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Published on: August 30, 2014
ACUTE LOWER RESPIRATORY INFECTION IN GUARANI INDIGENOUS CHILDREN, BRAZIL
Patricia Gomes de Souza1, Andrey Moreira Cardoso2, Clemax Couto Sant'Anna1
1Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Insights
This study analyzed acute lower respiratory infection (ALRI) in Brazilian indigenous children, finding viral infections predominated. Improved primary care is recommended to reduce unnecessary hospitalizations for ALRI.
Area of Science:
- Pediatric infectious diseases
- Indigenous health
- Public health
Background:
- Acute lower respiratory infection (ALRI) is a leading cause of mortality in children under five.
- Indigenous populations often face unique healthcare challenges and disparities.
- Understanding ALRI patterns in specific vulnerable groups is crucial for targeted interventions.
Purpose of the Study:
- To characterize the clinical presentation and treatment of ALRI in Brazilian Guarani indigenous children under five.
- To identify factors associated with different types of ALRI (viral, bacterial, viral-bacterial).
- To evaluate the appropriateness of hospitalizations for ALRI in this population.
Main Methods:
- Retrospective analysis of medical records of 211 indigenous children hospitalized with ALRI.
- Classification of ALRI based on wheezing, X-ray findings, and clinical-radiological-laboratorial evidence.
- Bivariate analysis using multinomial regression to identify associated factors.
Main Results:
- Viral ALRI (40.8%) was more common than bacterial (35.1%) or viral-bacterial (24.1%).
- Over half (53.1%) of hospitalizations lacked sufficient evidence for justification.
- Cough was linked to bacterial ALRI, while chest retractions and tachypnea suggested viral-bacterial cases.
Conclusions:
- Viral and co-infections are prevalent in indigenous children with ALRI.
- Clinical signs like cough, chest retractions, and tachypnea can help differentiate ALRI types.
- There is a need to enhance primary healthcare services for indigenous communities to optimize ALRI management and reduce inappropriate hospitalizations.
Objective:
To describe the clinical profile and treatment of Brazilian Guarani indigenous children aged less than five years hospitalized for acute lower respiratory infection (ALRI), living in villages in the states from Rio de Janeiro to Rio Grande do Sul.
Methods:
Of the 234 children, 23 were excluded (incomplete data). The analysis was conducted in 211 children. Data were extracted from charts by a form. Based on record of wheezing and x-ray findings, ALRI was classified as bacterial, viral and viral-bacterial. A bivariate analysis was conducted using multinomial regression.
Results:
Median age was 11 months. From the total sample, the ALRI cases were classified as viral (40.8%), bacterial (35.1%) and viral-bacterial (24.1%). It was verified that 53.1% of hospitalizations did not have clinical-radiological-laboratorial evidence to justify them. In the multinomial regression analysis, the comparison of bacterial and viral-bacterial showed the likelihood of having a cough was 3.1 times higher in the former (95%CI 1.11-8.70), whereas having chest retractions was 61.0% lower (OR 0.39, 95%CI 0.16-0.92). Comparing viral with viral-bacterial, the likelihood of being male was 2.2 times higher in the viral (95%CI 1.05-4.69), and of having tachypnea 58.0% lower (OR 0.42, 95%CI 0.19-0.92).
Conclusions:
Higher proportion of viral processes was identified, as well as viral-bacterial co-infections. Coughing was a symptom indicative of bacterial infection, whereas chest retractions and tachypnea showed viral-bacterial ALRI. Part of the resolution of non-severe ALRI still occurs at hospital level; therefore, we concluded that health services need to implement their programs in order to improve indigenous primary care.
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