Respiratory Infections In Preschool Children Research Articles

Exploring the Preventive Potential of Vitamin D against Respiratory Infections in Preschool-Age Children: A Cross-Sectional Study.

Recent studies hypothesized that vitamin D supplementation and subsequent higher 25(OH)D serum levels could protect against respiratory infections in children. This cross-sectional study, conducted from May 2022 to December 2023 in Timisoara, Romania, aimed to evaluate the potential influence of vitamin D supplementation on the incidence of respiratory infections among preschool-age children. This study examined 215 children over 18 months who were split into a group of patients with recurrent respiratory infections (n = 141) and another group of patients with only one respiratory tract infection in the past 12 months (n = 74). Patients were evaluated based on their serum vitamin D levels 25(OH)D, demographic characteristics, and health outcomes. The study identified that preschool-age children with recurrent infections had significantly lower mean vitamin D concentrations (24.5 ng/mL) compared to the control group (29.7 ng/mL, p < 0.001). Additionally, a higher proportion of vitamin D deficiency was observed among children with recurrent infections in the past 12 months. Notably, vitamin D supplementation above 600 IU/week significantly reduced the likelihood of respiratory infections, evidenced by an odds ratio of 0.523 (p < 0.001), indicating that preschool-age children receiving a dose of vitamin D higher than 600 IU/week were about half as likely to experience respiratory infections compared to those who did not. Furthermore, no significant associations were found between sun exposure, daily sunscreen use, and the incidence of respiratory infections. Conclusively, this study underscores the potential role of vitamin D in helping the immune system against respiratory infections in preschool-age children. The observed protective effect of vitamin D supplementation suggests a potential public health strategy to mitigate the incidence of respiratory infections in preschool children on top of the already known benefits.

BASIC INDICATORS OF PHYSICAL DEVELOPMENT IN CHILDREN AGED 5-6 YEARS WITH RECURRENT RESPIRATORY INFECTIONS

Background. Recently, scientific publications on various aspects of the problem of recurrent respiratory infections in preschool children have paid increasing attention to identifying influential factors contributing to frequent episodes of acute respiratory infections (ARI). In particular, these factors include significant deviations in children's physical development from standard values.&#x0D; Aim: to find out the relationship between the frequency of ARI episodes in children aged 60-83 months and their basic anthropometric indicators.&#x0D; Materials and methods. A total of 71 children (44 boys and 27 girls) aged 60-83 months, undergoing inpatient treatment on ARI, were involved in the clinical study.&#x0D; The number of ARI episodes during the previous year of their life was taken into account. Additionally, two integral indices of ARI recurrence, specifically the infection index (InI) and resistance index (RI), were calculated. The basic indicators of physical development were assessed in the children, including: 1) body weight; 2) body length; 3) body surface area; 4) body mass index; 5) chest circumference (CC); 6) integral index of dolichostenomelia. For the comparative analysis of the results obtained, the current standards of physical development indicators for children from the World Health Organization were used. The statistical processing of the digital data was performed with IBM SPSS Statistics 28 licensed software.&#x0D; Results. Rank correlation analysis and cross-tabulation did not demonstrate any interdependence between InI and RI, on the one hand, and the anthropometric indicators considered, on the other hand. Meanwhile, there was a very strong direct correlation between InI and RI (ρ=0.983; p&lt;0.001; 95% CI: 0.972-0.989) in the examined children. Linear regression analysis revealed the dependence of InI and RI on CC size (p&lt;0.001). At that, the degree of the impact of CC size on these clinical indices was almost the same, constituting 7.7% and 7.5%, respectively.&#x0D; Conclusion. Thus, according to the data obtained, the contribution of СС size to the susceptibility of children aged 60-83 months to recurrent respiratory infections among other potential risk factors is insignificant. However, given the widely recognized diversity of mentioned factors, the result deserves due attention. This should be accounted while developing the final integrated model for predicting the frequency of ARI episodes in preschool children.

Lactoferrin in the Prevention of Recurrent Respiratory Infections in Preschool Children: A Prospective Randomized Study.

