National Seminar on Acute Respiratory Infections in Children in ICDS PROJECTS

Item

Title
National Seminar on Acute Respiratory Infections in Children in ICDS PROJECTS
extracted text
I
library'^
and
^NF0i?IW4U0N

4

v V.

■—

'

1 5

j

' ~z •x*

jy

National Seminar
i*

on
Acute Respiratory Infections in Children

in

ICDS Projects
(29-30, August,1989)

- Background paper
- Annotated Bibliography
- Bibliography

Prepared by:
Dr. Dinesh Paul
Kum Tejinder Kaur
Smt Neelam Bhatia
Kum Rima Prothi

4

I

j

i

■

'

.

-•

■

■ Acute Respiratory Infections

Acute respiratory infections are out of control.

They represent a largely ignored challenge in the field
of c ommuiilcable diseases.

Acute respiratory inf ections

(ARI) can be defined as epldode of acute symptoms and signa
resulting from infection of any part of respiratory tract
or any related structure including paranatal sinuses, middle

ear and pleural cavity'•

Mortality and MorbKity
ARI constitutes a complex and heterogenous group

of illnesses with the three conditions i,e

bronchielitis. i,

acute laryrigitis and pneumonia being primarily responsible

for majority of ARI related deaths among children below
5 years of age.

In India, there were 3.3 million cases of

ARI reported in 1983 as influenza, diphtheria, measlesand
whooping cough .

During 1983-84, 9*63 million ARI patients

were seen as outpatients in hospitals and dispensaries of
14 states and union territories, Gf non specific ARI cases,
1.9% required hospitalization compared to 2.5% of influenza

case#.

Population based longitudinal studies involving

active surveillance by fortnightly to monthly home visits
Indicate that a child in the urban areas, on an average,

may suffer from 5-8 episodes of ARI per year,

J

first 5 years of life.

during the ,

In the rural areas, the reported

incidence per child is lower (1-3 episodes per year).
Annual incidence of penumonia among children under five

years is about 94 per 1000 children.

ARI accounts for

14.3 per cent of deaths during infancy and 15.9 per cent
of deaths between 1-5 years of age.

In the pediatric age

group, 20-24 per cent of deaths are reportedly attributable

: 2 s

to acute respiratory infections.

A similar pattern emerges

from community based longitudinal studies which show that

ARI accounts for 20-29 per cent of u/J.: deaths.

ARI most commonly occur in the first year of

life, followed by 1-4 years age

group.

In a longitudinal

study in urban Delhi, the incidence was 81 per 1000 months
during first years of life and then decreased to 68, 67^ 56

and 31 per 1000 months during the subsequent 4 years.
No reliable state wise ARI morbidity and mortality

data is available in the country.

A study conducted in

rural areas of Rallabgarh Blocky Haryana (1988) reported
that the morbidity due to ARI was 3.67 attacks/child/year.

Proportional mortality rate due to ART was 22.6%
children.

66.5% of deaths were in Infants.

rate was 1.31 per cent and ARI related

in under five

The fatality

mortality was 6.3/1000

children*
A longitudinal study conducted in a Semi-urban area
of Pondicherry (1986) showed that Upper Respiratory Infections

and Lower Respiratory Infections accounted 42 per cent and

9-3 per cent morbidity in the under five children respectively
Community based studies conducted by PGI, Chandigarh
reported that ARI accounted for 3.47 attacks per child per
year in under three children.

during first year of life.

The attack rate was 2.2 per cent

In a survey carried out in

children below five years (1984) and in another (1985) the

point prevalence of Acute Lower Respiratory Infection was

found to be 2.4 per cent and 7.2 per cent respectively.

S 3 :

Several cohort studies and studies based on routine reporting
of births and deaths carried out by PGI have Indicated that

ARI associated mortality is responsible for 20.5 - 25.0 per
cent of all deaths in pre-school children.

Severe, respiratory infections especially pneumonia, contribute
to 20-25% of all deaths in children with an estimated 600,000

deaths per year in India.

In addition to high mortality ARI

leeids to significant disability in the form of chronic r.apirai'ory
diseases, deafness, malnutrition and cardiac diseases,

The

burden of ARI illnesses is a considerable strain on the health

facilities of the country.

Respiratory infections tend to be

reported more frequently among males than females,

to female ratio is about 1.7 to 1.

The male

The difference may be due

to preferential treatment to male children who when sick are

more likely to be brought to hospital or a health care facility.
ARI twice or three times as common in winter

’ in summer.

The following table depicts the percentage distribution of
deaths among children less than 1 year and 1-4 years of age

due to respiratory infections.
Table 1 : Percentage distribution of deaths due
to respiratory"infections in InBia
(Rurgl) from 1981 to 1966^
I) year
1-4 years.
._____ 81 82 83 84 85 86 81 82 83 I
Causes Asthma

85

86 ,

&

Bronchities 1’2 2-1 2-° 1’9 2‘5 1-8 3.4 1.9 2.7 2.3 3.0 2.7

T.B. of
Lung s

0.3 0.4 0.2 0.3 0.3 0.3 I.^1.0 1.6 1.5 1.5 1.4

Pneumonia

43.745.244.343.743.847.030.029.128.833.131.628.9

Source s India, Office of the Registrar General,
Survey of Causes of Death(Rural) 1981-86.

i ■

: 4 :

Vaccine Preventable ARI
These include measles, diphtheria, whooping cough,

childhood tuberoculosis and pneumonoccal Infections,
following table depicts the annual incidence

The

of meashjp,diphtheria,

.-'hooping cough and tuberculosis from 1974 to 1987.
9 coble 2

Measles

Diphtheria

Pertussis

TuberSeuloasls
e

1974

119714

26912

243288

532692

1975

133561

34269

34552$

675508

1976
1977

157057

17813

373814

589768

124888

20596

303886

610531

1978

172177

22305

446431

668794

1979

143358

31346

335241

662600

1980

124031

34241

320110

657469

1981

197129

21130

359290

766974

<982

146796

21469

277848

841917

1983

129639

11713

211282

881328

1984

190881

13111

189287

987013

198 J

151332

11936

184368

903917

1986

116333

5246

124585

727149

1987

170602

7002

95919

692253

73%

73%

72%

Immuni­
zation 44%
coverage
of infant
as on Jan*89

a

Source : WH0/EPI/GEN/88.9 SEA July 1988

: 5 :
Op
Table3: Estimated annual numberxcases and deaths
presented from~pertussi's & measles

1987
Surviving Prevented Prevented Prevented Prevented
New Borns Infants Pertusis Pertussis measles
measles
deaths
cases
deaths
cases
(OOP's)
(OOP's)
(OOP's) (OOP's)
(000(s)
(000(s)
(OOP's)
22133

India 24758

9190

3575

103

107

It can be seen from the table that vaccine preventable

ARIs are decreasing beubause of better immunization coverage.
Data on pneumococcal infections in India are not

available.

A disease of continuing endemic’ity, it primarily

affects infants and elderly persons.

Case fatality in the

Western countries has been reduced to 5 to 10% among hospitalized
persons wi th antibiotics.

Vaccine against

pneumococcal

infection is not currently available in India.
Classification of ARI

The acute respiratory infections (ARI) can be classified
based on etiology, anatomical involvement, site of involvement

and most importantly on important signs and symptoms that can
be used for making management decisions.

therefore, can be based on the following:
%

1. Etiological

Viral
Bacterial
Fungal

Mycoplasma
Allergic

2. Anatomical
Rhinitis

Laryngitis

Sinusitis

Trachei tis

Otitis media

Bronchi tis

ARI classification,

: 6 :
haryngitis-tonsilitis-quinsy

Bronchiolitis

Epiglotitis

PnQeumonia (lobar, bronchial
or interstitial)

3. Site of involvement
*
URI, Pharyngitis(coryza,cough, sore throat)
' Jpp er

Hid

Epiglotitis, laryngotracheo bronchitis
(croup, stridor, hoarseness, retractions)

Lower

Bronchiolitis, pneumonia
(tachypnoea, wheeze, rales, nasal flaring, retractions

lianagement Oriented
Severe

(Unable to feed, Retractions)
(Resp. rate 70+stridor

Moderate Resp< rate 50+

HiM

Refer
Home Care with
Antibiotics

Cough
Resp.rate below 50
Stridor without retractions

Supportive measures
only

r
«

Simplified Decision Tree for ARI
1

•

■
...................................................

i .sal '• discharge and |
r Sore Throat
■'No ~

- -> Not ARI

Yes

Cough / 3 weeks

4- Yes
bputum Production
Chest Rattling

-— No—a Ear Faini —No-- > ADRI
i-- Yes--- > ADRI
Complicated
No

j Yes
- No "

-> ALRI MILA

'-No.

