Educating caregivers to recognise the clinical signs of pneumonia in children younger than 6 months

Background. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. Objective. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. Methods. The study involved a cohort of women presenting to the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between 7 July and 8 September 2016. A total of 90 women with children younger than 10 weeks were recruited. Participants were trained on identifying early signs of pneumonia using low-cost equipment. Follow-up training and assessment sessions formed part of the programme.Results. At pre-training assessment, the majority of the participants (n=83/90; 92.2%) recognised lower chest indrawing as a sign of respiratory disease requiring immediate hospital intervention. Participants' performance in determining rhythms of 50 breaths per minute (bpm) and 60 bpm improved significantly across sessions (p=0.011 and p≤0.001, respectively). After training, 87 participants (96.7%) were able to determine rapid breathing accurately compared with 73 participants (81.1%) before training (p=0.001).Conclusion. The results suggest that caregivers can be effectively trained to identify clinical signs of pneumonia in young children, even in low-resource settings. A training initiative as described in this study could be an effective public health intervention to help address the burden of pneumonia in low-resource settings

Serum Vitamin D, Calcium and Phosphate among children with pneumonia

Background:Vitamin D is partly responsible formaintainingcalcium and phosphatehomeostasisbut has been shown to have immune modulatory functions.Objective:To measure serumlevels of vitamin D, and plasma levels of calcium and phosphatein children with pneumonia and compare with those of apparentlyhealthy controls.Methods:A cross-sectional study involving seventy-six childrenwith pneumonia, matched with 76 apparently healthy controls.Results:There was no statistically significant difference in the mean serum vitamin D levels between the cases and the controls (t = 1.190, p = 0.236). The mean serum vitamin D level was significantly higher in childrenwith non-severe pneumonia than in those with severe pneumonia (t = 3.299, p =.002). Themean serum vitamin D level was higher among the controls than those with severe pneumonia (t = 2.674, p = 0.009).The mean plasmacalcium and phosphate levels in the controls were significantly higher than in the cases (t = 2.528, p = .013 and t = 4.594, p < .001 respectively). Plasmacalcium and phosphate levels did not vary with the severity of pneumonia. Pneumonia was independently associated with the occurrence of hypocalcaemia and hypophosphataemia (OR= 4.366, 95% CI = 1.851-10.295, p= 0.001; OR= 7.355, 95% CI = 1.545-35.027, p= 0.01 respectively). Conclusion:Children with severe pneumonia hadlower levels of vitamin D than those with the non-severe disease.Derangements in plasma levels of calcium and phosphateare common in children with pneumonia, and these abnormalities occur independently of low vitamin D levels

Les pneumonies de l'enfant a Libreville : une etude de 85 cas

INTRODUCTION : Les pneumonies sont l'une des principales causes de deces des enfants de moins de 5 ans. Au Gabon; en 2000; elles etaient la troisieme cause de mortalite des enfants de moins de 5 ans. L'objectif de ce travail etait d'en etudier les caracteristiques epidemiologiques et cliniques a Libreville. PATIENTS ET MeTHODES : Il s'agit d'une enquete descriptive retrospective conduite sur les dossiers d'enfants hospitalises du 1er juillet 2012 au 30 juin 2013; dans le service de pediatrie du Centre Hospitalier Universitaire de Libreville. Les donnees ont ete analysees avec le logiciel epi info 3.5.4. ReSULTATS : Sept cent quatre vingt et un enfants ont ete hospitalises; durant cette periode; 85 cas de pneumonies ont ete enregistres; soit 10;9%. Le sex ratio etait de M/F 2. La moyenne d'age etait de 2 ans et 9 mois. Les enfants de 0 a 2 ans representaient 62;5% de l'effectif. Le delai moyen de consultation apres le debut des symptomes etait de 12;4 jours. Un traitement avait ete administre a domicile avant l'admission dans 52;8% des cas; dont des antibiotiques (47;4%). Le statut vaccinal etait correct pour les vaccinations du Programme elargi de vaccination dans 15;3% des cas. La fievre representait 94;4% des motifs de consultation et la toux 87;5%. La tuberculose etait a l'origine de la pneumonie chez 7 enfants (9;7%). Les opacites parenchymateuses droites representaient 55;8% des anomalies radiographiques et les epanchements pleuraux droits 16;2%. Un deces a ete enregistre suite a la tuberculose. CONCLUSION : Avec une frequence de 10;9% des cas d'hospitalisation; les pneumonies representent un reel probleme de sante publique. Une methode diagnostique fiable de la tuberculose est necessaire en l'absence du test tuberculinique. L'introduction des nouveaux antigenes dans le Programme elargi de Vaccination; tels que le vaccin antipneumococique serait necessaire

Review Diagnosis; Aetiology; and Severity in Adult Community-Acquired Pneumonia

N/A

Diagnosis and Management of Community-Acquired Pneumonia in Childhood - South African Thoracic Society Guidelines

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence; severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective: To develop guidelines for the diagnosis; management and prevention of CAP in South African children. Methods: The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence; expert opinion was accepted. After peer review and revision; the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations: Recommendations based on epidemiological factors include a diagnostic approach; investigations; supportive therapy; appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation: These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in aediatrics; paediatric pulmonology; radiology; infectious diseases and microbiology. Published international guidelines have also been consulted

Spontaneous sputum examination for early diagnosis of pneumocystis carinii in Ugandan AIDS patients

Whereas pneumocystis carinii pneumonia (PCP) is one of the major complications and causes of death in patients with the Acquired Immunodeficiency Syndrome (AIDS); patients show that mycobacterium tuberculosis (MTB) is a commoner cause of HIV-associated pneumonia than PCP. Most methods used to diagnose PCP entail invasive and expensive techniques which are beyond the facilities available in developing countries. This study was therefore designed to evaluate spontaneous sputum examination as a cheaper method for the diagnosis of PCP. Sputum specimens collected in 1987 from 54 AIDS patients in Mulago Hospital were stained using a modified Gram stain and read by a competent technician. None of the 54 slides contained evidence of pneumocystis carinii. These results were consistent with other studies in Africa which show that PCP is rare among AIDS patients. [abstract terminated]