DR.

HAMMAD HABIB
Roll no. # Y 571673
M.Sc. Community Health & Nutrition
Allama Iqbal Open University,
Islamabad

THE ASSOCIATION BETWEEN THE

PREVALENCE OF ACUTE RESPIRATORY TRACT
INFECTIONS IN CHILDREN 5 – 15 YRS AGE AT
SANDESAR DISTRICT MANSEHRA;
A DESCRIPTIVE STUDY

DR. ARSHAD MAHMOOD

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UPPAL
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MBBS (Pb), MCPS (Pak), FACP (USA), MSc (Pak)
Additional Principal Medical Officer
District Headquarters Hospital Rawalpindi

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Agenda

1. INTRODUCTION

2. STATEMENT OF THE PROBLEM & RATIONALE

3. AIM, OBJECTIVE & HYPOTHESIS

4. METHODS OF RESEARCH

5. REFERENCES

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INTRODUCTION

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INTRODUCTION
 Acute respiratory illness is one of the main
causes of ill health in children. It includes a wide
range of effects, including viral and bacterial
infection of the lungs and respiratory tracts.
 Respiratory tract diseases are disease affecting
air passages including nasal passages, bronchi
and lungs.1
 These can be acute infections as pneumonia
and bronchitis and chronic conditions as asthma
and chronic obstructive pulmonary disease.1

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INTRODUCTION CONT . . .

 Acute Lower Respiratory Infections

contribute to 20% of all deaths under 5
years of age worldwide.
 Alone pneumonia is responsible for about
90% of these deaths.
 Causative organisms can be bacterial
(most commonly Streptococcus
pneumoniae and Haemophilus influenzae)
or viral.2

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INTRODUCTION CONT . . .

 High risks are seen in children who are

malnourished, low-birth weight and non-
breastfed so all children should also be
assessed for signs of severe malnutrition.
 Malnutrition and infection are very strongly
correlated as better nutrition leads to
stronger immune systems and less illness
and is a vicious circle. 3

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INTRODUCTION CONT . . .

 Most malnutrition-related deaths are attributable

to mild-to-moderate malnutrition rather than to
severe malnutrition.4
 Malnutrition has been associated with high ARI
morbidity.
 The rate of mortality from acute lower respiratory
infection (ALRI) in malnourished children can be
anywhere from 3 to 27 times greater than that in
better-nourished children (15-19).6

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STATEMENT OF THE
PROBLEM &
RATIONALE

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STATEMENT OF THE PROBLEM:

 In developing countries, more than 12

million children die each year and more
than 50% of them are malnourished.

 About 4 million of those deaths are due to

acute respiratory infection (ARI).9

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ARI MORTALITY WHO ESTIMATE 2002

 Estimate as % of all child death <5 years.

WHO region ARI % of child death
 AFR 22%
 EMR 19%
 SEAR 19%
 WPR 13%
 AMR 14%
 EUR 11%
 GLOBAL 19%

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Causes of < 5 Mortality

33%

22% 21%

12%
9%

Diarrhea Pneumonia Malaria Neonatal Others

causes

WHO - 2001
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UNDER-FIVES DEATHS CAUSES

(excluding neonatal causes of death)

 Pneumonia

}
 Diarrhoea
 Malaria
~ 50%
 Measles
 HIV/AIDS

Malnutrition contributes to more than

half of all under-five deaths
WHO - 2000

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Global distribution of cause-specific
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mortality among children under five

Pneumonia,
Neonatal severe
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infections, 10
Others, 10
AIDS, 3

Injuries, 3
diarrhoeal
diseases, 17
Measles, 4
Neonatal
Malaria, 8
diarrhoeal Birth asphyxia,
diseases, 1 8 Preterm birth,
Neonatal other, 10
2 Neonatal Congenital
tetanus, 2 anomalies, 3

Under-nutrition is implicated in up to 50 per cent of all

deaths of children under five (WHO – 2000)
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PREVALENCE OF ARI IN PAKISTAN

 Prevalence of ARI <5

P r e v a le n c e o f A R I in P a k is t a n
years of age: 37%
60
 No Gender Difference 50
S in d , 4 8
NW FP , 35
B a lu c h is t a n , 3 0 S in d
40
 25000 deaths due to 30
P u n ja b , 2 9 NW FP

Percent
B a lu c h is t a n
pneumonia per year. 20
P u n ja b
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 Sind; 48% 0
 NWFP: 35% 1
P ro v in c e
 Baluchistan:30%
 Punjab: 29%

WHO - 2000

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Table – 1.1 Pakistan nutrition statistics
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(WHO 2000 – 2007)

% of under-fives (2000–2007*) suffering from: underweight31

(WHO ref. pop.): moderate ; & severe

% of under-fives (2000–2007*) suffering from: underweight38

(NCHS/WHO): moderate ; & severe

% of under-fives (2000–2007*) suffering from: underweight13

(NCHS/WHO): severe

% of under-fives (2000–2007*) suffering from: wasting13

(NCHS/WHO): moderate ; & severe

% of under-fives (2000–2007*) suffering from: stunting37

(NCHS/WHO): moderate ; & severe

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RATIONALE
 No study has been conducted on effect of
nutritional status on ARI in district
Mansehra yet which is one of the biggest,
important and well representative districts
of NWFP
 Also very little work has been done on 5 to
12 years age group which needs lots more
focus for a better healthy future. This
study will be extremely helpful in all these
regards

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AIM, OBJECTIVE & HYPOTHESIS

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 Aim:
 Reduction in mortality and morbidity due
to acute respiratory diseases in children of
Pakistan.
 Objective:
 To know the effect of nutritional status on
incidence of acute respiratory diseases in
children (5-12 yrs) at district Mansehra.