^ALRI

vnosis

No —

—ALRI

l

Yes —

-- ^ALRI Severe Complicated

ipid Breathing
4- Yes

Last Indrawing

I

Moderately
Severe

J. Yes

Severe

8

ARI Control Programme *

11 in

1.

colll|,allE)|,tg.

should havo thrad rwaoritiol

'’Uind.-n.-tl c-iss)
C '13 O munatj'iniBiit.
.

Vacc.tnntlon ngaInst c
coinnion chllrJiioad rJisoosgo.

:5.

Ic’ai th

Ldue.':?I: ion «

cl1.0.33 e..jnmgjjuiiHjnt!
This olioul. J bo

> hr;:?o o i.lipl r? olinicnl

•n mild,

modi.’rntw

hr •:! a th ill:.),

(t riti,’

(recasa ion oT

1 r

■

in ore

ribgJ

in

in dr awing
i.n

n mether u r

1' h. n r in it in
1 ' f'c iml

k

ch

c

a

Thusri

nnd

(ill)

which will Jc otcigor is a

liierilfas tatIdno

ora

chest

(ii)

inability Lu drink.

liaa

(i) rapid

indrawing
i

/r

El V O

/Ml

ond raquiros c.litimicrobibl'
—t her spy •
I’res ent rarer ml or admlasiun ta

ir

hospital or

no car? o ary.

T linn ci a i c n i n

Idle worker >

t’ho l ino cd on thesu signa,

ch i.l d .roqulros

cati oasily rracognload

antibiotics

uili

arid which rt?qljirBa

c r huep.{ t al Is o t j On.
i

cheat

/MJ.

any of thesu symptoms; be may h

child with inode rn to Ad),
!■ '

us i11c|

|

than 5U pur inlrnito,

child with /' • ? 1

h• ' J th cun tri’
I

wholrus tat loris ,

nnd suvora.
C’VUffJ,

’ 'ci In rain t) r a cue vc
ch no I;

btiJwd uri I"
r snag emo nt uriontud cr.ltoria

■'-"'h. owing.)

niij.

require

(cough E’i I d rapid brooLhipg
rint.linl.crublol

tlirjrapy

Dr. Umesh Kapil, CTC.

i

i

itl 1110

-

<?
(4 mg/lcg, 12 hourly for five days)

Porni of oral cuntrimoxczolo

o r t inicillin or poncillin (oral or parenteral) and supportive
mu as ires

at ho .’no.

/I case of snvuro AHI

(cough and chest indrauing

o r c nigh and not

able to drink) needs immediate referral to a

hu al 1J i cuntro cr

a hospital.

i\ child with mild A.TI

(cough but no rapid hroathing or

requires only supportive mussures at homo.

ch’ist

indrawing)

This

Liould includo

feeding of

food and plenty of

fluids to drink.
■

Tho commonest

form of this

cctagory is upper respiratory infection

or a common cold which is a self limiting and- does not require
i

r.riy treatment.

strategy of management of mild, moderate and

1 ha above

s o v q ’ a /irtl has boon found fcasiblo in the: community based studies.
Li)

V .accir]_a tJjjjagainst common childhood disc as a :

Thu whooping cough and measles uro two important diseases
which contribute significantly to deaths amongst undorfives.

Diphtheria although uncommon also contribute to childhood mortality.

Un du

the Universal Immunisation programme,

Government of India,

it 11 envisaged that 135/j of infants would be covered with throe

dos es of DPT and one dose of measles vaccination.

The immunisation

coverage gainst these diseases would help in reduction of

du u Io thum.

The

AHI

is common manifestation

deaths

during measles,

whooping cough and Diphtheria episodes.

i i i)

Health education:
Health education has been comporod with a

bu t

L

is still

the best approach

’bottomless1

for prevention of (uli.

cham e.Ls of moss media should be used like T V4

n e ws p ap er,

pit

All

Ha*d i

rV '

,

ic magazines to spread health education

messages

on follouing

aspects:

1)

Adi is an important
causa of underfivs deaths,

ii)

Majority of /,!?I

iii)

Children with cough and difficult
breathing requires
treatment from a health worker

can be treated at community level.

immediately.

Fa'at breathing

and chest indrauing are signa of difficult breathing*

iv)

A child with cough should bo givan adequate

v)

A child with cough should be kept warm and not overurapped.

>/l)

Immunisation against Diphtheria,

food and drinks.

whooping cough,

and
moasies

Can prevent soms serious kinds of Respiratory

infections.

Health education of parents particularly'mothers on above
aspects would help m initiating action at the home level

in

treatment of ARI like in community management of diarrhoea*

The existing health care staff should ba given inservice

training in recognition of simple cUnlcal manifestations

help in community diagnosis

which

and management of /’dU.

T he
• laming of health profoosionals should be

decentralised
as

3

possible to achieve maximum

success and coverage.

I

1

far

/.

/

Annotated Bibliography
on
ARI

1

I.

. i; :

1- !

f

I

i

H

Viral infections of the respiratory tract in hospitalised
children
K.H. Carlsen, I Orstavik and K Halvorsen

Deptt of Paediatrics and Microbiology Laboratory, Ullev^l
Hospital and DOptt of PaediartricS, Aker Hospital, QslO/
Norway.
Study conducted : not mentioned
Study published : 1983

Hospital-based data
Ulleval and Akera Hospitals, Oslo, Norway

Published : Acta Pediatr Scand,1983; 72:53-56.
ABSTRACT

C Hactive

To discern specific patterns of different
viral infections of the respiratory tract in
hospitalised children.
|

Methodology

Virological examination of 70% (of the 3300)
infants and children with actite respiratory
infections, acute bronchial asthma or febrile
convulsions was conducted. Epidemiologicalr
clinical and laboratory data were collected
retrospectively from, hospital records.
Wilcoxon-Mann Whitney rank test was used for
statistical analysis.

Findings

Respiratory viral infections were diagnosed
in \p79 children. Respiratory syncytial virus
greatly out-numbered the other viruses: it
caused 58% of the total virus infections
and occurred in winter epidemics. Influenza
A and B virus occurred during late winter and
spring, rhinovirus had a seasonal distributi­
on towards spring and autumn, Whereas
adenovirus types 1,2, and 5 had no distinct
seasonal distribution. Whereas, respiratory^
syncytial ' Virus were mainly associated with
bronchiolitis^ and adenovirus type 7, with
pneumonia, rhinovirus infections werQ most
often found in children with episodes of
acute bronchial ascnma. The influenza A and
B’and adenovirus types 1,2 and 5 infections
often occurred with extra-respiratory
symptoms, especially febrile convulsions.

f!

management of ARIs
Child care practices in the i
.M
Kumar V, Kumar L, Manalet al
PGIMER, Chandigarh

Study conducted s not mentioned

Study published • 1984
Published j Indian Pediatr 19^4? 21:15-20

C qective

Me thodology

Findings

ABSTRACT
To study the knowledge of health workers and
mothers regarding aetiology and
<-- treatment of
respiratory infections.
I ,
Interview technique was used for collection
of information.
Most mothers and health workers?
- Prefer the modern system of
J^t^til!
of
RMPs
in
preference
mothers utilize services
to qualified doctors.
- Can differentiate URI as being distinct from
pneumonia
- Donot know pneumonia is caused by infectious

agents

Recommend­
ations—

- Do not know that pneumonia can be completely
treated in the village.
EQl„Eoreement, Health ^ucatlon J alsseminatlon
Of knowledge and training of RMPs.

