Misdiagnosis of pneumonia, bronchiolitis and reactive airway disease inchildren: A retrospective case review series in South East, Nigeria (original) (raw)
Related papers
PLoS ONE, 2013
Background: Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among "under-fives" with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. Methods: We enrolled 614 children aged 2-59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as "asthma syndrome" due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant's case report post hoc and made a diagnosis according to the study criteria. Results: Of the 614 children, 41.2% (95% CI: 37.3-45.2) had asthma syndrome, 27.2% (95% CI: 23.7-30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1-30.2) had viral pneumonia, while 5.1% (95% CI: 3.5-7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9-97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1-91.5) for bronchodilators and 43.1% (95% CI: 36.9-49.4) for steroids. Conclusion: Although reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia in Uganda.
Complications of pneumonia and its associated factors in a pediatric population in Osogbo, Nigeria
Nigerian Journal of Paediatrics, 2020
Introduction: Pneumonia is one of the leading causes of morbidity and mortality in underfive children. Nigeria still has a high burden of child death due to pneumonia. Many of these deaths result from the development of complications. This study was done to determine the pattern of pneumonia complications and its associated factors amongst underfive children with pneumonia. Methods: It was a hospital-based cross-sectional observational study involving 129 children aged 1 - 60 months with a diagnosis of pneumonia. The participants were recruited over a nine-month period. Clinical signs were recorded, and a confirmatory chest radiograph was obtained within 24hours of admission. Result: Of the129 subjects studied, 70 (54.3%) had complications. Children less than 24 months had a higher frequency of complications at presentation. Heart failure and anemia occurred more commonly. Other complications were pleural effusion, empyema, pneumatocele and pneumothorax. More than half (57.1%) o...
Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria
Nigerian journal of paediatrics, 2013
Background/Objectives: Pneumonia is a leading cause of morbidity and mortality in children and thus this study was designed to document the sociodemographic, clinical features as well as the bacterial agents responsible for pneumonia in children seen at University of Ilorin Teaching Hospital. Methodology: A descriptive cross-sectional study of children aged one month to 14 years with features of pneumonia admitted between July 1 st 2010 and June 31 st , 2011 was carried out. Sociodemograpic data, clinical features, complications and outcome were obtained. Chest radiographs and blood samples for culture of bacterial organism and full blood counts were obtained in all children. Results: Pneumonia accounted for 13.3% (167 out of 1254) of the all admissions during this period. The male: female ratio was 1.5:1, and 101(60.5%) of the children were infants. Bronchopneumonia was identified in 147(88%) children, lobar pneumonia in 15 (9%) while 5(3%) had a combination of both. Cough, fever, difficulty in breathing, tachypnoea and chest wall recessions were recognised as clinical features in the study population. Bacteraemia was present in 46(27%)children and Staphylococcus aureus was the most common organism cultured from the blood of children with pneumonia present in 11 (23.9%) out of the 46 (100.0%) isolates. Heart failure was associated complication present in 52 of the 60 children with one or more complications accounting for over 30% of all patients. Eleven out of the 15 children with lobar pneumonia had pneumonia-related complications which was significantly higher compared to 46 of 157 children with bronchopneumonia, p=0.003. The case fatality was 6.6%. Eight (72.7%) of the children that died were infants while the remaining three (27.3%) were aged between 12 and 60 months. The mean duration of hospitalization among those who survived of 6.5 ±5.0 days was significantly lower than the corresponding value of 10.2 ±12.3 days in those that died, p= 0.042. Conclusion: Pneumonia-related mortality and morbidity is high in under-five children, with the infant age group most affected. Bronchopneumonia is the most prevalent ALRI diagnosis but lobar pneumonia is associated with a higher mortality.