Few studies have evaluated the effect of bovine lactoferrin (bLf) on reducing respiratory infections in preschool children. This randomized controlled trial evaluated the effect of bLf in preschool children with recurrent respiratory infections. Participants were randomly assigned bLf (n = 25) or control (n = 25). Outcomes included respiratory infection episodes (RIEs), symptom duration, school absence and medication. Fifty children aged 4.2 ± 0.1 years were included. During the active 4-month phase, median number of RIEs was reduced by 50% in the bLf group [1-episode, interquartile range (IQR): 0-2] vs. control (2, IQR: 1-3; p = 0.02). The proportion of participants with >3 RIEs was significantly lower in bLf (n = 1, 4%) vs. control (n = 7, 28%) with 80% lower odds of upper RIEs in the bLf arm (odds ratio: 0.20, 95% CI:0.06-0.74, p = 0.015). The duration of symptoms (3 vs. 6, p = 0.009) and days absent from school (3 vs. 6, p = 0.15) were lower in the active arm. Over the 2-month follow-up, no significant differences were observed between groups for infection episodes, symptom duration or school absence. However, bLf-treated children received significantly less corticosteroids over the entire 6-month study period (32% vs. 60%; p = 0.047). bLf supplementation significantly reduced the frequency and duration of RIEs in children with decreased corticosteroid use.

A comprehensive analysis of anthropometric indicators in preschool children suffering from recurrent respiratory infections.

Aim: To determine the state of relationship between anthropometric indicators and susceptibility to recurrent respiratory infections in preschool children. Materials and Methods: A total of 143 children (73 boys and 70 girls) aged 12-59 months, undergoing inpatient treatment on acute respiratory infection, were involved in the clinical study. The number of acute respiratory infection episodes during a previous year of their lives was taken into account. Besides, the basic indicators of physical development were assessed in the children, including: 1) body weight; 2) body length; 3) chest circumference; 4) body mass index; 5) body surface area; 6) Vervek's index. Results: Cross-tabulation and rank correlation analysis did not demonstrate any interdependence between the susceptibility of the children examined to recurrent respiratory infections and their anthropometric indicators. Simultaneously, linear regression analysis showed that in the children aged 12-23 months, resistance index depended on their age and body length. The relative importance of the combined effect of the two above-mentioned indicators among all other potential risk factors for recurrent respiratory infections was 32.2%. Conclusions: The detailed analysis of the findings outlined the methodological basis for further studies of the association between the incidence of acute respiratory infections in preschool children and their physical development. Multivariate statistical calculations of various risk factors for recurrent respiratory infections, including abnormal anthropometric indicators, are likely to increase the informational value of subsequent examinations.

Changes in the microbiota of the upper airways and intestine in the treatment of acute respiratory infections in preschool children

Introduction. The microbiota of the upper airways and intestine in preschool children is directly involved in protecting the growing body from acute respiratory infections (ARI), which are the most common infections in children, about 65% of them turn into recurrent respiratory infections (RRI). Aim. To establish changes in the microbiota of the upper airways and intestine in the treatment of ARI in preschool children.&#x0D; Materials and methods. The study involved sixty 1–6 year (Me = 3.38 years) frequently ill children. They were divided into 3 groups depending on the chosen treatment lasting 90 days. Children of group 1 (n = 20) underwent nutrition correction. Children of group 2 (n = 20) received additional probiotics. Children of group 3 (n = 20) received both nutritional correction and probiotics at the prescribed doses. Before and after treatment, the composition of the microbiota of the oropharyngeal zone and intestine was determined by genetic sequencing of the V3–V4 region of the 16S ribosomal RNA gene, followed by bioinformatic analysis. &#x0D; Results. Significant differences were found mainly in the relative content of Firmicutes in the microbiota of patients treated. The content of Firmicutes in the microbiota of children receiving probiotics against the background of nutrition correction (30%) was significantly higher than in patients with nutrition correction (26.91%) and in children receiving only probiotics (25.95%). In patients of different groups, after treatment, a decrease in the content of Proteobacteria in the microbiota of the oropharyngeal zone was revealed. A significant decrease in the relative content of Bacteroidota (by more than 3 times) in 95% of patients, and a decrease in Proteobacteria (by more than 4.5 times) in 100% of patients was also found in the intestinal microbiota of group 3 patients treated with probiotics. In addition, there was a significant increase in the Firmicutes microbiota from 21.97% to 30.07% in 85% of patients, and an increase in the content of Actinobacteriota from 1.9% to 5.7% in 95% of patients. The relative content of undifferentiated microbiota after therapy was also significantly higher (70.08%) than before treatment (58.40%) in 85% of patients.