'1

13

Acute respiratory infectiohs in Kangrh districts
Magnitude and current treatment pradtlces 1

Jai P Narain and TD Sharma *
National Institute of Communicable DiseasesrDelhi
and * District Health department, Kangra Distt., Dharamsala,

U.P.
Study conducted: October i984> September 1985

Study published:

23 rural PHC

Hospital based data

- 1987

203 subcentres & 6 hospitals

Published: Ind. J Paediatr 1987: 65: 441-444
ABSTRACT

Obj ectives

To study the annual incidence
of acute respiratory infections
(ARI) arid to test the WHO criteria
for control of ARI under Indian
conditions, as per the opinion
of physicians practising at the
peripheral level.

-

A review of the medical records
of PHCs ip Kangra district for
calculation of annual incidence
rates for ARI considering the 1981
population census. Standard
questionnarie was filled by a
random sample of health sentre
physicians to elicit information
on current treatment practices
for ARI.

Methodology

Findings

■/Ai,
I

I

$

Of the 3,72,000 attendances at the
PHCs, 18% were for ARI and 12% .
for diarrhoeal diseases. The annual
incidence of visits for ARI among
children below 5 yrs was higher
than that of general population
(8.2/1000 Vs 6.7/1000). ARI was
more common during the post monsoon
period and among people living
in mountalneous areas. The case
fatality rate in hospitalised ARI
patients was 10.5%. Interview of
health centre physicians regarding
ARI management practices indicated
that chest indrawing (considered
by WHO as pathognomonic of severe
art) was not
ARI)
pot recognised as an
....contd»

m
important sign by majority of
physicians. Ninety one percnnt
of physicians disagreed (69% in
strong tepns) with the idea of
providing health workers with
antimicrobials for management
of 2kRI at the community level.
Recommendations

It is important to convince the
physicians of the rationale
belli nd and the need for providing
the PHC workers with antibiotics,
before launching a national
control pjrogiramme.

A uniform antibiotic policy needs
to be formulated in the management
of ARI throughout the country.
Rapid development of diagnostic
techniques for the etiologic
diagnosis of severe ARI, which
could be applied at the PHC level.

• .1

IS
Socio-economic andecologic correlates of acute respiratory
infections in preschool children

B.M.S. Walia, S.K; Gambhir, S. Slnghi and S,R* Sroa

Deptt. of Paediatrics, PGIMER> Chandigarh-160012
Sti ly conducted : 1980-82

Stu iy published : 1988

Rw il area
Mundikharar, distt. Ropar

Published? Indian Pediatrics, 1988; 25? 607-612*

ABSTRACT
Objective

To prospectively study acute respiratory
infections (ARI) morbidity in a rural child
population and its environmental correlates.

Methoddlogy

A total of 227 preschool children from a
population of 3,264 were selected for the
study. Data on health was collected by ANM
during fortnightly home visits. About 10%
of the cases reported by ANM were examined
by thedoctor•

Fi lings

There was no significant association between
ARI attack rates and different socio-economic
and environmental factors, viz, educational
.status of parents, per capita income, family
size, type of housing condition, cooking
fuel used, parental smoking andpreserice of
domestic animals in the house.

16
Acute respiratory infections in children:
A hospital based report
■

. i

A.K. Patwari, S. Aneja.

Mandal and D.N.Mullick

Deptt. of Pediatrics, Lady Hardings.Medical College and
Associated Kalwati Sarah Childten’s Hospital, New Delhi-110001
Study conducted : not>mentioned
Study published : 1988'

Hospital - based data
Kalawati Saran Children's Hospital
Published: Indian Pediatrics; 1988r.j25: 613-617
ABSTRACT

Objective;

To study the morbidity1 and mortality in
Children suffering from ARI during a two year
period.,

Methodology

Clinical examination of ear, nose, throat and
respiratory system was conducted for all
children and X-ray chest was taken in all the
caises and direct laryngoscopy performed in
some cases wherever indicated. Diagnosis of
pneumonia was radiologically confirmed.

Findings

' ARI constituted 26.9% of hospital admissions*
A total of 94% of all admissions due to ARI
were below the age of five years. Pneumonia
was the leading cause of hospitalisation m
underfives admitted with ARI (83.9%) followed
by bronchiolitis (5.0%) and post measles ARI
was 22% of all hospital deaths and more than
78% of them were infants. Case fatality in
children below five years of age was highest
with post measles ARI (39.7%),■pneumonia
(18.9%) hnd acute laryngotracheobronchitis
(14.4%)*ARI condributed to larger numebr of
hospital deaths in underfives as compared to
diarrhoeal.

/

! :’<U‘

#iV’.

'

''

I

f7

f

A
Involuntary smoklpg and incidence of respiratory illness
during first year of life.
'i

.

!

Pedreir^ FA, Guandolo VL, Feroli EJ et al, USA
Study conducted s not mentioned
Study published : 1985

b

punished: Pediatrics, 1985 ) 75:594-597
)1

ABSTRACT

i

0- j active

To study the association between involuntary
smoking and incidence of respiratory illness
during first year of life.

Methodology

Prospective cohort of 1144 children followed
during first year of life to assess relative
risk of ARI.

Fi idings

For bronchitis the relative risk was 1.44
and for tracheitis 1.9, when any one of
the parent smoked.

!■

• ri .

'

- k'

Vi:

i

A

18

Nutrition and acute respiratory.infections

Eds. Douglas RM and Kerby Eaton E,
In, Acute Respiratory infections
Proceeding of an international workshop>
”

1

Sydney, Aug. 1984 University of Adelaide,
Adelaide, 1985s 68-71
ABSTRACT
Objective

To study morbidity and mortality due to ARI
in.malnourished children

MGthbdo'logy

Prospective urbane cohort7of 492 of the 810
children admitted to hospital for ARI children
'below,S years. PEM by weight for age.

Findings

ARI episodes Were similar in normal or mild
PEM (7.2) and moderate or;severe PEM (7.2).
Forty one percent had itoddrate-severe PEM v/s
'population prevalence of 21%. ARI case
fatalitv rites moderate'’to severe PEM 7.7%
Mild iPEM 2>3% and normal^0.7%. Relative risk
of ARIk,death withrmoderate and severe
PEM was 3.3. i

t.

19
?■

Clinical profile of acute bronchiolitis

Devendra Sareenj Usha Sharmd & S Saxena
Depth of Paediatrics, Jay Kay Lo^ MCHI, Jaipur

Study conducted s not mentioned
Study published : 1903

Hospital based data
Jay Kay Lori Mother & Child Health Ihstltrite, Jaipur
Published: Arch Child Hlth, 1983r 25(1), 1-8

ABSTRACT

Objective

to find out the clinical profile of acute
bronchiolitis.

Methodology

A thorough clinical examination of 400
children with clinical diagnosis of acute
bronchiolitis and recording 6f information
on past and present morbidity and family
history was done ih btder to institute
appropriate treatment. Routine laboratory
investigations were also conducted.

(

Findings

Acute bronchiolitis was most commonly obser­
ved In infants below 6 months of age.
Congestive cardiac failure was found in 22%
of these children and radiological
evidences of emphysema was seen in most of
thefn.' Most of them improved within 10 days.
’Highest mortality was observed in infants
belbw 6 months of age and those having
associated congestive cardiac failure.

Recommenda-

Cases of acute bronchiolitis should be
investigated properly and managed accordingly
.to reduce mortality due to this viral
disease in early infancy.

; “

tlbns.

a

.

10

A comparative anhlydld bf fcHe treatment practices
being followed in the management pf acute respiratory
infections (ARI) in children.

Singh S, Kumar L and Kumar V
PGIMER, Chandigarh

Study conducted : 1984--85

Unpublished Study
ABSTRACT

Objective

To compare the treatment practices
being followed in the management of acute
respiratory infections in children.

Methodology

Interview and observation techniques
wereused for collection of data.

Findings

Pediatricians provide better care than
others« Institution - based doctors
i perfotin better than private practitioners.
Need for continuing education and onjob-training programme. Gross misuse
of aHtimiorobials in commori cold.
Inadequate duration of antimicrobial therapy
in streptococcal sore throat. Incorrect
choice gf. antimicrobials iri pneumonia.
Tetracyclines still being used in children.

