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Epidemiology of pneumonia in rural underfives
1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi.
Insights
Acute respiratory infections (ARI) disproportionately affected infants and children under three years old in rural settings. Mortality was highest among neonates and in severe cases, particularly during seasonal climate shifts.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Acute Respiratory Infections (ARI) pose a significant health burden on young children globally.
- Understanding the epidemiological patterns of ARI, especially pneumonia, is crucial for targeted interventions.
- Rural populations often face unique challenges in accessing healthcare, potentially increasing ARI risks.
Purpose of the Study:
- To investigate the epidemiology of acute respiratory infections (ARI), with a focus on pneumonia, in rural under-five children.
- To determine attack rates, risk factors, and case fatality rates associated with ARI in this population.
- To identify specific age groups and seasonal patterns that are most vulnerable to severe ARI outcomes.
Main Methods:
- A one-year prospective cohort study of 5335 rural children under five years of age.
- Detailed epidemiological analysis of pneumonia cases, including attack rates, duration, and demographic factors.
- Calculation of case fatality rates across different age groups, sexes, and seasons.
Main Results:
- The overall ARI attack rate was 0.29 per child per year, with infants experiencing a higher rate (0.59).
- Children under three years accounted for 87.7% of ARI episodes, with 47.7% occurring in infants.
- The case fatality rate was 1.26%, significantly higher in neonates (10.7%) and severe cases. Females exhibited a higher case fatality rate (1.5% vs 1.1%).
- ARI attack rates were elevated during winter, and case fatalities peaked during autumn, coinciding with climatic changes.
Conclusions:
- Infants and young children under three years are the most vulnerable to ARI in rural settings.
- Prompt identification and management of severe pneumonia cases are critical to reduce mortality.
- Seasonal variations and climatic changes significantly influence ARI outcomes, necessitating adaptive public health strategies.
Abstract:
Rural underfives (5335) were followed for a period of one year from January to December 1987 for acute respiratory infections (ARI). Those affected with pneumonias were studied in detail to know the epidemiology. The children reported an attack rate of 0.29/child/year. Severe cases constitute 0.5%. Infants had higher attack rate (0.59/child/year), 47.7% of episodes occurred in infants and 87.7% occurred in children below 3 years. Males had a higher attack rate (0.32 vs 0.27). Mean duration of attack was 5.45 +/- 1.95 days. The attack rate was higher in winter. The case fatality rate was 1.26%. It was highest in neonates (10.7%) Females had higher case fatality rate than males (1.5% Vs 1.1%). Mortality was very high in severe cases. Case fatalities were high in seasons when the climatic change occurred, the highest being in autumn.