Assessment of acute upper respiratory tract infections in children aged 1 to 5 in chuongmy district, hanoi city – Tran Thi Nhi Ha

Journal of military pharmaco-medicine n o 4-2018 185 ASSESSMENT OF ACUTE UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN AGED 1 TO 5 IN CHUONGMY DISTRICT, HANOI CITY Tran Thi Nhi Ha*; Quach Thi Can** Hoang Duc Hanh*; Tran Van Tuan*** SUMMARY Objectives: To determine the situation of acute upper respiratory infections in children aged 1 to 5 years preschool in Chuongmy district, Hanoi City. Subjects and methods: A cross- sectional analytic study on 2,150 children aged 1 to 5 years was carried out from October 2014 to February 2015. These children were chosen randomly from 6 preschools representing three ecological regions in district. Diagnosis of upper respiratory tract infections (URTI) was based on the revised WHO guidelines for diagnosis and management of childhood pneumonia. The data was analyzed using the statistical software Stata. Results and conclusion: The proportion of URTI was 30.74%, male accounted for 31.65% and female 29.71%. According to month of birth, we found that children under 24 months, 25 - 36 months, 37 - 48 months and over 48 months had correspoding rate of URTI of 54.88%, 44.13%, 34.73%, 25.10%. Gender, month of birth, weight at birth, nutritional status, vaccination, passive smoking, types of cooking stoves, regular caregiver were not associated significantly with URTI. * Keywords: Acute respiratory tract infections; Upper respiratory infections; Under-five children. INTRODUCTION Acute respiratory tract infections (ARI) are the most common in childhood, comprising as many as 50% of all illnesses in children less than 5 years old and 30% in children aged 5 - 12 years [4]. Multiple factors determine the frequency and nature of these illnesses. These include host factors, environmental factors and infecting agents. ARIs are divided into URTI and lower respiratory tract infections. URTI are usually caused by viruses (germs). There are over 200 different types of viruses that cause URTI. ARI is a major cause of morbidity and mortality worldwide. Each year, about 1.3 million children under 5 years die from ARI worldwide. ARI constitutes one third of the deaths in under five children in low income countries. The World Health Organization (WHO) estimated that respiratory infections account for 6% of the total global burden of disease [5]. * Hanoi Department of Health ** National Otorhinolaryngology Hospital *** Vietnam Military Medical University Corresponding author: Tran Thi Nhi Ha (tranthinhiha@yahoo.com) Date received: 27/02/2018 Date accepted: 10/04/2018 Journal of military pharmaco-medicine n o 4-2018 186 URTI has been recognized as one of the most common medical problems in daily lives of people worldwide. A strong confirmation for the prevention of URTI is rather inadequate, and thus, patients take preventive measures on the basis of their own experience or preferences [6]. In Vietnam, researchers said that ARIs caused the most mortality in children under 5 years old [1, 2]. However, the records about URTIs in Vietnam are still rare according to the ICD10 classification, especially in rural areas. This study therefore aimed at determining the situation of URTIs in children aged 1 to 5 years followed by ICD10, in Chuongmy district, Hanoi City. SUBJECTS AND METHODS This was a community-based cross- sectional analytic study carried out in winter from October 2014 to February 2015 in Chuongmy district, which is 20 km away from the west of Hanoi City. It has an estimated population of about 337,600 inhabitants. Many people's lives rely heavily on agriculture. At this time-study, due to low economic income, many couples had to go to work far away; these children were taken cared of by their grandparents or others. In their surroundings, they have become passive smokers because of cooking appliances such as wood, coal or electricity interspersed with gas, even smoke of cigarettes... All of this led to passive smoking. Sample size calculation: Chose 6 targeted communes representing 3 ecological regions. In each commune, all children who met selective criteria and did not violate exclusion criteria were enrolled in preschools. The sample size was calculated using the formula for epidemiological description of cross sectional study. A pre-study showed the prevalence of URTI in children under 5 years in Backan 2010 was 36.1% [2] From formula, we calculated sample size was 2,124. 