Recommendatjlons

More,emphasis on current management
practices in ARI.

r

2-1

Man gement of severely malnourished children by village workers
in Integrated Child Development Services* in India.
Pro

B bi Tandon et al

* C airman ICD3 Central Technical Committee for Health and

Nut»ition

I
t
k

Dat ; analysed by Dr Ajit Sahai, Biostatistics Division of
ICD
Central Cell
Stud7 conducted

not mentioned

Stud y publi shed

198^

I
?■
V -<

Hur-. 1, tribal and urban area

Fifteen states of India
Published

J 'Prop Paediatr, 1984;

30:274-279

i

i

ABSTRACT
Objective

To evaluate the management «of severely malnourhshed
!

children by village workers in Integrated Child
Development Services in India.

biet' odology A multistage stratified random sampling procedure

Was used for the selection of 6 anganwadis each
from rural, tribal and urban slum stratp of projects
from 15 major states.

at 406 anganwadis.

The study was carried out

Four thousand, two hundred and

•ninety tv/o children v/ith severe protein energy

■■ l

; I

malnutrition v/ere followed up every week for 6 to

12 weeks by 33 consultants.
Findings

Eighty five

percent children improved, 6.3% had

no change, 3*6% deteriorated, 3.0% died and ,2.1%
were lost to follow up.

Diarrhoea, short fever and

iI

apparent respiratory illness were associated illnesses<

contributing to the death in 42.6%, 38.0% and
34.9% of fatal cases.

Prevalence of severe mal-

nutrition and fatality were higher in younger

children less than 3 years of age compared to older
<

ones between 3 to 6 years of age.

Referral from

I

I"1-ip

I
!

village centre to larger health facilities was

not utilised by majority of the relatives of the
It is concluded that village level

sick children.

rf; ■

I

i

management of severely malnourished children by a
■

local worker is an acceptable and eJ^fective

approach and low cost.
The above mentioned
.
,, approach is, recommended

liecommendation

for countries with endemic protein-calorie mal-

.

nutrition.

1B

ft

-

:
-Hl

'

' ! 'i

-

■'

< ■ n

■

.

■

'

i.

' I

I:

I
‘■I’1

I

.1

■I

't i

J

!. I;

ii' f" •"
■

■I
■. Ill

,

1I

\

■

■I

Ji

I

2-3

Sequential health effect study in relation to air pollution

in Bombay, India.
Kamat, SR; Doshi, VBj

Published : Eur J Epidemiol, 1987s 3(3): 265-277.
Abstract

Objectlye

To study the effect of air pollution on health
of the population.

Methodology 4129 subjects from 3 urban (high, medium and lew,

according to SOg levels) and a rural community

were studied for a period of four years.

Morbidity was studied in relation to ecologic
factors including levels of SO2.

Findings

- i

i. ...wuMtMa

Initially in the three urban areas and the

rural community, the standardized prevalences

(in percent) were : for dyspnoea 7.3, 6, 3.2 and

5.5 for chronic cough and colds. 18.0, 20.8, 12.1

and 11 percent.

The diagnosis of chronic bron­

chitis was done in 4.5, 4.5, 2.3 and 5.0 percent

and cardiac disorders 6.8, 4.3, 8.2 and 2.7 percent
in respective 4 ^reas.

After 3 years, 55 - 60%

of urban and 44% of rural subjects were reassessed.
Several minor symptoms- besides above ones were

related closely to the urban air pollution profile.
Yearly declines were larger in all urban areas as

compared to rural area.

The'frequency of colds

cough and dyspnoea was greater in urban area.
especially in "urban medium" area.

Monthly trends

correlated to.SOg levels and the daily fluctuations

: 2^1

with SOg revealed a threshold between 50 to 100 jugs/
cm/day.

The major factors affecting morbidity were

pollution, nutrition, occupation, smoking and age.

I

2.5
Recent respiratory and enteric adenovirus infection in

children in the Manchester area
Richmond, SJ; Wood, DJ; Bailey. AS}
Published : J R Soc Med. 1988: 81(1) : 15-18

Abstract

Objective

To study the clinical and epidemiological
aspects of a recent respiratory and enteric

adenovirus infection in children.

Methodology A community-based

study was conducted during

a three year period to study the clinical and
epidemiological aspects of respiratory and enteric

adenovirus infection.
Findings

Seventy three group B adenoviruses (29 type

3 and 44 type 7)isolated.

Considerable genetic

heterogeneity was identified, particularly amongst

the type 3 isolates, but this genome variation
could not be correlated with either clinical or
epidemiological findings.

Group F adenoviruses

were found in 132 (4.1%) of 3202 stool specinuens
from children with gastroenteritis and, after

rotaviruses, they were the most common viruses
identified.

Unlike rotaviruses, these enteric

adenoviruses were endemic throughout the 3 years
study period and the greatest proportion of
infections (47.6%) were found in babies under
6 months old.

Nosocorn'ial infections in a pediatric intensive care unit
Milliken, J; Tait, GA, Ford Jones, EL: Mindorff, CM;
Gold, R;* Mullins, G;
Published : Grit Care Med, 1988; 16(3) : 233-237.

Abstract
Objective

To study nosocomical infections in a
pediatric Intensive Care Unit (PICU).

Metholology A total of 1388 patients in FICU were studied
over a period of 30 months.

Findings

In all, 116 infections occurred in FICU.
Lower respiratory tract infections comprised
15% of the infections.

The remaining infections

were divided equally among Gl, skin, eyes,
upper respiratory, postoperative wounds, and

other sites.

Coagulasenegative staphylococci,

pseudomonas aeruginosa and staphylococcus aureus

were the most prevalent pathogens.

Surgical

patients had similar rates of infection to

medical patients.

Patients in the first 2 years

of life, particularly those between 7 and 50 days
of age, had the highest rate of infection.

Onset of infection was more common after the
first week in the FICU with 11% of patients

staying 14 to 20 days, 27% of patients staying
21 to 27 days, 48% of patients staying 28 to

34 days, and 52% of patients staying more than

35 days before the onset of infection.

The

risk of nosocoml^al infection increases with

arterial and central line use, prolonged intubation, ventilation, Intracranial pressure

monitoring and

paralysis.

Respiratory syncytial virus epidemics : variable dominance
of subgroups

A and B strains among children, 1981-1986.

Hufron, MA; Belsbe,

Dwell, C; Morrby, E;

Study Conducted : 1981-86

Study Published : 1988

Published: J Infect Dis, 1988; 157(1)jI^J-I^S.
abstract

Objective; To study
study the
the ais
’criouuxvn of subgroups A and B
distribution

strains from respiratory syncytial virus in
Huntington, West Virginia.

Methodology Two hundred and thirty five

infants and children

were studied for RSV.

rindings

RSV vjss isolated from 211 of the 235 infants

and children.

One

hundred and sixty strains

(75.8%) were identified as subgroup A and 51
(24.2%) as subgroup B. Subgroup A strains

occurred at least three times as often in all

yeai’S except 1984-85•

Evaluation of the health status of 0 to 4 year old
children in ■m urban community of Abidjan
Diomnnde, I; Hey, JI.; Imboua Bogui, G; Semenov,Fl;

Study conducted : 198.5
Study published : 1933
area
Abidjan, Ivory coast

Published : lied Trop Mars, 1988; 48(2):111-115. ,
ABSTRACT

Objoctive

fp evaluate, the health status of 0 to 4 year
old childrc?n in Abidjan.

i

Lotdotology Four thousand households were randomly selected
including 653 children under foui" years.

Mo thers,

v;ore interviewed and children examined.

Findings

Seven teen percent children were below the weight
curve standardise

for Ivory Coast, 8 percent

had a ral'.io arm diameter on head diameter lower ;

or level of 0.27 and 5zr% a ratio between 0.28 and

0.31•Diarrhoea was noted among 10% of children,
bronebopneumopathy among 44.7%, rhinitis among
53.6% and otitis 15.4%.

The interview of mothers

confirmed these results; in addition appeared

that

of children have hod measles in the

1 >reced injj mon 111.