Aim: To identify clinical parameters other than respiratory rate which are simple and equally predictive ofpneumonia in under five children. Patients and Method: One,hundred and one children with f, J!Spiratory symptoms s 28 days were studied. Detailed history, physical examination and chest radiography were done on each child. Data was analyzed using the EPI-INFO version' 5 software. Results: A combination of history of difficult breathing and/or observation of chest in-drawing was the best predictor of pneumonia in all age groups studied (75% sensitivity, 80% positive predictive value). Conclusion: · We suggest that the current WHO guideline on the use of respiratory rate to predict pneumonia be expanded to include history of difficult breathing and/or observation of chest in-drawing as major criteria for predicting pneumonia in under five . children.
Annals of Medical and Health Sciences Research, 2015
Background: Reports from the developed nations reveal respiratory tract infections as the leading cause of childhood hospital admissions. Children may be admitted for a variety of respiratory illnesses. Data on the spectrum of pediatric respiratory illnesses admitted in the hospital is scarce. Aim: To determine the pattern of pediatrics respiratory illness admissions, seasonal frequency, underlying risk factors and outcome. Subjects and Methods: A retrospective assessment of respiratory cases admitted in the pediatric ward from 2005 to 2010 was conducted using case notes. Parameters considered included month of presentation, age, sex, immunization and nutritional status, tools of diagnosis and patient outcome. Results were analyzed using the Statistical Package for the Social Sciences with the level of significance P ≤ 0.05. Results: Of the 239 cases admitted, there were more males than females (1.4:1). The commonest case was Bronchopneumonia, 71.6% (171/239 out of which 161 were uncomplicated, 5 had effusions and 6 were associated with measles). Other cases were Pulmonary Tuberculosis, 10.9% (26/239), Lobar pneumonia 8.8% (21/239), Bronchiolitis, 5% (12/239), Aspiration pneumonitis 2.1% (5/239) and Bronchial asthma, 0.8% (2/239). Mortality was 7.5% (18/239) mostly from Bronchopneumonia amongst the 1-5 years old. Mortality was significantly associated with malnutrition (P < 0.001) and poor immunization status (P < 0.01). Conclusion: Bronchopneumonia was found to be the commonest illness with significant mortality and peak occurrence in the rainy season. More emphasis must be laid on anticipatory guidance and prevention by encouraging the immunization, good nutrition and increased attention on children even after 1 year of age.
UPTH . Studies on pneumonia within Nigeria and abroad
2012
Background: Childhood mortality which remains high in children under the age of 5years is largely due to infectious and other preventable causes such as Human immunodeficiency virus/ Acquired Immunodeficiency 1 Syndrome ((HIV/AIDS), pneumonia and malaria . The prevention of pneumonia deaths is therefore an important th approach if the 4 Millennium Development Goal (MDG4) is to be attained. Aim: The aim of this study was to describe the pattern, clinical features, management and complications of pneumonia in under-five children admitted in the University of Port Harcourt Teaching Hospital (UPTH) and to highlight their morbidity and mortality. Methods: This was a retrospective cross sectional descriptive study of children diagnosed with pneumonia who were admitted into the children's wards between January 2007 and December 2009. The case notes of all children diagnosed of pneumonia who were admitted into the paediatric wards as recorded in the ward register, were reviewed.