2,150 children were included in the study. Study procedure: Participants were recruited between 8 am and 5 pm from Friday (12 - 12 - 2014) to Saturday (13 - 12 - 2014) from all of the preschools. Out of 2,150 children, 1,147 boys and 1,003 girls were recruited and their parents were interviewed. The parents or guardians of the child were informed about the study at the waiting room and then were interviewed. Findings from the consultation were used and additional information was obtained from a complementary history and physical examination. Data collection: Examination data was collected by doctor from Vietnam National Children's Hospital. Case definition for URTI was based on the ICD10 [7]. Data management: Data was entered, cleaned and analyzed using the statistical software Microsoft Excel 2016 and analyzed by SPSS software and p-value less than 0.05 was considered statistically significant, OR (odds ratio) and confidence interval 95% also was measured Journal of military pharmaco-medicine n o 4-2018 187 RESULTS Figure 1: Incidence of symptomatic acute upper respiratory infections. According to the figure, we found that the most symptoms of URTI were runny nose (39.12%), cough (37.81%); others were less common. Table 1: Prevalence of acute URTI in children by gender. Boys (n = 1,147) Girls (n = 1,003) Total (n = 2,150) Gender n (%) n (%) n (%) p χ² None URTI 784 (68.35) 705 (70.29) 1489 (69,26) URTI 363 (31.65) 298 (29.71) 661 (30.74) 0.332 0.942 The proportion of URTI were 30.74%. However, the difference URTI between boys and girls was not statistically significant. Table 2: Prevalence of acute URTI by age group (n = 2,150). ≤ 24 months (n = 82) 25 - 36 months (n = 281) 37 - 48 months (n = 452) > 48 months (n = 1335) Total (n = 2,150) Index n (%) n (%) n (%) n (%) n (%) p χ² None URTI 37 (45.12) 157 (55.87) 295 (65.27) 1000 (74.90) 1489 (69.26) URTI 45 (54.88) 124 (44.13) 157 (34.73) 335 (25.10) 661 (30.74) < 0.001 69.47 Cough and cold 18 (21.95) 42 (14.95) 71 (15.71) 251 (18.08) 382 (17.77) > 0.05 4.90 Rhinitis 31 (37.8) 89 (31.67) 96 (21.24) 177 (13.26) 393 (18.38) < 0.001 79.85 Journal of military pharmaco-medicine n o 4-2018 188 Allergic rhinitis 13 (15.85) 41 (14.59) 55 (12.17) 117 (8.78) 226 (10.64) < 0.001 13.11 Pharyngitis 24 (29.27) 75 (26.69) 84 (18.58) 169 (12.66) 352 (16.37) < 0.001 46.86 VA inflammation 20 (25.32) 45 (16.73) 49 (11.37) 96 (7.63) 210 (10.30) < 0.001 41.58 Tonsillitis 15 (18.99) 59 (21.38) 81 (18.54) 154 (12.20) 309 (15.04) < 0.001 21.76 Total 82 281 452 1335 2,150 The proportion of children with URTI increased with age groups. The children with age of 48 - 60 months occupied 62.09%, while this rate was 3.8% in under 24-month children. When calculated in terms of disease incidence in each group, the data is reversed with age. This means that the older they are, the lower rate of URTI is. This is also true for the rate of specific diseases such as pharyngitis, rhinitis... Table 3: Prevalence of acute URTI in order: months of birth; birth weight; feeding status and vaccination (n = 2,150). URTI None URTI Criteria n % n % p The first one (n = 1,125) 365 32.44 760 67.56 Months of birth The 2nd one and over (n = 1,025) 296 28.88 729 71.12 0.073 < 2.5 kg (n = 71) 20 28.17 51 71.83 Birth weight ≥ 2.5 kg (n = 2,079) 641 30.83 1438 69.17 0.633 Breastfeeding (n = 1,976) 602 30.47 1374 69.53 Lack breastfeeding (n =155) 52 33.55 103 66.45 Feeding status Parenting (n = 19) 7 36.84 12 63.16 0.574 Full (n = 2,119) 649 30.63 1,470 69.37 Vaccination Lack vaccination (n = 31) 12 38.71 19 61.29 0.333 The incidence of acute URTI in the 1st child was (32.44%) higher than that in the 2nd child (28.88%), but the difference was not