The diarrhoeas or the ORK

infections prevalence is linked with the lack of

drinking water at home, the IRA prevalence with
commun.i by habitat; OIU-> infections are more frequent
anion.'; children from illiterate mothers.

He co rumen d a t i on

The situation can be improved by socio-economic

progress and emphasizing measles immunization.

Longitudinal studies

of infectious diseases and physical

grov/th of infants in Huascar,

an under-privileged periirbah

community in Lima, Peru.

Loper-de-domana, G; Brown, KH; Black, BE;
Kanashiro, HC;

Study Conduc ted : 1982-1984
Study Pub1isbed : 1989

1
1

Urban area

i

Lirnn, Peru

I

129(4):769-734.
Published : Am J Epidemiol, 1989;

I

abstkact

Objective

To Study infectious diseases and physical grov/thi

of infants in periurban community in Lima.
A sample of 153 Peruvian newborns were studied
Method ol or,y

longitudinally, during the firat yeai- of life.
Th- newborns included in the study were the

ones v/1 th birth v/eipht p;rcater than 2500 g.
Surveillance workers inquired about morbidity
thrice a v/eek during home

' I

I ■

visits besides taking •

g

authropondetric measurements.
Ejjld iu r:; 3

i I

During 48, 209 child days of observation,

'I

upper respiratory.infections were present on

13( 409 child days (27-8% prevalence) and

il

(15.5% prevalence).
,
diarrhoea on 7,466 'child days (.--- .
The diarrhoea incidence rate averaged 9,..8
episodes/child/year of observation; all children

iVAd at'least one episode of diarrhoea,

Average

veldts approximated those of NCHS standards

upto first 5-6 months and declined thereafter.

: 00:

Average lengths were less than the reference date, at all

ages.

Rabes of stunting and wasting increased progressively

during the first year of life.

a

r-V

X

Jtj,

^Z..

:■

*

■y

I

i

■ v

•31
'iral etiology and epidemiology of acute respiratory
nfections in children in Nairobi, Kenya.

Hazlett, DT; Bell, TTl; Tukei, PM; Ademba, GR;

Ochieng, WO; Magana, JM; Gathara, GW; Wafula, EM,
J amba,. A; Ndinya Achola, JO; et al
■

r

»

Published : Am J Trop lied Hyg, 1988; 39(6) :632-640,

abstract
Ob/jective

I

of acute
To study viral etiology and epidemiology
respiratory infections in children in Nairobi.

were
■nthodology Clinical and microbiological studies
years of
conducted on 322 children under five
age.

Findings

Viruses were demonstrated in 54% of the 822 children
the viruses identified
studied, but over half of
'

were types not commonly associated elsewhere with
the causation of severe ARI. Respiratory syncytial,
parainfluenza, and adenouiruses occurred in the
same age groups and during similar w&cJther conditions
as elsewhere.

Herpes simplex, rhino, and

enteroviruses play causative roles in some cases
of severe ARI in Kenyan children.

X* \

Cf**"**

i ■

CH - I 35

. 1UP

clinical criteria for identification of
Assessment of
severe acute lower respiratory tract infections in
children
IM;
Campbell, H; Byass, Pj Lamont, AC; Forgie,
0’Meili KP; Lloyd levans, N; Greenwood, BM;
Published : Lancet, 1989; 1(8653):297-299.

ABSTRACT

Objective

To assess clinical criteria for identification

of severe acute lower respiratory tract
infections (LRI) in children
Methodology;

A

cohort of 500 Gambian children under 4 years

Clinical and radiological
of age v/os, studied•
examination was conducted.
Find ings

Symptoms and signs at presentation were related

to radiological evidence of lobar consolidation,

indicating severe LRI.

In infants, a fever greater

than 38.5 degrees C, refusal to breast feed, or

the presence of vomiting were the best predictors
of severe LRI. In Children aged 1 to 4 years, a
fever of greater than 38.5 degrees^ or a respi­
ratory rate greater than 60/min were the most
accurate clinical signs for severe LRI.

indrawing did not discriminate severe

Chest

LRI.

33

Analysis of respiratory syncytial virus diseases in
hospitalized children in the district of steyr 1984-85.

Emhofer, J; Ploier, R; Popow Kraupp, T;
Brunhuber, W;
Study Conducted : 1984-85

Study Published : 1988

published : Pediatr Padol, 1988; 23(1)! 15-23

ADSfRACT
Objective

To study the pattern of respiratory syncytial

virus (RSV) diseases in hospitalized children
i

I •

in Steyr.

I
I •

'
,

’

■

Methodology Nasopharyngeal secretions of hospitalized
infants with diseases of the lower Respiratory
tract were examined for viral antigens.

Findings

R3V antigen could be detected in 3^ of the
71 secretions,

In these infants a serious

clinical course, pneumonia

bronchiolitis or

obstructive bronchitis was dominant , but
I
charecteristic
pattern.
laboratory tests showed no

rulmonary X-rays of the RSV-infected. infants
revealed interstitial pneumonia with or without
pulmonary infiltration, in addition to symptoms
of hyper inflation.

i

31/

. Respiratory syncytial virus

Sinnott, JT; Gilchrist, LS; Ellis, L;
Published : Pediatri cs, .1989; 83(3) :380-384

ABSl’RACT

I
■j ■

Respiratory syncytial virus (RSV) is Considered
to be a significant pathogen causing bronchiolitis and
pneumonia through close contact.

Infants suffering from

congenital heart disease or bronchopulmonary dysplasia are

more succeptible.

Available diagnostic studies include

viral isolation, fluorescent antibody stains and enzyme
Aerosolized ribavirin therapy is beneficial.

immunosassays•

Strict environmentai control and use of protective clothing

and eyewear help to reduce nosoconxial spread of RSV.

k

i
i
i•

55

Morbidity pattern in children below three years

attending

a rural health centre in Haryana

Umesh Kapil and A.K. Sood
Nutrition Unit, AIMS, New Delhi-110029
Human
and Deptt. of Preventive? and Social Medicine,
Medical College, Rohtak.
Study conducted
conducted :: net mentioned

Study published : 1989

Rural area
Faridabad
Published : Ind redia-trics, 1989; 26:550-552

ABSTRACT
Cbjectiv e

To study the morbidity pattern in children
below three years attending a rural health

centre

in Haryana.

Methodology

to the rural health
All the children coming
centre were prospectively studied.

Findings

The common morbidity conditions found were
pyoderma (23.65%), respiratory infection (21.18%),
diarrhoea (20.05%), ear
ear infection (6.58%) and eye

The maximum episodes of
recorded in summer season (39.22%)

infection (5.^6%).

morbidity were
followed by rainy (31.36%) and winter season

(30.16%).
Re c omnend_a_tj^ons
Medicines may be supplied according to seasonal
pattern of diseases.

i
'•

.I

Group A streptococcus - associated upper respiratory
tract infections in a day-care centre.

Sum th, 'ID; Wilkinson, V; Kaplan, Eb;
Published : Pediatrics, 1989; 83(3) : 380-38A.

ABSTRACT
Objective

To study group A streptococcus - associated

upper respiratory tract infections in a day
care centre.

Methodology Microbiologic and antigenic studies were
conducted in a day care centre. Both, the
children and the adult inmates were studied.
Findings

During an initial three month period, symptomatic
upper respiratory tract infections associated
with throat cultures or rapid antigen detection
tests positive for group, A streptococci developed

in 55 of 214 (26%) children and adult staff in
in the centre. Fifty two of the 146 (36%) children
■

■■

■'

I

.

and 2 of the 24 (8%) adult staff, who Were off
antib iotircs, had throat cultures positive for
Of the 54 group A strep- r
tococcTal isolates found, M2, T2|;28 (35%),

group A streptococci.

M3

, T3/13(3O%), and M-NT, T25 (20%).

The overall

group A streptococcal positiv*ity rate whs 49%
for 187 ohtldren and 33% for 27 adult staff;
18 of 66 (27%) children younger than 3j/2 years
A streptococci
of age were found to have group
in their upper" respiratory tracts.

