Acute respiratory infections: sentinel survey in Egypt.

A survey of 115 health centres in five governorates provided morbidity figures for acute respiratory infections (ARI) from 75,789 records. The findings give an estimate of antibiotic requirements, including dosage forms for young children, and help evaluate the performance of individual health centres and the entire ARI programme.

PIP: To obtain accurate data on the incidence and clinical profile of acute respiratory infections (ARI) in Egyptian infants and children aged 4 years and under, 115 randomly selected health centers in five of the country's 26 governorates participated in an ARI Case Registration System. Each month during 1993, specially trained physicians assigned to the project submitted a case diagnosis form. The survey yielded a total of 75,789 records representing seven categories: very severe disease (0.9%); severe pneumonia (2.9%); pneumonia (9.9%); otitis media (10.7%); pharyngitis (22.8%); asthma (4.8%); and cough, cold, and bronchitis (48.1%). 4.1% of patients were under 2 months old, 29.9% were 2-11 months of age, and 66.0% were 1-4 years old. Pneumonia cases peaked in January and fell off in June. When the reliability of disease symptoms as reported by caretakers was compared to the corresponding clinical signs observed by physicians, specificity was in the 95-97% range, but sensitivity was extremely low (e.g., 48-59% for rapid breathing). This analysis enabled health centers to calculate the annual drug requirements for use in ARI. For example, the finding that 34% of ARI cases involve children under 12 months of age led to a decision to ensure that one-third of the amoxycillin ordered for use in the clinics is of the 125 mg strength.

Synthesis of new 7-substituted 4-methylcoumarin derivatives of antimicrobial activity.

New cyclic derivatives derived from 4-methyl-7-coumarinyloxyacetic acid hydrazide have been synthesized. Some representative examples were screened for antimicrobial activity.

Assessment of respiratory rate and chest indrawing in children with ARI by primary care physicians in Egypt.

In a baseline study for training purposes, two indicators of acute respiratory infections (the respiratory rate (RR) and chest indrawing) were assessed by Ministry of Health physicians in Egypt using a WHO test videotape. Chest indrawing, as defined by the WHO Acute Respiratory Infections (ARI) programme, was not widely recognized by current health personnel. Viewing a WHO training videotape led to significantly more correct assessments of chest indrawing compared with a group that had not viewed this videotape. The accuracy of using a timer versus a watch, and a 30-second versus 60-second counting interval was also evaluated. Rates counted over 60 seconds were more accurate than 30-second counts although the difference between them was not clinically significant. Counting of rates using timers with audible cues was comparable to using watches with second hands. Careful training of primary health workers in the assessment of RR and chest indrawing is essential if these clinical findings are to be used as reliable indicators in pneumonia treatment algorithms.

PIP: The timely treatment of acute lower respiratory tract infections (ALRI) in children depends upon the correct assessment of clinical findings. In the context of launching a national ALRI control program in Egypt, the authors surveyed the knowledge, attitudes, and practices of physicians in measuring respiratory rates (RR); examined the effect of a World Health Organization training videotape upon the recognition of chest indrawing; and examined the effect of different time intervals and providing audible timers on the accuracy of RR assessment. 320 Ministry of Health physicians participated in the study; 45% from maternal-child health care units, 30% from urban health centers, 18% in rural health units, and 7% in the district hospital or in school health. It was found that chest indrawing was not widely recognized by current health personnel and that the training compared with groups of physicians which were not exposed to the intervention. It was also found that counting RR for 60 seconds was more accurate than 30-second counts, but the difference between the 2 approaches was not clinically significant. Rate counting with audible cue timers was comparable to using watches with second hands. It is clear that primary health workers need to be carefully trained in assessing RR and chest indrawing if these clinical findings are to be used as reliable indicators in pneumonia treatment algorithms.