Prevalence of lower respiratory tract infection in Severely malnourished Children
Abstract
One hundred and seven children aged below 5 years with
clinical features of severe malnutrition were studied for lower
respiratory tract infection. A clinical history was taken and
physical examination carried out on these children. The presence
of lower respiratory tract infection (LRTI) was confirmed using
chest radiographs.
The ages of the children ranged from 1.5 - 60 months. of the
children, 100 (93.6%) were less than 36 months old. There was a
male preponderance, with a male to female ratio of 1.74 : 1.
There were 40 patients with marasmus (37.4%), 39 with kwashiorkor
(35.5%) and 29 with marasmic kwashiorkor (27.1%) . •
of all children studied 69.2% had radiological pneumonic
changes. A significantly higher proportion of patients under one
year of age had LRTI compared to the other age groups. A greater
proportion of the children with marasmus had pneumonia (82.1%)
compared to those with kwashiorkor (58.3%) and marasmic kwashiorkor
(75.0%).
A history of cough was present in 80% of patients with LRTI.
The other clinical features of LRTI, that is, history of
fever, fast breathing, and difficulty in breathing and the physical
signs of temperature of more than 37.5"C, respiratory rates greater
than 50 per minute, heart rate of more than 140 per minute, nasal
flaring, chest indrawing, crepitations and bronchial breathing were
present in less than half of the patients with LRTI.
The clinical features found to be strongly associated with
LRTI were a history of cough, chest indrawing and a respiratory
rate of more than 50 per minute. of the symptoms and signs studied
chest indrawing had the strongest association with LRTI. However
none of the clinical features had good predictor value for LRTI as
they all had very low sensitivities and negative predictive values.
From the study it is recommended that all severely
malnourished children should have chest X-rays and where this is
not possible antibiotic therapy for LRTI should be instituted in
children admitted with severe malnutrition as a very high
proporti on of these chi Idren have LRTI whi Ie cl ini cal features are
present in less than half of these patients.
Citation
the Degree of Master of Medicine (paediatrics)Publisher
University of Nairobi Department of Medicine
Description
A dissertation submitted in part fulfillment
for the Degree of Master of Medicine (paediatrics)
in the University of Nairobi