Abstract
ObjectivesThe current study was a hospital-based surveillance of cases hospitalised with WHO-defined community-acquired pneumonia in children aged 2–59 months, to assess the radiological abnormalities in chest X-rays and to identify the demographic and clinical correlates of specific radiological abnormalities, in residents of prespecified districts of Uttar Pradesh and Bihar, India.DesignProspective, active, hospital-based surveillance.SettingMultisite study conducted in a network of 117 secondary/tertiary care hospitals in four districts of Uttar Pradesh and Bihar, India.ParticipantsIncluded were children aged 2–59 months, hospitalised with community-acquired pneumonia, residing in the project district, with duration of illness <14 days and who had not been hospitalised elsewhere for this episode nor had been recruited previously.Main outcome measureConcordant radiological abnormalities in the chest X-rays.ResultsFrom January 2015 to April 2017, 3214 cases were recruited and in 99.40% (3195/3214) chest X-rays were available, among which 88.54% (2829/3195) were interpretable. Relevant radiological abnormalities were found in 34.53% (977/2829, 95% CI 32.78 to 36.28). These were primary end point pneumonia alone or with other infiltrates in 22.44% (635/2829, 95% CI 20.90% to 23.98%) and other infiltrates in 12.09% (342/2829; 95% CI 10.88% to 13.29%). There was a statistically significant interdistrict variation in radiological abnormalities. Statistically significantly higher proportion of abnormal chest X-rays were found in girls, those with weight-for-age z-score ≤−3SD, longer duration of fever, pallor and with exposure to biomass fuel.ConclusionsAmong hospitalised cases of community-acquired pneumonia, almost one-third children had abnormal chest radiographs, which were higher in females, malnourished children and those with longer illnesses; and an intra-district variation was observed.
Highlights
Community-acquired pneumonia (CAP) is the leading cause of death in young children worldwide
Pneumonia accounts for 16% of deaths in children under 5 years of age, which translates into almost 1 million deaths annually, with 0.9 million deaths reported in 2016.1 2 Most deaths due to pneumonia occur in low-income and middle-income countries, in sub-S aharan Africa and South Asia.[2 3]
We found that large proportion of hospitalised cases of pneumonia were from urban areas, as there is poor healthcare seeking from rural areas.[37]
Summary
Community-acquired pneumonia (CAP) is the leading cause of death in young children worldwide. CAP could be of either viral or bacterial aetiology.[5,6,7] In young children, bacteria associated with pneumonia are predominantly Streptococcus pneumoniae and Haemophilus influenzae type b, while viruses are respiratory. To reduce the incidence of bacterial pneumonia, vaccination against Haemophilus influenzae type b is already under the national immunisation programme of India since 2011. Thereafter, WHO introduced pneumococcal conjugate vaccine (PCV) in countries, such as India, with high child mortality rates.[8] PCV-13 was launched in May 2017 under the national immunisation programme of five Indian states (Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh and Himachal Pradesh) in a phased manner.[9] It is expected to be rolled out in other parts of the country in the near future
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