Nehal Ahmed
CHILDHOOD PNEUMONIA IN LOW-AND-MIDDLE-INCOME COUNTRIES *
Аннотация:
To review epidemiology, aetiology, diagnosis, prevention and management of childhood pneumonia in low-and-middle-income countries
Ключевые слова:
lower respiratory tract infection (LRTI), LMIC (low-level-and-middle-income countries), epidemiology, aetiology, prevention, management
INTRODUCTION: Pneumonia remains a major cause of morbidity and mortality. Risk factors include young age, malnutrition, immunosuppression, tobacco smoke or air pollution exposure. Better methods for specimen collection and molecular diagnostics have improved microbiological diagnosis, indicating that pneumonia results from several organisms interacting. Induced sputum increases microbiologic yield for pertussis or M.tuberculosis, which has increasingly been associated with pneumonia in high TB prevalence areas. The proportion of cases due to S.pneumoniae and H influenzae B has declined with new conjugate vaccines; S aureus and H influenzae non-type b are the commonest bacterial pathogens; viruses are the most common. Effective interventions comprise antibiotics, oxygen and non-invasive ventilation. New vaccines have reduced severity and incidence of disease, but disparities exist in uptake. Globally, pneumonia is one of the major killers of children under the age of five years. In 2015, approximately 700000 children younger than 5 years died from pneumonia worldwide, despite general improvement in living conditions, improved nutrition and better vaccines. Furthermore, pneumonia continues to be the leading cause of morbidity for young children outside the neonatal period, particularly in low-and-middle-income countries (LMICs). Understanding the current epidemiology, and diagnostic and management strategies in these settings may improve preventive, diagnostic and treatment approaches. Epidemiology and Aetiology: A. Epidemiology: Models of childhood pneumonia from the Global Burden of Disease (GBD) in 2015 show a decreasing trend for pneumonia incidence, severe morbidity, and mortality in LMICs. Approximately 101.8 million pneumonia episodes were estimated in children under-5 years in 2015, East and South East Asia, Central Europe and tropical Latin America reported the fastest (>50%) reduction in under-5 pneumonia mortality during 2005- 2015. in Brazil, vaccination with PCV-10 was associated with a substantial reduction in allcause pneumonia hospitalization in the target age-groups for vaccination and in unvaccinated individuals aged 40–49 years, reflecting the herd protection provided by vaccination. Recent data from a multi-country study in four LMICs showed that measles vaccine was associated with a 15-30% decrease in pneumonia in children in India and Pakistan, and remains an important intervention in the Global Action Plan for Pneumonia and Diarrhoea (GAPPD). B. Aetiology: The aetiology of pneumonia has been increasingly ascribed to multiple organisms as detected by molecular testing. The increased use of pneumococcal conjugate vaccine (PCV) and H. influenzae type b (Hib) vaccine has changed pneumonia aetiology, with S aureus and H influenzae non-type b now the commonest bacterial pathogens and viruses most common. However, the identification of aetiological pathogens may be difficult as distinguishing colonizing from pathogenic organisms can be difficult on respiratory specimens and multiple co-pathogens are common. DIAGNOSIS OF PNEUMONIA: 1. Chest X-ray, 2. Blood test: Although white blood cell count, C-reactive protein (CRP) and erythrocyte sedimentation Rate are higher in children with a bacterial aetiology of pneumonia or mixed bacterial-viral aetiology in comparison to viral aetiology, these tests are nondiscriminatory. CRP levels of ≥ 40mg/L are associated with confirmed bacterial pneumonia especially S. pneumoniae and H. influenzae, and negatively associated with RSV pneumonia. 3. Classification of pneumonia: In 2013, the World Health Organization (WHO) guidelines for classifying and treating childhood pneumonia were revised. Children presenting with cough or difficulty in breathing were classified into 3 diagnostic categories (pneumonia, severe pneumonia or no pneumonia) according to clinical features. Pneumonia is now defined as tachypnea and/or chest indrawing in a child older than 2 months. Severe pneumonia is defined as cough or difficulty breathing with at least one of the following: (i) central cyanosis or oxygen saturation <90% on pulse oximetry, (ii) severe respiratory distress (grunting, very severe chest indrawing), or (iii) any general danger sign (inability to breastfeed or drink, lethargy or unconscious, convulsions). Children without signs of pneumonia or severe pneumonia are classified as no pneumonia: cough or cold. Abnormal oxygen saturation on pulse oximetry predicts oral antibiotic failure in childhood pneumonia. Children with pneumonia seen at outpatient settings without the capacity to perform appropriate investigations such as pulse oximetry, nutritional assessment or HIV testing may need referral
Номер журнала Вестник науки №8 (17) том 4
Ссылка для цитирования:
Nehal Ahmed CHILDHOOD PNEUMONIA IN LOW-AND-MIDDLE-INCOME COUNTRIES // Вестник науки №8 (17) том 4. С. 92 - 96. 2019 г. ISSN 2712-8849 // Электронный ресурс: https://www.вестник-науки.рф/article/2033 (дата обращения: 20.04.2024 г.)
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