Acute respiratory infections in rural underfives

V.P. Reddiah and 3.K. Kapoor
Centre for Community Medicine, AIIMS, New Delhi-110029
Study Conducted : 1986

Study Published : 1988

Rural area
Ballabgarh block

published : Indian J Pediatr, 1988; 55: 424-426
ABSTRACT
Objectives To find out the morbidity and mortality due

to ARI, and their seasonal variation.
Methodology All (5,078) the underfives of 25 villages of
Ballabgarh block were prospectively studied.

A monthly follow-up was conducted by trained
I

field assistants to record the episides of ARI
occurring in preceding two weeks and recording

b i r I;h s a nd d ea 111 s.
Findings

Attack rates v;ere caiLculated.

The morbidity due to ARI was 3.67 attacks/child/

year with lowest attack rates in summer(2.1 in June)

and highest in winter(4.78 in January).

The

moderate and severe cases constituted 14.7% of
all cases.

Proportional mortality rate due to

ARI was 22.6% in these children.

were in infants.
■

66.5% of deaths

But the case fatality was
i

1.51% and the ARI related mortality was 6.3/1000

children and underfive mortality was 26/1000
children.

58
Acute respiratory infections of children

A nev; priority for Community Health Programmes
M.C. Steinhoff
Assistant Professoi.
.
Department of Epidemiology and Pediatrics, University oi
Michigan, Ann Arbor, Michigan, USA.
Study Conducted : not mentioned

Study published : 1986
Data from //HO and SR3 (Sample Registration Scheme), Govt,
of India
'I'1

Published : Ind J Commj • Med, 1986;

XI(1) :1-9

adstract
L’o review data on Acute Respiratory infections
(AIM) amony children. in India and compare it

v.'itlv data from N. America.
Petliodp.logy

A comparative analysis of data from \\IlO and
SRS, Govt. of India, was conducted.

Findings

Children in both India and North America experienced

5 to 8 episodes of ret-piratory tract infectiq/year.

AIM

mortality was nearly all due to deaths from

pneumonia.

ARI mortality rates in developing

countries are upto 100 times higher than ARI rates
Currently seen in N. America or N. Europe. SRS

surveys for childhood mortality showed that ARIs
account for 20 to 30 percent of deaths of children
under five in India.

The symptoms reported in

cases of ARI are attributed to infections due to
a number of organisms.

-•
.

■'

■

'.Wil

. i'! a

1S

j '

J: I-

L
A longitudinal study of morbidity among under-five
children in a semi-urban?area
i
I

S. Venkatesh* and R.D. Bansal**

i

* Deptt. of Preventive and Social Medicine, University
College of Medical Sciences, New Delhi-110029
* *Deptt..of Preventive and Social Medicine, Lady Hardinge

Medical College, New Delhi-110001.

Study Conducted : 1982
Study published : 1986
....

i

1

■

■•.

‘ >!

i

'

Urban area
ii.
Kuruchikuppam municipal wards, Pondicherry

Published : Indian J of Comm. Med

I.
1986; XI(1):11-2O

ABSTRACT

i

Objective To determine the incidence and prevalence of

morbidity; to identify the leading causes of
morbidity; and to study the effects, £f any, of

seasonal variations on the morbidity pattern.
Methodology A longitudinal study vias conducted on 224

children under five years of age.

The children

were clinically examined and their mothers were

interviewed for medical history of the children.

Findinga

A child had 4.85 episodes of illness annually

on an average.

Incidence rate for illness

episodes and children affected was highest during
the second quarter of the year, i.e., April to
J une •

Upper respiratory tract infections Showed^

the highest recurrence (3»95) followed by diarrhoea

(3.49)•

Respiratory illness and diarrhoea

accounted for 64<9% of all morbidity.

!

BI BLIOGRAPHY

i
f
i

\LtO:

BIBLIOGRAPHY

J

ii
1.

Acute respiratory infections in undfer-f ives:
15 million deaths a year (edito rial)
Lanc.et, 1905; 2(8 45 7) :6 99-7fl1

2.

Ag re,

F;

The relationship of mode of infant feeding and
location of care to frequency of infection
Am 0 Dis Child, 1985; 139(8): 809-811

4

3 .

Anestad,

t

G;

--- -------- ----------- ---- ~ -. —
,
_respiratory
—,--------- ---- -— z
--------------------_
_/
Surveillance
of
viral —
infections
by
rapid immunofluorescence diagnosis, with emphasis
on virus interference.
Epidemiol Infect, 1907 ; 99(2): 523-531

4.

Artemov,

.

i

i

VG;

Zamotin,

BA; Lysov,

i

i

IV;

Infectious morbidity in children of both sexus
during the first 7 years of life.
Zh Plikrobiol Epidemiol Immunobiol, 1986 ;

(7) : 71-75
5 .

8 eng u igu.! , Y ;
Control of acute respiratory infections
children in Para, Brazil.
Bol of Sanit Panam, 1987; 102(1) ;36-48

6.

Berrman, S; Pic Intosh,

in

K;

Selective primary health c?re: strategies for
control of disease in the developing world.
XXI. Acute respiratory infections
Rev Infect Dis, 1985; 7(5): 674-691

7.

Birchfield,

PIE;

Illnnoons and children in a preschool centre
Hatern Child Nurs 3, 1986; 15(3);
•
187^197

0 •

a.

Bjerregaard, P;
Infectious diseases in Greenlanders of Upernayik
Scand 3 Prim Health Care, 1 905 ; 3(3)
163-169
Brown,

RB; S techenb erg ,

B ; Sands,

PI;

i'
I

’

I

•Hosmer, D; Ryczak, PI;
Infections in a pediatric intensive care
unit
IAm
DisChild, 1987 ; 141(
1 41 (i(3): 267-270
I

10.

Bulla,

A;

I •

The exceedingly high burden of scute and chronic
r f
.
‘
‘
ospiratory
diseases-global
situation and prospects
Z Erkr Akmungsargane, 1986; 167(1-2)
6 3-6 7
?''

11 .

0ulia;,

a;

Hitze,- K.L.;

Acutg resoiratory infections: a review.
Bulletin of the World Health Organisation,
1978; 56(3)i 401-498

^1

12.

Campbell ,

H;

Byass, P; Lamont,

AC; Forgia, IM;

O' Neill, KP; l£oyd Evans, N; Greenwood, BM;
Assessment of clinical criteria for identification
□p severe acute louer respiratory tract infections
in children
Lancet, 1989; 1 (8633) :297-299

13.

Carlsen st al;
Viral infections of the respiratory tract in
hospitalised children
Acta Pediatr Scand, 1983; '72:53-58

14.

Chretien, 3; Holland, U; Hacklem, P;
«►

Hurray, 3; Uoolcock, A;
Acute respiratory infections in children
A Global public health problem.
Neu England 3 Hed, 1984; 310(15):
982-984

15.

Canavan
DA;
Robinson FL; uomcv
Connally, 3H; Russell, 3D; Robinson,
-..,, -r.
Echovirus type 7 outbreak in Northern Ireland during
1984
z k
Ulster Hed 3 , 1985; 54(2) :191-195

16.

Damodaran, H; Nadamuni Naidu A;
Ramesuar Sarma KV;
Anemia and morbidity in rural pro-school
Ind 3our Ned Res, 1979; 69:448

17.

Datta,

children

N;

ARI in L BU infants
3 of Pediatr, 1987; 54: 171-176
18 .

Datta,

N;

Kumar,

V;

etal .

! '

Case management in the control ofjacute respiratory
infections in lou birth weight infants: a ffeasibility
<l“

study.
,
Bull Uld HjBth Org,
19.

Danny,

1987

(in press).
*

,

FU;

Acute respiratory infections in children:
etiology and epidemiology
Pediatr Rev, 1987; 9 (5): 135~146

20 .

Denny, FU;

«

Clyde, UA 3r;

Acute lougr respiratory tract infections in
nonhospitalised children
3 Pediatr, 1986; 108 (5 Pt 1): 635-646

21 .

Denny, FU; Collier, AH; Henderson, FU;
Acute respiratory infections in day care.
Rev. Infect Dis, 1986; 8(4); 527-532

»

22.

Denny,
Loda, FA;
Acute respiratory infections are the leading
cause of death in children inrdeveloping countries
Am 3 Trop Fled. Hyg, 1986; 35(1): 1-2
?•
: C
:
r ■"

;

, r

{ ■■ •I

:

HZ-

23.

