The utility of white blood cell counts in differential diagnosis of acute respiratory tract infections in children treated at Kenyatta National Hospital

Abstract

Background: Most upper respiratory tract infections (UR'ITs) in children have a viral cause. resolve spontaneously and in most cases do not require laboratory investigations for diagnosis. Acute lower respiratory tract infections (ALRI) may be viral, bacterial or of mixed aetiologies. Diagnosis and management of acute respiratory infections (ARls) in our set up can be made using clinical criteria or Kenyan Integrated Management of Childhood Illnesses (lI\ICI) protocols which are adapted from World Health Organisation (WHO) generic guidelines for IMCI.

However, children with respiratory infections in hospital settings undergo many routine tests like White blood cell (WBC) counts and blood cultures. These laboratory tests account for a large proportion of the cost of treatment of ARIs. Clinicians use WBC counts to try and differentiate URTI from ALRI without any evidence. this and the cost of the test form the main justification for this study.

Objectives: To determine the utility of WBC counts in diagnosis and management of Acute Respiratory Infections in children treated at Kenyatta National Hospital.

Methodology A descriptive cross sectional study where children aged 3 months- 13 years were enrolled from both out patient and inpatient populations. A sample size of 272 children with a WHO clinical diagnosis of acute respiratory infections was used. The study population was classified into URTI and ALRI groups using WHO IMCI classification for acute respiratory infections of No Pneumonia (URTI) and Pneumonia (ALRI).

After treating any emergencies those who met the inclusion criteria and gave consent were enrolled into the study, four milliliters of blood was taken in EDT A vaccutainers and analyzed using the SELDYN 3200 electronic cell counter. Total