BMC Infectious Diseases, 2008
Background The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. Methods A group of paediatricians conducted a retrospective review of clinical and laboratory data including C-reactive protein concentration and chest radiograph findings among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia. Our aim was to evaluate which disease entities the WHO definition actually captures and what is the probable aetiology of respiratory infections among these episodes diagnosed in this population. Results Among the 12,194 children enrolled to the vaccine study we recorded 1,195 disease episodes leading to hospitalisation which fulfilled the WHO criteria for pneumonia. In total, 34% of these episodes showed radiographic evidence of pneumonia and 11% were classified as definitive or probable bacterial pneumonia. Over 95% of episodes of WHO-defined severe pneumonia (with chest indrawing) had an acute lower respiratory infection as final diagnosis whereas 34% of those with non-severe clinical pneumonia had gastroenteritis or other non-respiratory infection as main cause of hospitalisation. Conclusion The WHO definition for severe pneumonia shows high specificity for acute lower respiratory infection and provides a tool to compare the total burden of lower respiratory infections in different settings. Trial registration ISRCTN62323832
Prevalence of Pneumonia in Children’S Under Five Years in Al Sabbah Hospital Juba – South Sudan
Research Square (Research Square), 2021
Background: Each year, pneumonia affects about 450 million people globally; it is a major cause of death among all age groups resulting in 4 million deaths (7% of the world's total death) yearly. Pneumonia is de ned as the presence of fever, acute respiratory symptoms, or both, plus evidence of parenchymal in ltration chest radiography. Although, in the past decade the incidence of the disease was reported to have declined by half percent, that alone was considered to be the slowest decline in comparison to other diseases The objective of the study is to determine the prevalence of pneumonia in Al Sabah Children Hospital and to assess the risk factor associated. Method: A cross-sectional study design was used to determine the prevalence of pneumonia in children under-ve years in Al Sabah hospital, Juba South Sudan. The study ran from 18 th September to 5 th of October 2021. 241 participants were randomly selected for the study and primary data were obtained through questionnaires. Results: The prevalence of pneumonia in children under-ve years was found to be 22.4.7%. The incidence is highest in males 23 (57.5%) compared to females17 (42.5%). The ethnicity of the patients from Dinka (37.5%) and Bari (30%), Shilluk (7.5%), Mundari (2.5%), Madi (5%) Nuer (7.5%), Murli (5%), Lolobo (2.5%) and latoka (2.5%) and the leading ethnicity with high morbidity of pneumonia was found to be in Dinka. Conclusion: The prevalence of pneumonia in children under-ve years in Al Sabah hospital is high compared to the previous research done by the students of Upper Nile University at the University of Juba in 2019 with the prevalence of 21%
Maternal perception of pneumonia in children: a health facility survey in Enugu, eastern Nigeria
Annals of Tropical Paediatrics, 2002
In a health facility-based study to determine the knowledge of mothers regarding recognition of pneumonia in their preschool children, 400 women were interviewed using a pre-tested structured questionnaire. Sixty-one per cent of them would recognise pneumonia by diYcult breathing, 42% by fast breathing and 26.5% by severe cough. Few of the mothers mentioned signs suggestive of 'chest indrawing' (8.5%) and 'central cyanosis' (1%). The maternal knowledge score on pneumonia signs increased signi cantly with educational status and social class (p<0.05). While a substantial number of mothers (51%) perceived fast breathing to be an indication of severe pneumonia, a sizeable number (87.5%) were unsure if late signs such as chest indrawing and central cyanosis suggested severe disease. On the basis of the WHO criteria, it is concluded that maternal recognition of pneumonia in children is at best modest while knowledge of signs indicating severe disease is poor. These ndings underscore the need to modify the WHO criteria to include diYcult breathing and to highlight during local ARI health education campaigns that late signs such as chest indrawing and central cyanosis indicate severe and potentially fatal pneumonia.
BMC pulmonary medicine, 2014
Respiratory diseases are one of the causes of childhood morbidity and mortality as well as hospitalization globally. The patterns of different respiratory illnesses in several parts of the world have been reported but there are few on the combined burden of the diseases. Determination of the burden of respiratory diseases as a group will help ascertain their collective impact on the health systems in order to develop intervention measures. Data from case notes of children with respiratory diseases admitted to the University of Nigeria Teaching Hospital Enugu, Nigeria over a six year period were extracted. Age, gender, admission rates, types of respiratory illness, duration of admission, season of presentation and outcome were analysed. Descriptive and inferential (Chi square) statistics were used to describe the various disease types and ascertain association of the disease outcome, seasonal pattern with the types of diseases. Of the total of 8974 children admissions, 2214 (24.7%) w...