ABSTRACT
Background: Lower respiratory tract infections (LRTI) contribute significantly in terms of hospital admission and mortality. Along with attempts to improve treatment modalities, it is imperative to identify risk factors that will aid in prevention of these infections.Methods: This was a case-control study done in tertiary care hospital, Cuttack, enrolling inpatients between 2 months to 5 years with symptoms suggestive of LRTI as cases. Those with tuberculosis, aspiration pneumonia, asthma and nosocomial infections were excluded. After obtaining consent, questionnaire was administered to parents, regarding their socio-demographic and other relevant details. Data analysis was done using statistical software Epi Info™, version 6 and association of each variable with LRTI assessed with chi-square test.Results: A total of 314 children were enrolled in the study, with 158 being cases. The case-fatality rate was 23% and 53.8% suffered from complications, the most common being respiratory failure. A significant association was seen between LRTI and social variables namely maternal literacy(p-value<0.005), socioeconomic status (p-value<0.001) and number of children (p-value<0.001), housing pattern (p-value<0.001), fuel used at home (p-value=0.003), ventilation adequacy (p-value=0.004), presence of separate kitchen at home (p-value=0.0009) and presence of overcrowding (p-value<0.001) and individual factors improper breastfeeding(p-value<0.005) and weaning(p-value=0.03), malnutrition (p-value<0.001), vitamin A deficiency(p-value=0.03) and history of respiratory infection in mother (p-value=0.025) or siblings(p-value=0.048).Conclusions: The burden of lower respiratory tract infections can be substantially reduced by prevention using the identification of risk factors such as housing patterns, education of parents and improved nutrition of the children, and measures to combat the same, at each level.
ABSTRACT
Background: Neonatal sepsis remains a leading cause of neonatal mortality and morbidity, diagnosis of which remains difficult due to variable presentations. With the increasing threat of antimicrobial resistance, it is important to identify perinatal risk factors which are associated with higher incidence of definite sepsis, to initiate empirical antibiotics, while awaiting blood culture reports.Methods: This was hospital based cross-sectional study done in SVPPGIP, Cuttack, Odisha during January 2019 to April 2019, enrolling all neonates ≥37 weeks gestation and aged less than 72 hours, with suspected early onset sepsis. Neonates with TORCH infections, congenital anomalies, syndromic baby or with surgical conditions were excluded. After obtaining informed consent, blood culture was sent for all and their perinatal risk factors noted. Blood culture positive newborns were considered to have definite sepsis. Data was analysed with Chi-square test and percentages, using SPSS 18.Results: Among the 200 cases, incidence of definite sepsis was 26%. The most common risk factor was low birth weight and birth asphyxia. Majority (67%) had single or lesser risk factor and number of risk factors was significantly associated with definite sepsis. A significant association was seen between blood culture positivity with low birth weight (p=0.003), foul smelling liquor (p= 0.025), birth asphyxia (p 0.018) and premature rupture of membranes (p= 0.016). The combination of maternal fever and unclean vaginal examination was also significantly associated with the same.Conclusions: Protocols for initiating empiric antibiotics need to be formulated, taking into account the significant risk factors, in resource limited settings, to avoid resource and time wastage.
ABSTRACT
Background: Antimicrobial resistance is emerging as global threat to health, the injudicious use being linked to multiple reasons namely parental misconceptions, easy drug availability and previous experiences.' Children, due to frequent illnesses, are victims of this misuse and more than fifty percent of these drugs are self-medicated by caregivers. This study attempts to assess the trends associated with self-medication with antimicrobials in children and the factors associated with it.Methods: This is a hospital based cross-sectional study, among pediatric outpatients aged 1 month to 14 years, in SCBMCH and SVPPGIP, Cuttack, during March 2019 to September 2019. A structured dichotomous questionnaire was administered to caregivers, including details of socio-demography and antimicrobials self-medicated. A pilot study was done for period of 1 month, and questionnaire accordingly modified. Data was analysed with Chi- square test and percentages, using SPSS 18.Results: Among the 300 patients studied, prevalence of self-medication with antimicrobials was 21%. Most patients self-medicated on pharmacists' advice (44.4%), commonest reason being similar illness previously (41.3%). Fever (31.7%) and cold cough (28.6%) were usual conditions, with Azithromycin being most frequently administered. 54% of cases self-medicating antimicrobials, had errors of dose or duration, with 27% reporting side-effects. Child's age (p=0.042), father's age (p=0.044), mother's age (p=0.002), chronic illness in child (p=0.002) and type of family (p=0.011) were significantly associated with antimicrobial self-medication in children.Conclusions: The high prevalence of self-medication with antimicrobials mandates need to educate parents and enforce laws regarding illegal dispensing of these drugs, to reduce the threat from resistance.