ERYTHROCYTIC AND THROMBOCYTIC INDICATORS IN PRESCHOOL CHILDREN SUFFERING FROM RECURRENT RESPIRATORY INFECTIONS

Anemia is both a significant cause of frequent acute respiratory infections in preschool children and a complication of these infections. While, it is quite often accompanied by deterioration of immunity functioning. Moreover, there has been reported that acute respiratory infections can combine with thrombocytosis in children of different ages. It is also important to focus vision to the relationship between particular indicators of immune status, the acute respiratory infections occurrence, and the expression degree of undifferentiated connective tissue dysplasia. The study is aimed to assess the erythrocytic and thrombocytic indicators in preschool children having the different anamnestic occurrence rate of acute respiratory infections and the different expression degree of particular signs of undifferentiated connective tissue dysplasia. Materials and Methods. Seventy-six children (43 boys and 33 girls) aged from one to six years old, undergoing inpatient treatment on acute respiratory infection, were involved in the clinical study. A wide range of erythrocytic and thrombocytic parameters was taken into consideration. Two markers of acute respiratory infections recurrence (infectious index, resistance index) and dolichostenomelia integral indicator were calculated for each child as well.&#x0D; The statistical processing of the obtained primary digital material was performed by IBM SPSS Statistics&#x0D; 26 licensed program. Results. Such indicators as blood haemoglobin concentration, mean corpuscle haemoglobin concentration, mean cell volume, platelet number, thrombocytocrit, microcytic anaemia factor and volume haemoglobin distribution width factor (coefficient of variation) were statistically lower in the children of the younger age group compared to the older children. The microcytic anaemia factor was lower than its reference values in 40 (52,63 %) patients, and erythrocyte hypochromia was diagnosed in 48 (63.16%) clinical cases. Conclusion. The higher infectious index values in preschool children have been found against the background of the lower mean cell haemoglobin and mean cell volume. The volume haemoglobin distribution width factor (coefficient of variation) and the microcytic anaemia factor among the examined patients are in inverse correlation with the infectious index. There is linear regression dependence between the infectious index on the erythrocyte anisocytosis index and the mean cell volume. The studied integral indicators of acute respiratory infections occurrence among the children do not demonstrate a statistically significant relationship between the platelet parameters and the dolichostenomelia integral indicator.

Incidence of acute respiratory infections in preschool children in an outpatient setting before and during Covid-19 pandemic in Lombardy Region, Italy

IntroductionThe incidence of acute respiratory tract infections (ARTIs) in children is difficult to estimate because they are typically treated in outpatient settings and the majority of epidemiological data originate from hospital settings and refer to the most severe illnesses. Therefore, the incidence of ARTIs in a real-world setting remains largely unexplored. Therefore, this study aims to estimate the incidence of ARTIs, upper respiratory tract infections (URTIs), and lower respiratory tract infections (LRTIs) in children aged 0–5 years in an outpatient setting.MethodsThis prospective cohort study was conducted in Lombardy, Italy, from October 1st, 2019, to March 31st, 2021, before and during the COVID-19 pandemic that began in March 2020. Caucasian healthy children aged 0–5 years were recruited from 69 Family Pediatricians (FP) and followed-up in an outpatient setting. Data were collected whenever a child was referred to FP and ARTI was diagnosed (Covid-19 related ARTI were excluded). The primary outcome was an estimate of the incidence of ARTIs. The incidence of ARTIs in different age groups and the effect of the COVID-19 pandemic on the incidence of ARTIs were secondary outcomes.ResultsWe enrolled 484 children, 249 male (51.8%), mean age of 2.39 ± 1.68 years. The mean estimated incidence of ARTIs was 12.1/100 children × 30 days (95% CIs: 9.5–12.9), with the highest value observed in infants aged 1–12 months (24.9/100 children × 30 days; 95% CIs: 17.6–28.9). The mean estimated incidence of URTIs was higher than that of LRTIs (8.3 – CIs: 7.6–8.9 vs 3.8/100 children × 30 days – CIs: 6.4–4.3, respectively). The comparison of ARTIs, which occurred in the pre-pandemic winter, to those measured during the COVID-19 pandemic, revealed an impressive 82.1% drop in the incidence rate (CIs: 77.8–85.7).ConclusionsThis study showed that infants aged 1–12 months are more likely to develop ARTIs than older children and that COVID-19 pandemic has dramatically altered the epidemiology of ARTIs in children aged 0–5 years.

