CALLA positive (CD10, CD19, HLA, DR) was the dominant immunotype in 75 children (69 per cent). T-cell ALL was seen in 15 (14 per cent), biphenotype in three (2 per cent), and B in one (0.9 per cent). Seventy children (53 per cent) were treated with a high risk protocol, 25 (17 per cent) received an intermediate risk, and 40 patients (30 per cent) received a standard risk protocol. Analyzing the outcome in 135 children, 34 (27 per cent) had event free survival (EFS) at the time of analysis; of these 41 per cent had EFS after 2 years of therapy, 31 per cent after 3 years and 18.7 per cent after 4 years (i.e. 1 year after stopping 3 years of therapy). Fifty-seven children (41 per cent) dropped out; 25 (18 per cent) died due to sepsis. Treatment obstacles included delay in diagnosis, poor health education and facilities, poor supportive care, and socio-economic problems.     

Prevalence of poliovirus antibodies in healthy children of Ahmedabad

Antibodies against polioviruses were estimated in 258 healthy children upto 3 years of age in Ahmedabad. Fifty per cent of the children were negative for all three poliovirus antibodies before immunisation. Only 7.8 per cent of children had antibodies against all the three types of poliovirus. Prevalence of poliovirus type 1, type 2 and type 3 antibodies were 32.3, 31.8 and 15.5 per cent respectively. In the 3–6 months age group 39.6 per cent children were having poliovirus antibodies against one or more type but the per cent positivity increased in the age group 25–36 months to 78.6 per cent children. There was no difference in the prevalence of polio antibodies between the two sexes. About 92.0 per cent of children upto 3 years of age were lacking in one or more types of poliovirus antibodies in their blood, and would be susceptible for paralytic poliomyelitis if not immunised. Financed by a grant from the Indian Council of Medical Research, New Delhi. This paper was presented in the 28th Annual Conference of Indian Association of Pathologists and Microbiologists heald at Chandigarh in December, 1979.     

Raised Stool and Serum IgA Levels in Undernourished Infants with Chronic Diarrhoea and Associated Parasitic Infestations

Sixty children with chronic diarrhoea, age ranging from 9 months to 3 years and 15 normal healthy children of same age group, all belonging to the low socio-economic families formed the basis of this study. Fifty-six out of these 60 children were undernourished and were marasmic. Stool examination showed enteropathogenic E. coli in 24 (40 per cent), Ascaria lumbricoides in 12 (20 per cent) and Giardia lamblia in 6 (10 per cent). Coeliac disease was detected in 2 (3 per cent) and combined IgA-IgG deficiencies were found in one case (2 per cent). No cause could be found in 15 (25 per cent) cases. Multiple aetiological factors were found in 7 (12 per cent) cases. Stool IgA levels were significantly elevated in the patients than in the controls and more so in the patients with giardiasis and also in patients with coeliac disease. Serum IgA levels were remarkably raised in the patients with diarrhoea due to enteropathogenic E. coli, indicating probable spilling of gut-associated IgA into the circulation. No IgA was detected in the stool of a dysgammaglobulimic patient, who had both serum IgA and IgG deficiencies.     

Association of gastroesophageal reflux disease in young children with persistent respiratory symptoms

Forty children aged between 3 months and 3 years (median age 14 months) with persistent respiratory symptoms beyond 4 weeks or recurrence of respiratory symptoms were investigated for gastroesophageal reflux (GER). Diagnostic tests included upper gastrointestinal endoscopy, oesophageal biopsy, gastroesophageal scintiscan and 24 h ambulatory oesophageal pH monitoring. GER was detected in 14 (35 per cent) of these patients; which included 38 per cent of the enrolled cases of recurrent bronchopneumonia, 40 per cent cases of reactive airway disease, and 22 per cent cases of persistent cough. Amongst the cases detected to have GER, the age of onset of respiratory symptoms was less than 1 year in 86 per cent of cases (p < 0.01), nocturnal symptoms of cough and wheeze were reported in 78 per cent (p < 0.05), and 86 per cent cases did not present with typical gastrointestinal symptoms (p < 0.01). Family history of asthma was absent in all cases of GER-related reactive airway disease (p < 0.01). Cases detected to have GER were followed for 3-6 months after starting anti-reflux therapy. A significant (p < 0.01) decrease was noticed in the number of further episodes in children with GER-related recurrent bronchopneumonia and reactive airway disease after starting anti-reflux therapy. Improvement was also noticed in nocturnal symptoms and nutritional status after anti-reflux therapy was started. Our results suggest that GER may be one of the possible contributing factors in any child with recurrent and persistent respiratory complaints. Early diagnosis and anti-reflux therapy in cases with GER-related respiratory complaints can result in significant improvement in symptoms.