statistically significant (p > 0.05). In the group of children with weight at birth < 2.5 kg, the incidence of URTI was 28.17%, lower in children ≥ 2.5 kg (30.83%), the difference was not statistically significant (p > 0.05). In terms of feeding status and vaccination, we had the same results. Journal of military pharmaco-medicine n o 4-2018 189 Table 4: Prevalence of acute URTI in children by smoking status; type of stoves use and caregiver (n = 2,150). URTI None URTI Criteria n % n % p Yes (n = 1,022) 330 32.29 692 67.71 Passive smoking No (n = 1,128) 331 29.34 797 10.66 0.139 Use only gas or electric stove (n = 1,048) 324 30.92 724 69.08 Types of stoves used Alternate firewood/coal/oil stove (n = 1,102) 337 30.58 765 69.42 0.866 Parents (n = 2,099) 643 30.63 1456 69.37 Regular caregiver Others (n = 51) 18 35.29 33 64.7 0.476 As shown on table 4, environmental factors such as exposure to wood smoke, cigarette smoke (passive smoking), types of stoves used, regular caregiver were not increased significantly (p > 0.05). DISCUSSION * Characteristics of age groups of children participating in the study: Children's age group are mainly over 48 months, accounting for 65.3%; 31.53% of children aged 24 - 48 months, only 3.16% of children under 24 months. In fact, almost preschools currently enroll children 18 months or older. This study aimed at determining the proportion of URTIs and identifying some related risk factors in children under 5 years preschool. A high proportion of URTI was 30.74%, which was lower than the study in Uganda [1], Backan (Vietnam) [2], but consistent with the study in Hong Kong [9], this may be related to different place time periods used in these studies. In Backan, the weather is usually colder than in Hanoi, which may lead to higher URTI in children. WHO said that most children have about four to six acute respiratory tract infections each year accounting for a substantial proportion of consultations to primary care physicians [10]. In the study, we also found that, children have URTI 3 - 5 times each year. The real data will be showed in other report. In Vietnam, smoking is men’s habit and they often smoke in the house, which makes women and children largely passive smokers. According to Alexis A. Tazinya, Gregory E. Halle-Ekane, Lawrence T. Mbuagbaw et al, the risk factors significantly associated with ARI were: infection with HIV, poor maternal education, passive smoking, exposure to wood smoke Journal of military pharmaco-medicine n o 4-2018 190 and contact with person with ARI [4]. In Vietnam, the findings by Nguyen Hoang Son [3] showed the association between ARI and smoking. The children whose families used coal or oil had higher risk of URTI than those whose families use electric cooker. However, in our study, environmental factors such as exposure to wood smoke, cigarette smoke, types of stoves, regular caregiver were significantly increased with the proportion of URTI. On the other hand, some other factors like months of birth, birth weight, feeding status, vaccination aren’t also associated with statistical significance. In fact, today, the number of people smoking and using coal or oil in cooking has reduced; other stoves like gas have been replaced, therefore, we found no connection between URTI in children. The further studies should be recommended. CONCLUSION The proportion of URTI in preschool children in Chuongmy district was 30.74% and that of boys was 31.65% and girls 29.71%. Some risk factors not significantly associated with URTI were: months of birth, birth weight, feeding status, vaccination, passive smoking, types of stoves, regular caregiver. There should be more studies on URTI in preschool children. REFERENCES 1. Trần Quỵ. Nhiễm khuẩn hô hấp cấp tính ở trẻ em. Bài giảng nhi khoa, tập 1. NXB Y học. Hà Nội, 2013, tr.380-396 2. Đàm Thị Tuyết. Một số đặc điểm dịch tễ và hiệu quả can thiệp đối với nhiễm khuẩn hô hấp cấp ở trẻ em dưới 5 tuổi tại huyện Chợ Mới, tỉnh Bắc Kạn. Luận án Tiến sỹ Y học. Trường Đại học Thái Nguyên. 2010. 3. Nguyễn Hoàng Sơn. 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