RETROSPECTIVE ANALYSIS OF PREDICTOR OF RECURRENT RESPIRATORY INFECTIONS IN PRESCHOOL CHILDREN

Among the current trends in the systemic prevention of recurrent respiratory infections in preschool children is the differentiated detection and clustering of the most significant ante- and prenatal factors associated with frequent acute respiratory infections. Thus, a comprehensive retrospective investigation of such factors in terms of their association with the integral indicators of acute respiratory infections recurrence in preschool children is exceptionally relevant. The study of particular manifestations of undifferentiated connective tissue dysplasia during recurrent respiratory infections is of great clinical and social relevance. This study research aims at determining the levels of inter-dependency between recurrence indicators of acute respiratory infections in preschool children and ante- and prenatal predictors analyzed retrospectively. Fifty-one children (24 boys and 27 girls) aged 1 to 6 years old, undergoing inpatient treatment for acute respiratory infection, were involved in the clinical study. Two markers of acute respiratory infection recurrence (infection index, resistance index) and dolichostenomelia integral indicator, which is used as the marker of external signs of connective tissue undifferentiated dysplasia, were calculated for each child. In addition, the retrospective analysis of 67 ante- and prenatal factors directly related to the children were examined. The statistical processing of the obtained digital material was performed by IBM SPSS Statistics 26 licensed software. Only non-parametric statistics methods were applied in the purpose.&#x0D; The first stage of investigating the inter-dependency between the acute respiratory infections frequency, the particular manifestations of undifferentiated connective tissue dysplasia, on the one hand, and the ante- and prenatal predictors, on the other hand, was carried out. The results obtained provided the grounds for the further research in the outlined direction involving the higher number of patients and using the more sensitive statistical methods. The higher infectious index values in the preschool children correlate with the following factors as lower initial overall age of their parents, smaller number of their mothers’ previous pregnancies, larger mothers’ body weight at the beginning of pregnancies, longer deliveries, lower Apgar scores in the newborns and no vaccination for tuberculosis. The resistance index values in the examined children increase with the simultaneous decreasing in the haemoglobin concentration in the mothers’ blood just before the deliveries and in cases of no vaccination in newborns for tuberculosis. The dolichostenomelia integral indicator in the patients aged from 1 to 6 years directly correlates with their age as well as with such retrospectively studied predictors as the newborns body mass index, the presence of foetoplacental insufficiency and the total number of complications caused by connective tissue dysplasia in their mothers during the pregnancies and deliveries.

Effect of Daily Bacillus subtilis DE111 Intake on GastrointestinalHealth and Respiratory Infections in Children Attending Day-care: ARandomised, Parallel, Double-blind, Placebo-controlled Study

Children beginning preschool typically have an increased prevalence of gastrointestinal and respiratory infections. This study aimed to evaluate safety and efficacy of the probiotic Bacillus subtilis DE111® in gastrointestinal health and respiratory infections in preschool children. In a randomised, parallel, double-blind placebo-controlled study 102 day-care attending children aged 2-6 years received B. subtilis DE111® (1 × 109 CFU) or placebo once a day for 8 weeks. Participant diaries were completed by parents and evaluated by investigators to follow the incidence and duration of indicators of gastrointestinal health and respiratory infections as well as any adverse events. Saliva samples were collected at baseline and completion of the intervention to measure sIgA levels. A significant reduction in duration of vomiting (2 days vs. 14 days, p=0.045), duration of hard stools (0 days vs 15 days, p=0.044), and duration of overall gastrointestinal discomfort (18 days vs. 48 days, p=0.0499) was seen. No difference in incidence of respiratory infection was observed (41.3% probiotic vs 36.2% placebo, p=0.60). A statistically significant increase of sIgA levels was observed in the placebo group (1.37-fold, p<0.01), but not in the probiotic group (1.05-fold, p=0.61). Overall, data suggests intake of the probiotic B. subtilis DE111® is safe for use in children and supports a healthy gastrointestinal tract with a reduced duration of vomiting, hard stools and overall gastrointestinal discomfort.

