Prevalence of lower respiratory tract infection in Severely malnourished Children

Abstract

One hundred and seven children aged below 5 years with clinical features of severe malnutrition were studied for lower respiratory tract infection. A clinical history was taken and physical examination carried out on these children. The presence of lower respiratory tract infection (LRTI) was confirmed using chest radiographs. The ages of the children ranged from 1.5 - 60 months. of the children, 100 (93.6%) were less than 36 months old. There was a male preponderance, with a male to female ratio of 1.74 : 1. There were 40 patients with marasmus (37.4%), 39 with kwashiorkor (35.5%) and 29 with marasmic kwashiorkor (27.1%) . • of all children studied 69.2% had radiological pneumonic changes. A significantly higher proportion of patients under one year of age had LRTI compared to the other age groups. A greater proportion of the children with marasmus had pneumonia (82.1%) compared to those with kwashiorkor (58.3%) and marasmic kwashiorkor (75.0%). A history of cough was present in 80% of patients with LRTI. The other clinical features of LRTI, that is, history of fever, fast breathing, and difficulty in breathing and the physical signs of temperature of more than 37.5"C, respiratory rates greater than 50 per minute, heart rate of more than 140 per minute, nasal flaring, chest indrawing, crepitations and bronchial breathing were present in less than half of the patients with LRTI.

The clinical features found to be strongly associated with LRTI were a history of cough, chest indrawing and a respiratory rate of more than 50 per minute. of the symptoms and signs studied chest indrawing had the strongest association with LRTI. However none of the clinical features had good predictor value for LRTI as they all had very low sensitivities and negative predictive values. From the study it is recommended that all severely malnourished children should have chest X-rays and where this is not possible antibiotic therapy for LRTI should be instituted in children admitted with severe malnutrition as a very high proporti on of these chi Idren have LRTI whi Ie cl ini cal features are present in less than half of these patients.