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 Hypothesis:
 Good nutritional status decreases
incidence of acute respiratory diseases.

 Significance:
 α ═ 5% at 95 % CI.

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 Limitations:
 Single researcher
 limited time
 limited financial and human resources
 regional cultural constrains
 Study design being descriptive survey
 Delmitations / Strengths:
 Constant expert supervision of the supervisor,
 cheapness of the study
 primary data collection are some of the strengths of the
study.
 Involving female staff
 Involving statistician

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METHODS OF RESEARCH
 Population:
 Children (5 – 12 yrs age) of union council
Sandesar, district Mansehra.

 Sample & sampling technique:

 Simple random sampling.
 Sample size; N = 300

 Research design:
 Descriptive survey.

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METHODS CONT . . .

 Research instrument / Pilot testing:

 A structured questionnaire will be prepared in
English and then translated into Urdu language
for convenience.
 Weight machines, measuring taps & stationary
 Pilot testing of questionnaire will be carried out
in union council Baffa of Mansehra. Field editing
will be done of questionnaire. Researcher will
make sure that the data is collected properly by
data collectors by refilling the 5-10
questionnaires in the field in front of him.

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METHODS CONT . . .
 Data collection:
 This will be done in about two months starting from
Dec 1st, 2009 to January 31st, 2010. A team of about
five to six members will be hired comprising of both
male and female and they will be trained to collect 23
data.

 Analysis and interpretation of data

 Analysis will be done using SPSS version 17
 Descriptive statistics such as means, standard
deviations, frequencies, rates, and ratios will be
calculated for different variables.
 Chi square test will be applied to find out correlation
where necessary.
 Linear and logistic regression analysis will be done
where applicable.
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METHODS CONT . . .

 Ethical issues
 Written approval will be taken from ethical committee
of Allama Iqbal Open University. Data will be collected
after detailed verbal consent and confidentiality of the
data will be ensured at all levels.

 Exclusion / inclusion criteria

 Children aged 5 to 12 years irrespective of their sex
will be included in the study.
 Mothers of the children will be included for getting
information about the ARI prevalence.
 Children with long debilitating illness, mental disability
and those who do not want to participate will be
excluded

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DEFINITION OF IMPORTANT TERMS

 ARI will be defined as the mother's report of

cough, fever and running nose for less than
seven days. (WHO)

 BMI stands for body mass index, and is a

measure of bodily mass in relation to frame
size. Weight (kg)/height (m2) is most often
used for adults. (WHO)

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CLASSIFICATION OF BMI VALUES BY THE WHO 10

BMI Nutritional Status

Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Pre-obese
30.0-39.9 Obese
Above 40 Very obese
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REFERENCES

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References:
 Respiratory tract diseases retrieved on Oct 10,2009 from
http://www.who.int/respiratory tract diseases/
 Acute respiratory infections in children retrieved on Oct 10,2009 from http://
www.who.int/acute respiratory infections in children/
 Nutrition retrieved on Oct 10, 2009 from http://www.who.int/nutrition/
 Pelletier, DL., Frongillo, EA., Schroeder. DG., & Habicht, IP. (1995). The effects of
malnutrition on child mortality in developing countries. Bull World Health Organ. 73,
443-8.
 Garene, M., Ronsmans, C., & Campbell, H., (1992). The magnitude of mortality from
acute respiratory infections in children under 5 years in developing countries. World
Health Statistical Quarterly. 45, 180±91.
 Graham NMH., (1990). The epidemiology of acute respiratory infections in children
and adults: a global perspective. Epidemiol Rev. 12, 149±78
 Bhutta, ZA., Ahmed, T., Black, RE., Cousens, S., Dewey, K., Giugliani, E, et al.,
(2008). What works? Interventions for maternal and child undernutrition and survival.
Lancet. 371, 417-40.
 Black3. RE., Allen. LH., Bhutta, ZA., Caulfield, LE., de Onis, M., Ezzati, M., et al.,
(2008). Maternal and child undernutrition: global and regional exposures and health
consequences. Lancet. 371, 243-60.
 Fishman2, SM., Caulfield, LE., de Onis, M., Blossner, M., Hyder, AA., Mullany, L., et
al. (2004). Childhood and maternal underweight. In: Ezzati M, Lopez AD, Rodgers A,
Murray CJL, eds. Comparative quantification of health risks: global and regional
burden of disease attributable to selected major risk factors. Geneva: WHO,. 39-161.

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THANKS

QUESTIONS ACKNOWLE
??? TEXT TEXT
D-GEMENTS

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