The Association Between Environmental Lead Exposure and Recurrent Respiratory Infections in Children Aged 3–7 Years in Shenyang, China

To investigate the lead exposure levels, and the effect of blood lead level (BLL) on recurrent respiratory infections in children aged 3-7 years in Shenyang. A case-control study including 78 children with recurrent respiratory infections and 141 controls was performed. Venous blood was obtained for BLL, and a questionnaire was completed. The BLL was significantly higher in children with recurrent respiratory infections than that in the control group [Median (IQR): 2.56 (1.29-6.19) vs 1.99 (0.90-5.92) µg/dL, P=0.029]. Children with BLL ≥1.95 µg/dL were more likely to be suffering from recurrent respiratory infections (OR=2.328, 95%CI=1.228-4.413) than those with BLL <1.95 µg/dL. High lead level can increase the risk of respiratory infections in preschool children.

Factors that are associated with the development of acute respiratory infections in the kindergarten - an analysis of the population of 1,528 children

Introduction/Objective. Acute respiratory infections (ARI) are very common amongst children attending preschool institutions (PIs) and they represent a significant public health problem. Strict compliance with the legal regulations should reduce the incidence of respiratory infections in children. The aim of this research was to determine predictors for the appearance of ARI in kindergarten. Methods. The research was conducted as a cross-sectional study at the six PIs located on the territory of Vozdovac municipality during a six-month period (from January to June 2016). The target population consisted of 1,528 children who were between three and seven years old. Data analysis was done using descriptive statistics (?2 test and Spearman?s rank correlation coefficient). Results The increase in the number of children for 30% above the norm was a predictive factor for the increase of respiratory infections (p &lt; 0.001). Sex differences were not a predictive factor for the emergence of respiratory infections in any age group. In all organizational units, March was the period when respiratory infections were on the increase (37.2%, p &lt; 0.001), and it was significantly higher (p &lt; 0.001) in cases, when the diseased child had a brother and/or a sister in the same kindergarten. During the observed period, the number of teachers corresponded to the range of one educator per 12 to 19 children. A constant number of educators could not reduce the incidence of respiratory infections, especially during the February?March period (p &lt; 0.001). Conclusion. In addition to active treatment and strict compliance with the legal regulations in the organization of PIs, the reduction in incidence of respiratory infections in preschool children could be achieved if the number of enrolled children complied with the standard, as well as by preventive procedures in children?s groups: avoiding overheated and dry air, regular ventilation, fresh air, well-planned diet, physical activity, personal hygiene and cleanliness.

Превентивные меры воздействия на рекуррентные респираторные инфекции у детей дошкольного возраста с бронхиальной астмой

Превентивные меры воздействия на рекуррентные респираторные инфекции у детей дошкольного возраста с бронхиальной астмой

The effectiveness of the use of the drug recombinant interferon alfa-2b for the prevention of acute respiratory infections in preschool children

Acute respiratory infections (ARI) are the most common diseases of children, the main reasons for which are the age-related characteristics of the immune response, exacerbated by adverse perinatal factors, allergies, and increased contact with potential pathogens (the beginning of visits to preschool institutions, etc.).Objective: to evaluate the effectiveness of the use of the drug recombinant interferon α-2b to reduce the incidence of acute respiratory infections in preschool children.Throughout the year, there were 50 children under observation (average age 29.2 ± 0.97 months) attending preschool institutions. Recombinant interferon α-2b, ointment — VIFERON® 2500 IU 2 times a day for 14 days, in the next 4 weeks — 2500 IU 2 times a day 3 times a week was used for 25 children of the main group for the prevention of ARI in the pre-epidemic period.Results: The use of recombinant interferon α-2b in children of the main group showed a statistically significant decrease in the incidence of ARI, pneumonia, otitis, and the disappearance of pathological symptoms in the nasopharynx. An increase in the level of antiviral cytokines (IFN-α, p = 0.0088, IFN-γ, p = 0.0014) and a decrease in the concentration of pro-inflammatory (IL-1β, p = 0.0072) were recorded. Carriage of S. aureus, S. epidermidis, Candida albicans decreased by 2 times. Decrease in titer of antibodies to Str. pyogenes (p = 0.0251), Str. pneumoniae (p = 0.0491), Branchamella catarrhalis (p = 0.0369), Haemophilus influenzae (p = 0.0251) indicates a decrease in the sensitization of the child's organism to microbial antigens.

