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Comparison of WHO Clinical Criteria and Radiological Findings of Pneumonia in Children Aged 02-59 Months
A R Mondal1, B K Majumder, R B Chowdhury
1Dr Ashiqur Rahman Mondal, Junior Consultant (Paediatrics), SD, On Deputation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Insights
Pneumonia diagnosis in children can be improved using World Health Organization (WHO) clinical criteria, especially in resource-limited settings. Chest indrawing was a key indicator differentiating radiograph-confirmed pneumonia cases in young children.
Area of Science:
- Pediatrics
- Radiology
- Public Health
Background:
- Pneumonia remains a significant cause of childhood mortality in low and middle-income countries.
- The World Health Organization (WHO) developed clinical criteria for pneumonia diagnosis in resource-constrained settings.
- Chest X-ray, the gold standard, is often inaccessible in primary healthcare facilities in developing nations.
Purpose of the Study:
- To compare the accuracy of WHO clinical criteria against radiological findings for diagnosing pneumonia in children aged 2-59 months.
- To evaluate the effectiveness of clinical signs in identifying pneumonia when chest X-rays are unavailable.
Main Methods:
- A cross-sectional observational study involving 112 children aged 2-59 months was conducted.
- Data collection included clinical assessments and chest X-rays for all participants.
- Statistical analysis was performed using SPSS software with a significance level of p<0.05.
Main Results:
- Radiological findings confirmed pneumonia in 52 (46.43%) of the children.
- Fever, cough, and fast breathing showed 100% sensitivity but lacked specificity in differentiating cases.
- Chest indrawing was significantly more prevalent (p=0.003) in radiograph-confirmed pneumonia cases (sensitivity 63.46%).
Conclusions:
- WHO clinical criteria, particularly chest indrawing, can aid in identifying pneumonia in children where radiological confirmation is not feasible.
- Clinical signs like fever, cough, and fast breathing are common but less specific than chest indrawing for radiologically confirmed pneumonia.
- The study underscores the importance of integrating WHO guidelines with clinical assessment for effective pneumonia management in resource-limited areas.
Abstract:
Despite recent advances, pneumonia contributes substantially to childhood mortality in low and middle-income countries. To reduce case fatality, World Health Organization (WHO) adopted a working formula to identify pneumonia clinically in resource constrained setting. Chest X-ray is the gold standard test to diagnose pneumonia but this tool is not readily available or affordable in primary health facility in developing countries even when it is indicated. Objective of the study was to compare WHO clinical criteria and radiological findings of pneumonia in children aged 02-59 months. This cross-sectional observational study was conducted at inpatient department of Paediatrics of Rangpur Medical College Hospital from July 2015 to June 2017. Total 112 patients aged 2 to 59 months fulfilling selection criteria were enrolled into this study. Data were collected and chest X-ray was done for each patient. Data were analyzed through SPSS software (version 16.0). Minimum level of significance was predetermined as p<0.05. Among 112 patients, mean age of chest radiograph positive cases of pneumonia was 7.64±7.08 months and that of negative cases 10.75±10.95 months. There was no statistically significant difference of age (p=0.083) between chest radiography positive and negative cases. Radiological findings were positive in 52(46.43%) cases and negative in 60(53.57%). Fever, cough and fast breathing were present in all patients with sensitivity 100%. Chest indrawing was significantly more (p=0.003) among 52(46.43%) cases who demonstrated positive radiological findings with sensitivity 63.46% (95% CI = 48.96% to 76.37%). There was no statistically significant difference of fever, cough and fast breathing between radiograph positive and negative cases. Chest indrawing was significantly more in radiograph positive cases. The results highlighted the importance of adoption of positive radiograph of WHO guideline to identify pneumonia.
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