Doraisingham, 9; Goh, KT; Ling, A£;
Epidemiology of viral infections in Singapore
Ann Acad Med Singapore, 1987; 16(2);
243-249

24t

Doraising ham, S; Ling,

i

.

AE;

Patterns of viral respiratory tract infections
in S ing spore
Ann Acad M ed S i ng apo re, 1986; 15(1);

"I.

9-14
25.

Douglas, RM;
Acute respiratory infections*
Regional oFfice for the Western Pacific
1979 (Document WHO/WPR/RC 30/TP/l)

i

I
t.

26.

Edurards, KM;
Wright, PF;

Thompson,

Adenovirus infections

3; Paolini,

in young

3;
!.

children

Pediatrics, 1985} 76(3); 420-424

27.

Cochi, SL ;

Fleming, DW;
Broome, CV;

Hightower,

i

A J;

Childhood upper respiratory tract infections: to what
degree in incidence affected by day-care attendance?
Pediatrics, 1987; 79(1)i 55-60
23.

Ford, GW;

Rickards,

AL;

Kitchen, UH;

Lissenden, 3V; Keith, CG; Kyen, Mil;
Handicaps and health problems in 2 year old
children of birth weight 500 to 1B00 g.
Aust Pediatr 3, 19 85; 21(1) : 15-22

29.

Fosarelli, PD; De Angelis,
Hell its, ED;

C; Winkelstein,

3;

first two years of life
4(2): 153-159

Infections illness in the
P’diatr Infect Dis, 1985;
3U.

fox, JP; Cooney, l*IK; Hall, CE; Toy, 1*101;
Rhinoviruses in Seattle families, 1975-1979
Am 0 Epidemiol, 1985; 122(5): 830-846

31 .

Friedric, U; Ende, U;
I ncid once, and significance of disease of the
paranasal ©inuses
in small children
Z Arzt£ Fortbild Jena, 1986; 80(17):

707-710
32.

Geller Bernstein, G; Kenett, R; Ueisglass, L;
Tsur* S; Lahav, l*l; Levin, 5;

Atopic babies uith wheezy bronchitis.
Follow­
up study relating prognosis to sequential Ig£
velues, type of early infant feeding, exposure to
percental smoking and incidence of lowar
respiratory tract infections.
Allergy, 1979; 42(2)
■' r
85-91
■

:-r

V

, i h

_•

■■

i

■

Hj
Giugliawi, ER; Seffrin, »CF; Goldan, M;
Horn, SF, Ebrahim, GJ;
.,11_\ ) of the urban squatter
The malnourished children
families: a study] 5in Porc^o Alegre, Brazil
J Trop Pediatr, 1987; 33(4) ; 194-196

3 3.

34.

Gray,

Dillon,

BM;

i 1

HC Jr;

'■Ip

Clinical and epidemiologic: studies of
in children;
phoumococcal infection i..
Pediatr Infect Dis, 1986; 5(2); 2^1-207
35.

Gupta,

K0; Walia,

i i
; ’•

.

BNS;

A longitudinal study of morbidity 'in children

r

in a rural area of Punjab.
Ind 3our Pediatr, 1900; 47(387)S297
36.

Hazlett, DT; Bell ;

TM;

'JO; Magana,,

Ochieng,

Tukei,

PM;

Ademba,

GR;

!I

JM;, Gathara,
uow.«fc«, GM;
—

u«, A; Mdinya
Ndinya Achola, 00, etal ;
Uafula, EM; Pamba,
and epidemiology of acute
Respiratory’inf ecti.ons in child ten i n Nal robl, Kenya

Am J Trop Med Hyg ,

37.

Heinz,

F;

Tumova,

1 988;
B;

39(6); 632-640

! ■,

Krama r,

R ; Vai a,V;

Januska,

J,

Effectiveness of virologic surveillance of acute
respiratory diseases of viral origin.
Cask Epidemiol Mikrobiol Imunol, 1967;
36(3)S 132-139

30.

Indira Bai, K;
Morbidity patterni in children under five
in a rural community
.Arch"' Chid 'l-ll th', ’ 1 97 3; 15(2) :B3

Anwar,

11
;l

Z; Pardede N;

39.

Ismail, R; Djamil, H;
ArFin, F;
'.Acute respiratory tract inf
o n p r ev nl ence,
nag
pm
ont
in
the community in
mortality and case msi
villages
of
rural
South
Sumatra,
Indonesia ||
el ev pn v
■ ----Pediatr Indanes, 1967; 27(3-4); 61-67

40.

Kalra,

A; Pandey,

DN; Dayal, RS;

i
!

■

' '
A (Nendo of morbidity and mortality
pediatricCmed
icz$L)
amongst children hospitalised in a |
; ■
i
unit Agra.
Ind Pediatr, 1980; 27 : 693
I !
1

41 .

Kamnt, SR; Doshi, VBJ
'
Soqupntial health effect study in relation to
air pollution in Bombay, India
Eur 0 Epidemiol, 1987; 3(3);265-277

42.

Kapil,

AK;
Morbidity pattern in children belou three yepys
attending a rural health centre in Haryana
Ind Pediatr, 1989;' 26: 550-552

43.

KenoalI ,

U; Sood,

EJ ;

in the population
Acute respiratory infections
i
3 R 50C Med, 1985; 78(4): 282-290

I

*

44.

Khatua, SP;
Acute Bronchiolitis (A study of 205 cases)
Ind Pediatr, 1977; XIV (4)$ 205

45 .

Klein, 00;
Emerging perspectives in management a nd p r ev ention
of~infactions of the respiratory tract in infants

AnO3CreldfrT985, 70(68); 38-44
46.

Koh no j C; Ohtahara, Sj
C8US. Of OBftb in «v«r«ly.M"^CS.?p2,d chlldten

No To HattstBO, 1986s 18(6). 420-422
47.

•Kumar, L;
Sever® lower respiratory trect infection;

?‘„in°nS5 ep:Si:u^??e?^-i98
48•

Kumar, I, Singh RPJ
Staphylococcal lung disease in Indian children
‘ aXfracti. Symposium on Acute Respiratory
Infection in Asian Children. Sixth Asian Congress
□p Pediatrics, p 51

49.

Kumar,

V;

Need for a national control programme for acute
54(2): 145-148

50.

51 .

5?-.

53.

Kumar, V; Datta, N; Kumar, L;
Experienc. In th. irnpl f'
"pr !«"" y health
e”"!
Technical
Croup on Aeut, Respiratory
"f’cllcna, Second heetin,. Ceneve, fl.reh-25-29,1985
Document 'JHO/TRl / ARI • TAG. 11/85 14 ,
Kumar, V;

Kumar, L; l^and, Fl;

Cnld Core practices in the management of ARls
tnd Pediatr, 1904; 21 ;15-20
Kumari, S; Gupta, RJ Bhargeva, SK;
A nursery outbreak with salmonal!a Newport.
Ind Pediatr, 1900; XVIII(l)s1
I eng, T; Lafaix, C; fassin, D; Arnaut, I?

X! .Wi'#?
study of 151 children in
lot 3 Epidemiol, 1906; 15(4); 553-5

*

♦ todlnol

54.

L eowski,

;

Mortality from acute respiratory infections
in children under 5 years of age: global estimates
'JI d Hl th Stat Quart. Rapport Trimestriel
De Statistiqu^s Sanitaires Mondiales, 1986;
39 (2): 138-144

55.

Lirnpi tikul, U;

Thisyakorn, U;

Louer respiratory tract infection due to
flycoplasma pneumoniae in Thai Children
J fled Assoc Thai, 1 987; 70(6) : 335-337
56.

i

tokeshwar, SH; Pai, PPI;

Mortality in children - An analysis of 1690 deaths
Ind Pediatr, 1980; XV11(2):145
57.

Lopez~de~Roni ana , G; Brown, KH;
Black, R.E; Kanashiro, HC;
Longitudinal studies of infections diseases
and physical growth of infants in Huascar,
an underprivileged periruban community,
in Lima, Peru.
Am J Epidemiol, 1989; 129(4): 769-78*4.

i :

58.