The impact of passive smoking on the frequency of respiratory infections in preschool children

The impact of passive smoking on the frequency of respiratory infections in preschool children

Pneumonia during the first two years of life does not increase risk of respiratory infections in preschool children

To investigate the relationship between severe pneumonia during the first two years of life and subsequent respiratory infections in preschool children. This was a cross-sectional study. We interviewed parents of children who were classified as exposed (n = 36) or non-exposed (n = 84), based on whether they were hospitalized with radiologically-confirmed pneumonia during the first two years of life. The main outcomes were physician-diagnosed respiratory infections (acute otitis media, pharyngitis, and pneumonia) and use of antibiotics during the last 2 and 12 months. There were no significant differences between two groups in terms of prevalence of acute otitis media, pharyngitis, pneumonia and use of antibiotics during the last 2 months (5.9 vs 6.2%, 14.3 vs 26.0%, 0.0 vs 1.2% and 36.7 vs 38.7% respectively; P > 0.05 for all comparisons) and during the last 12 months (20.6 vs 18.5%, 40.0 vs 45.5%, 2.8 vs 2.4% and 76.7 vs 77.3% respectively; P > 0.05 for all comparisons). Pneumonia severe enough to require hospitalization during the first two years of life does not increase the risk of respiratory infections in preschool children.

Influence of exclusive breast feeding on occurrence, severity and recurrence of acute lower respiratory infections in preschool children

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Antibiotic prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections.

Antibiotic resistance is associated with prior receipt of antibiotics. An analysis of linked computerized databases for physician visits and antibiotic prescriptions was used to examine antibiotic prescribing for different respiratory infections in preschool children in Canada. In 1995, 64% of 61,165 children aged <5 years made 140,892 visits (mean, 3.6 visits per child) for respiratory infections; 74% of children who made visits received antibiotic prescriptions. Antibiotics were prescribed to 49% of children with upper respiratory tract infection, 18% with nasopharyngitis, 78% with pharyngitis or tonsillitis, 32% with serous otitis media, 80% with acute otitis media, 61% with sinusitis, 44% with acute laryngitis or tracheitis, and 24% with influenza. Acute otitis media accounted for 33% of all visits and 39% of all antibiotic prescriptions. The estimated Canadian-dollar cost of overprescribing was $423,693, or 49% of the total cost of antibiotics ($859,893) used in this group. This population-based study confirms antibiotic overprescribing in Canada.

Host factors and acute lower respiratory infections in pre-school children.

The relationship between certain host-related variables and the short-term outcome of hospitalization for severe acute lower respiratory infections was studied prospectively in a cohort of 103 pre-school Nigerian children. The respective mean ages of those with bronchiolitis and croup were 3.2 months and 18.9 months while the corresponding M:F ratios were 2.5:1 and 1:1. It was highly significant that all the eight children that died were malnourished (P less than 0.01). Furthermore, malnourished subjects with pleural effusion, in whom bacteraemia was common, stayed longest in hospital while subjects with bronchiolitis and croup, in whom malnutrition was distinctly uncommon, had the shortest duration of admission. Multiple microbial identifications and bacteraemia were common in malnourished subjects with ALRI. Mortality was significantly higher in older children (P less than 0.05), but sex, immunization/breast-feeding status and co-existing measles or pertussis, were individually neither related to the admission outcome nor the duration. It is concluded that malnutrition is a strong predictor of ALRI-related death in the pre-school child. The significance of bacteraemia and multiple microbial identifications in malnourished children, and the ARI-control implications of the study are discussed.