Respiratory rates among rural Gambian children: a community-based cohort study

Area of Science:

• Pediatrics
• Tropical Medicine
• Public Health

Background:

• Normal respiratory rates (RR) are documented for young children in the tropics, but data for older children are scarce.
• Accurate RR assessment is crucial for diagnosing respiratory illnesses in children, especially in resource-limited settings.

Purpose of the Study:

• To establish age-specific reference curves for respiratory rates in Gambian children aged six months to 14 years.
• To identify factors influencing respiratory rates, including age, nutritional status, and environmental conditions.
• To propose a new cutoff for elevated respiratory rates in children over five years old.

Main Methods:

• Longitudinal monitoring of respiratory rates in rural Gambian children over two rainy seasons.
• Utilized generalized additive models to construct reference curves and linear mixed-effect models to identify influencing factors.
• Collected 67,512 RR measurements from 830 children aged six months to 14 years.

Main Results:

• Developed RR reference curves for children aged one to 13 years.
• Identified age, stunting, ambient temperature, and time of measurement as independent predictors of RR.
• Proposed a cutoff of >26 breaths/min for raised RR in children over five years old.
• Observed greater RR variability in repeat measurements among children with signs of illness.

Conclusions:

• The study bridges a critical data gap for older children's respiratory rates in tropical regions.
• While environmental and nutritional factors influence RR, their impact is not significant enough to alter current WHO guidelines.
• Increased RR variability in sick children suggests that single measurements may be insufficient for reliable assessment, highlighting the need for careful evaluation in diagnosing illness.