final synopsis aiou dr hammad

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THE ASSOCIATION BETWEEN THE

PREVALENCE OF ACUTE RESPIRATORY TRACTINFECTIONS IN CHILDREN 5 15 YRS AGE AT

SANDESAR DISTRICT MANSEHRA;

A DESCRIPTIVE STUDY

DR. ARSHAD MAHMOOD

UPPALMBBS (Pb), MCPS (Pak), FACP (USA), MSc (Pak)

Additional Principal Medical Officer

District Headquarters Hospital Rawalpindi

DR. HAMMAD HABIBRoll no. # Y 571673

M.Sc. Community Health & Nutrition

Allama Iqbal Open University,

Islamabad


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LOGO 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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LOGO INTRODUCTION

Acute respiratory illness is one of the maincauses 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 pneumoniaand bronchitis and chronic conditions as asthma

and chronic obstructive pulmonary disease.1

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LOGO INTRODUCTION CONT . . .

Acute Lower Respiratory Infectionscontribute to 20% of all deaths under 5

years of age worldwide.

Alone pneumonia is responsible for about90% of these deaths.

Causative organisms can be bacterial

(most commonly Streptococcuspneumoniae and Haemophilus influenzae)

or viral.2

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High risks are seen in children who aremalnourished, 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 illnessand is a vicious circle. 3

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Most malnutrition-related deaths are attributableto 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 inbetter-nourished children (15-19).6

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STATEMENT OF THEPROBLEM &

RATIONALE

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LOGO 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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LOGO ARI MORTALITY WHO ESTIMATE 2002

Estimate as % of all child death


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LOGO Causes of < 5 Mortality

22% 21%

9%

33%

12%

Diarrhea Pneumonia Malaria Neonatal

causes

Others

WHO - 2001

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LOGO UNDER-FIVES DEATHS CAUSES(excluding neonatal causes of death)

Pneumonia

Diarrhoea

Malaria

Measles

HIV/AIDS} ~ 50%

Malnutrition contributes to more than

half of all under-five deathsWHO - 2000

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LOGOGlobal distribution of cause-specific

mortality among children under five

Others, 10

Preterm birth,

10

Birth asphyxia,

8

Neonatal

diarrhoeal

diseases, 1

diarrhoeal

diseases, 17

Neonatal other,

2 Neonatal

tetanus, 2

Congenital

anomalies, 3

Malaria, 8Measles, 4

Injuries, 3

Pneumonia,19

AIDS, 3

Neonatal severe

infections, 10

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

deaths of children under five (WHO 2000)

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LOGO PREVALENCE OF ARI IN PAKISTAN

Prevalence of ARI


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LOGOTable 1.1 Pakistan nutrition statistics

(WHO 2000 2007)

% of under-fives (20002007*) suffering from: underweight(WHO ref. pop.): moderate ; & severe 31

% of under-fives (20002007*) suffering from: underweight(NCHS/WHO): moderate ; & severe

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% of under-fives (20002007*) suffering from: underweight(NCHS/WHO): severe

13

% of under-fives (20002007*) suffering from: wasting

(NCHS/WHO): moderate ; & severe

13

% of under-fives (20002007*) suffering from: stunting(NCHS/WHO): moderate ; & severe

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LOGO RATIONALE

No study has been conducted on effect ofnutritional status on ARI in districtMansehra yet which is one of the biggest,important and well representative districtsof NWFP

Also very little work has been done on 5 to12 years age group which needs lots more

focus for a better healthy future. Thisstudy will be extremely helpful in all theseregards

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AIM, OBJECTIVE & HYPOTHESIS

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Hypothesis:

Good nutritional status decreases

incidence of acute respiratory diseases.

Significance:

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 thestudy. Involving female staff Involving statistician

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LOGO 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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LOGO METHODS CONT . . .

Research instrument / Pilot testing: A structured questionnaire will be prepared in

English and then translated into Urdu languagefor convenience.

Weight machines, measuring taps & stationary Pilot testing of questionnaire will be carried out

in union council Baffa of Mansehra. Field editingwill be done of questionnaire. Researcher will

make sure that the data is collected properly bydata collectors by refilling the 5-10questionnaires in the field in front of him.

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Data collection:

This will be done in about two months starting fromDec 1st, 2009 to January 31st, 2010. A team of aboutfive to six members will be hired comprising of bothmale and female and they will be trained to collect 23data.

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 becalculated 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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Ethical issues

Written approval will be taken from ethical committeeof Allama Iqbal Open University. Data will be collectedafter detailed verbal consent and confidentiality of thedata 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 beexcluded

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LOGO 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 framesize. Weight (kg)/height (m2) is most often

used for adults. (WHO)

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LOGO 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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LOGO References:

Respiratory tract diseases retrieved on Oct 10,2009 fromhttp://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 fromacute respiratory infections in children under 5 years in developing countries. WorldHealth Statistical Quarterly. 45, 18091.

Graham NMH., (1990). The epidemiology of acute respiratory infections in childrenand adults: a global perspective. Epidemiol Rev. 12, 14978

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 healthconsequences. Lancet. 371, 243-60.

Fishman2, SM., Caulfield, LE., de Onis, M., Blossner, M., Hyder, AA., Mullany, L., etal. (2004). Childhood and maternal underweight. In: Ezzati M, Lopez AD, Rodgers A,Murray CJL, eds. Comparative quantification of health risks: global and regionalburden of disease attributable to selected major risk factors. Geneva: WHO,. 39-161.

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http://www.who.int/acutehttp://www.who.int/acutehttp://www.who.int/acutehttp://www.who.int/acutehttp://www.who.int/acute


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QUESTIONS???

THANKS

TEXT TEXTACKNOWLED-GEMENTS

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final synopsis aiou dr hammad

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