Respiratory tract infections in children in developing countries

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Acute respiratory infections are the main cause of morbidity worldwide, and pneumonia represents one of the main causes of death in children younger than the age of 5 years in developing countries. Several risk factors for acquiring respiratory infections in developing countries, such as poverty, restricted family income, low parental education level, low birth weight, malnutrition, and lack of breastfeeding, have been described. Another important factor in recent years that has aggravated the problem of acute respiratory infections in developing countries is the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic. In developing countries, identifying the etiology is difficult and World Health Organization recommends making the diagnosis of pneumonia based on clinical parameters. The diagnosis and suitable treatment administered by primary healthcare workers, particularly in rural areas, is part of the strategy to prevent mortality. Finally, it is important that industrialized countries support the economic growth of the developing countries to improve their healthcare system and to ensure that performed research studies will give benefits to their populations.

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Etiology

Identifying the etiology of pneumonia in children is difficult, even more so in the developing countries where not all the diagnostic tools, including the invasive ones such as lung aspiration or pulmonary biopsies, are available. Even so, some studies have reported the main responsible microorganisms for lower respiratory infections as follows: S. pneumoniae, H. Influenzae, and, with less frequency, Staphylococcus aureus. Among the viral agents are respiratory syncytial virus (RSV),

Diagnosis

In developing countries, the diagnosis of pneumonia in children is established on a clinical basis and sometimes is supported with x-rays studies. The causal agent in most cases is not identified because the ability to perform blood cultures and lung aspiration is limited to large hospitals.51 The diagnosis of pulmonary infections caused by bacteria that colonize the upper respiratory tract, such as pneumococcus, Hib, and M. catarrhalis, needs to be established with the isolation of these

Mortality

In developing countries, children younger than 5 years old are more susceptible to acute respiratory tract infections, which carry a high mortality rate, especially in children younger than the age of 24 months and in those with acute malnutrition56, 57, 58, 59

Researchers have calculated that more than 10 million children younger than the age of 5 years died in 2000, most of them by preventable causes and almost all in poor countries. Only six countries (India, Nigeria, China, Pakistan, the

Prevention

According to the WHO estimates for the year 2003, 11 million children died before reaching 5 years old, 2 million of them from diarrhea, 2.1 million from pneumonia, and another million from malaria. Currently, 26 percent of the children younger than 2 years old worldwide are not immunized against diphtheria, pertussis, and tetanus; 28 percent do not receive oral rehydration therapy for diarrhea; 52 percent do not receive vitamin A supplements; 32 percent do not have access to iodized salt: 58

Treatment

The diagnosis and suitable treatment administered by primary healthcare workers, particularly in rural areas, is part of the strategy to prevent mortality from ARIs. For this purpose, specific and simple criteria have been developed by the WHO to identify children with lower respiratory tract infections who should receive antibiotics. These criteria are based on the fact that a great proportion of the mortal cases of pneumonia are caused by pneumococcus and Hib, that antibiotic treatment of

Conclusions

ARIs continue to be one of the main causes of morbidity and mortality in children younger than the age of 5 years in developing countries, favored by factors such as poverty and low education and socioeconomic level as well as malnutrition, crowding, and the AIDS epidemic. For all these reasons, concerted support efforts from industrialized countries through multinational organizations are required to develop direct strategies to improve the general conditions of developing countries. This

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