Respiratory syncytial virus-associated lower respiratory tract infection in under-5-year-old children in a rural community of central Thailand, a population-based study.

The population-based cohort study on the epidemiology of respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRI) (RSV-LRI) was conducted in Takhli district from November 1998 to February 2001. The incidence of RSV-LRI was 12.6/1,000 child-year and 5.8/ 1,000 child-year during the first and second year, respectively. RSV accounted for 35.8 per cent of all LRI cases during the first year and significantly decreased to 17.5 per cent during the second year. Three-quarters of RSV-LRI occurred among children under 2 years old (76.6% during the first year and 62.2% during the second year). Most of RSV-LRI in both years occurred from July to October. Risk factor for morbidity of RSV infections were age less than or equal to 2 years (OR = 2.38, 95% CI = 1.22-4.67 p = 0.009) and sleeping with more than 3 persons in the patient's bedroom (OR = 2.92,95% CI = 1.42-6.00, p = 0.002). Most RSV-LRI (63.9%) were clinically diagnosed as having pneumonia. No RSV-LRI deaths were detected. During the first year, RSV subtype B was predominate, in contrast to the second year when subtype A was more predominate. Further research to determine the annual change in subtype of RSV-LRI and correlation of severity of disease with specific subtypes needs to conducted in order to prepare for the future introduction of a vaccine.

Economic burden in management of acute lower respiratory infection, patients' perspective: a case study of Takhli District Hospital.

A cross-sectional descriptive study to determine the economic burden in management of acute lower respiratory infection from the patient's perspective was conducted at Takhli District Hospital from March 2000 to February 2001. Information obtained from interviewing caretakers of 165 children with LRI and data collected from medical records revealed the cost per case ranged from 140 to 6,471 baht with an average total cost per case of 1248 baht. The main determinants of the average total cost per case included the diagnosis of diseases, type of patient (outpatient or inpatient), wheezing association and respiratory syncytial virus positivity. Children with severe pneumonia accounted for the highest in the average total cost per case (2,348 baht) while those with bronchitis accounted for the lowest (924 baht). The average total cost per case of inpatients was 3.5 times higher than that of outpatients. Health policy efforts to improve the effectiveness of care in an ambulatory setting may reduce the financial cost of the illness.