Upper respiratory tract infections in children age 2 to 10 years in Quetta : A prevalence study

The present study was carried out to asses the prevalence of upper respiratory tract infection (URTIs) in children at combined military hospital (CMH), Quetta from September, 2017 to April, 2018. The data were sampled by visiting the Pediatrician office and outpatient department (OPD) weekly. Of the total children examined, 64 were male and 36 were females (Age range 2-10 years). Out of 100 patients evaluated, ratio of URTIs was 41%, 25%, 20%, 12% and 2% in the form of Pharyngitis, Tonsillitis, Laryngitis, Rhinitis and Sinusitis respectively. Pharyngitis showed highest prevalence in male was 50% while Tonsillitis was the most prevalent (42%) compare to Laryngitis (25%) in females. Children aged 2-5years were found more infected (56%) by Pharyngitis like complication than children with 7-10 (28%) and 5-7 (16%) years of age. Highest ratio of Tonsillitis (50%) was found in patients of 7-10 years followed by 32 and 16 percent prevalence in the patients were 5-7 and 2-5 years old. Sinusitis was least prevailed sex wise (males=3%), (females= 2%), however, it was found slightly higher (11%) in patients aging 7-10 years. This is the first study in children with URTIs conducted in Quetta that can help the parents to take proper health care of underage children. It emphasizes the need of up-to-date facilities and infra-structure in our setup to improve treatment outcomes in this respiratory tract infections.


Introduction
Upper respiratory tract infections are the most common, widespread infectious disease usually referred to the word form URTIs [1].It is the illness caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx, larynx, or ear.The Upper respiratory tract consists of airpassage from the nostrils to the vocal cords in the larynx, including the para-nasal sinuses and the middle ear, which pertain direct invasion of the mucosal lining of the upper air-passage.Among

Study area
The current study was conducted between September 2017 to April 2018 in Combined Military Hospital (CMH) Quetta.CMH is located in the north-east of provincial capital (Quetta) cantonment area with the Gps coordinates of Latitude: 30.215ºN and Longitude: 67.030ºE.The city is at an average elevation of 1680 meters (5510 feet) above sea level with an mean annual temperature (15.8 °C) and mean annual rainfall 244 mm (Pakistan Meteorological Department in Quetta).Ethical approval was taken both from the institutional committee for higher studies & research board, University of Balochistan Quetta and the department of Paediatrics at combined military hospital (CMH) Quetta cantt.Parents or guardians signed a written informed consent form, as approval for their children to be participants.

Sampling
The data were sampled by visiting the pediatrician office, or hospital outpatient departments (OPD) on different dates from September 4, 2017 to February 26, 2108.The focus of this study was only on office-based and hospital-based outpatient visits.thecharacterization of age done from 2-5 years, 5-7 years and 7-10 years Cross tabulation and binary logistic regression techniques were computed to fulfill the requirements of the objectives of the present study with the help of SPSS software.

Identification of URTIs
Children aged 24 months to 10 years only were included in the study.During this period, visits of children diagnosed with URTI complaints were identified by the consultant pediatrician from combined military hospital (CMH), and a designed questionnaire was managed by the chief investigator.In data sets, up to 5 distinct diagnoses were made for each visit in accordance with criteria from the International Classification of Diseases.

Statistical analysis
The chi square test was used to evaluate significance of associations between sex and UTRIs; age and URTIs, which were coded as categorical variables.A P value of 5% (2tailed) level of significance was considered statistically significant.All statistical analyses were conducted using SAS software version 9.4.

Discussion
In the present study (September 2017 to February 2018), overall prevalence of URTIs was found to be 45% (Figure 1).Our study are comparable with study done by Rahman and Rahman [19, 20] where they observed nearly similar results found to be 47% and 44% respectively.A local study by Samoo et al. [21] observed higher proportion (62.5%) of URTIs in males than female children was 37.5%.Table 1 indicated sinusitis as the least prevailed complication observed only in 1.6% (1/64) male and 2.8% (1/36) females.However, there are some pediatric studies and most have various limitations.A study [13] found a higher proportion (14-61%) of URTIs in children (under five years) compared to the 8-56% found in our and other studies [19, 20].This differences in the proportions of URTIs could be as a result of variation in age groups studied, different study populations, and different study settings.
In the present study sex-wise prevalence of URTIs were more prevalent as pharyngitis in boys than in girls when compared with laryngitis, tonsillitis.Rhinitis and sinusitis (Figure 2).The present study established a significant relationship between URTIs and sex at 5% level of significance.It was also found that most of the male children 32/64 (50%) with URTIs were diagnosed with pharyngitis compared to females 9/34 (25%) (Figure 2).The predominance of males might be because of being more vulnerable to infections secondly, the society pays no attention to the health of girls in loweconomy countries like us, therefore, seek early medical help for their survival [22].In contrast, 41.7% of the children (15/36) are diagnosed with tonsillitis were females.Although tonsillitis was not as common as pharyngitis noted in the present study.According to age-wise, more UTRIs cases were seen in 2-5 years of age group include 45.0% males and 12.0% females.This group had more URTIs with pharyngitis (56.1%) and laryngitis (22.8%) than their comparative age groups while children between 7-10 yeas had higher Tonsillitis prevalence (50%) compare to others (Figure 3).It may be assumed that environmental factors like exposure to wood smoke, cigarette smoke, and contact or living with someone who had a cough were found to significantly increase the proportion of URTIs    The ratio of URTIs among 64 male and 34 female children was 45%.Pharyngitis and tonsillitis were the most prevailing complications diagnosed in males, and the later in female children.Pharyngitis and tonsillitis were also found as the most prevalent cases of URTIs determined age wise.From the findings of this sturdy it is concluded that male children are more vulnerable to infection, associated with exposure to wood and cigarette smoke and or contact with person having acute respiratory tract infections.It is suggested that measures should be taken by the ministry of public health to slake these conditions and prevent its spread and severity will reduce the morbidity and mortality associated with this problem.

Figure 1 .Figure 3 .
Figure 1.Proportion of different types of URTIs evaluated in the present study in children aged 2 to 10 years

Table 1 . Relationship between Sex and URTIs
Chi-Square Tests: 12.582 a , df:= 4, Asymptotic 2-sided significance =.014 at P-value = 0.05 Relationship between sex and URTIs is found significant at 5% by chi-square test
The burden of acute respiratory infections in crisis-affected populations: a systematic review.Confl Health 4: 3.