Luwang, NC; Singh, SB; Devi, N;
Morbidity pattern amongst pre-school
children of a hill tribal community of
Manipur, Ind dour of Prev Soc Med,
1989; XV(4): 169.

59.

Moderova, E; Kestnerova, V; Cervenka J;
Pucekova, C;
Prevalence of nosocomial infections in
Selected hospitals
J Hyg Epidemiol Microbiol Immunol,
1987; 31(4): 365.- 374.

1

60.

61.

1;
i

I

1 Menzel> K
*
Medical care for infants in the maternal
health service - significance for
reducing postneonatal mortality.
Z Gesamte Hyg, 1987; 33(2) : 83-84.
MenzelK;Frey, J; Hotze, W; Borner, B;
Uniform care of children upto 3 years
of ege at child day care centres in the
city of Erfurt.
Z Gesamte Hyg, 1987; 33(2) : 75-77.

F
>.

i

62.

Milliken, J; Tait 5 GA;'Ford-Jones, EL;
Mindorff, CM; Gold, R; Mullins, G;
Nosocomial infections in a pediatric intensive
care unit.
,
Crit Care Med, 1988; 16(3) : 233-237.

63.

Mohs, E;
Acute respiratory infections in children:
possible control measures.
Bull Pan Am Health Organ,
1985 ; 19(1) : 82-87.

64.

Mtango, FDE; Neuvian, D;
Acute respiratory infections in children
under five years. Control project in
Bagamoyo District, Tanzania.
Trans Roy Soc Med Hyg, 1986;'80: 851-858.

65.

Narain, JP;
Epidemiology of acute respiratory
infections.
Indian J Pediatr, 1987; 54(2): 153-160.

6.

Narain, JP; Sharma, TD;
ARI in Kangra District.
Ind J Pediatr, 1987 ;65 : 441-444.

67.

Narain, JP; Sharma. TD;
Acute respiratory infections in Kangara
district : magnitude and current treatment practices.
Indian J Pediatr, 1987; 54(3) : 441-444.

I

47

I •

I
I

68.

Narain, JP; Sharma, RS; Sehgal, PN;
Control of acute respiratory infections
in children.
J Common Dis, 1987; 19(2) : 136-140

69.

Pacini, DL; Collier, AM; Henderson, FW;
Adenovirus infections and respiratory
illness in children in group day care.
J infect Dis, 1987; 156 (6) : 920-927.

4

■1

Partatmo,A; Soenarto, Y; Triatmodja; Ismangoen
H; Haksohusodo, S; Slemon, RD;
Mild acute upper respiratory infection (AUKIJ
in children from the Outpatient Paediatric
Department, Dr. Sardjito General Hospital

70.

I,; ‘i
c

Pediat?rindones, 1987; 27(1-2) : 20-28.
71.

Patwarl, AK; ek al
Acute respiratory infections in children.
Ind Pediatr, 1988; 25 : 613-617

72.

Pedreira, FA; et.al
Involuntary smoking and incidence of
respiratory illness during first year of
life
Pediatrics, 1985; 75 : 594-597.

73.

Pickering; LK;
Infections in day care.
Pediatr Infect Dis J, 1987; 6(6) : 614-617.

74.

Pio, A;
WHO Programme on Acute Respiratory
Infections.
Ind J Pediatr, 1988; 55 : 197-205.

75.

76.

77.

f-

Pi°, A;

i

i j

-f

Acute respiratory infections in children or
developing countries : an international
point of view.
Pediatr Infect Dis, 1986; 5:179-183.

Pio, A; et al
The magnitude of the problem of acute
repiratory infections.
glas, RM;
& Kerby - Eaton E(eds),
In:DouglasF
respiratory
infections in childhood.
Acute
of
an
international
workshop, Sydney,
Proc.
August 1984. Adelai'de, University of
Adelaide, 1985.
Prasad Rao, DCV; Puri, RK;
J
Morbidity pattern seen in urban pediatric!
centre.
Ind J Pediatr, 1973; 40:396.

a

I

r

: -l. ' •

■A ;

*

78.

Proceedings of the International workshop,
Sydney, Nutrition and Acute Respiratory
Infections.

79.

Ravasarinoro, M; Razafimihery, J; Razasamparany,
M; Coulanges, P;
Viral etiology of acute respiratory infections
in Madagascan children
Arch Inst Pasteur Madagascar, 1986;52(i) : 147’155.

30.

Recommendations for using pneumo coca'al
vaccine in children.
American Academy of Pediatrics,
Committee on Infections Diseases, 1984-85.
Pediatrics, 1985; .75 : 1153’1158.

■L.

I

, ih

I

31.

SK:,
Reddiah, VP; Kappor1 j DIX
Acute respiratory iinfections in rural underfives.
55:424-426.
Ind J Pediatr, 1988;
~

82.

Reeves, WC; Dillman, L; Quiroz, E; Loo, S;
Lugue, S; Harris,
Harris, S; Brenes, MM; de la
Quardia, ME; Centeno, R; Sanchez, V; et al
Epidemiology of acute respiratory disease
at the Peadiatric emergency room of the
social security medical centre in Panama
city, Panama.
Bull Pan Am Health Organ,
1985; 19(3): 221-234

83.

Respiratory syncytial virus surveillance
in various regions across Canada.
Can Med Assoc J, 1987; 15; 136(2) : 157-158

8 +.

Richmond, SJ; Wood DJ; Bailey, AS;
Recent respiratory and enteric adenovirus
infection in children in the Manchester area.
J R Soc Med, 1988, 81(1) : 15’18.

8 i.

Ruley, ID; Lehmann, D; Alpers, MP; etal
Pneumococcal vaccine prevents death from !
acute lower respiratory tract infections |
in Papua New Guineai-' children.
i
Lancet, 1986; 2 : 877-881.

86.

River on (?orteguera, R; Rojo Concepcion, M;
Gonzalez Valdes, JA;
Mortality due to acute respiratory
diseases in children younger than 5
years old. Cuba, 1968-1984.
Sante Publique Bucur, 1987; 30(3): 197-206.

87.

Santhakrishan, BR; Peter A;Ragu, BV;
Morbidity and Mortality pattern of
children in Madras city.
Ind J Pediatr, 1973; 40(310) : 389.

a

I

• J

■

f

-

88.

Sareen Devendra; etal
Clinical profile of acute bronchiolitis,
Arth Child Hl.th, 1983; 25(1) : 1-8.

89.

Schopfer, K; Germann, D; Eggenberger, K;
Bachler, A; Wunderli, W;
Viral respiratory infections in children:
new diagnostic methods for early detection
Initial results of a pilot project in
Switzerland.
Schweiz Med Wochenschr, 1986, 116(16): 502-507

90.

Shann, F;
Etiology of severe pneumonia in children
in developing countries
Pediatr Infect Dis, 1986; 5: 247-252.

91.

Singh, S; Kumar, L; Kumar, V;
A comparative analysis of the treatment
practices being followed in the management
of ARI in children.
Unpublished study.

92.

Sinha, B; Banerji, SC; Singh, G;
A prospective study of morbidity and
mortality among infants in Allahabad
city.
Ind Med Gaz, 1979; CXIII(3);83.

93.

Sinnott, JT 4th; Gilchrist, LS; Ellis, L;
Respiratory syncytial virus.
Infect - <control - Hosp - Epidemiol. 1988;
468.
9(10) : 465

94.

Smith TD; Wilkinson V; Kaplan El;
•Group A streptococcus - associated
upper respiratory tract infections in
a day - care centre.
Pediatrics, 1989; 83(3) ; 380-384.

95.

Stansfield, SM;
Acute respiratory infections in the developing
world : Strategies for prevention, treatment
and control.
Pediatr Infect Dis J, 1987; 6:622-629.

96.

Steinhoff, MC;
Acute respiratory infections of children,
A new priority for community health
programmes.
Ind J Comnr Med, 1986; XI(l):l-9

97.

Tandon, BN; etal
Management of severely malnourished
children by village workers in
ICDS in India.
J Trop Pediatr, 1984; 30:274-279.

t

t

*

*

A
Media
11203.pdf

Position: 6105 (1 views)