Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
PLoS One. 2019 Mar 20;14(3):e0214086. doi: 10.1371/journal.pone.0214086. eCollection 2019.
Community Acquired Pneumonia (CAP) is the leading cause of mortality in children younger than five years of age in developing countries, including India. Hence, this prospective study was performed to estimate the incidence of CAP in children (2-59 months)in four districts of Northern India.
A cross-sectional survey in rural Lucknow was conducted using cluster sampling technique to assess the proportion of CAP cases that were hospitalized in last 12 months (hospitalization fraction). Another prospective study was done to assess number of hospitalized CAP cases in same districts in 2016. For this, a surveillance network of hospitals that admitted children was established. Cases with WHO-defined CAP with less than 14 days of illness were eligible for inclusion. Informed written parental consent was obtained. A mathematical model was developed to estimate the incidence of CAP in each district, taking into account number of cases hospitalized in one year, assuming it to be equal to hospitalization fraction and using Lucknow district as reference, correcting for child-population per hospital for each district. Population census data of 2011 was taken as denominator.
In cross-sectional survey (February to May 2016), 3351 children (2-59 months) from 240 villages were included. Of these 24.58% (824/3351) children suffered from CAP in last 12 months and out of these 4% (33/824) children were hospitalized. Computed incidence of CAP per 1000 child-year for Lucknow was 86.50 (95%CI: 85.72-87.29); Etawah 177.01(95%CI: 175.44-178.58); Patna 207.78 (95%CI: 207.20-208.37) and Darbhanga 221.18 (95%CI: 220.40-221.97). Infants (2-11 months)had almost five to ten times higher incidence of CAP than those in 12-59 months age category.
Incidence of CAP in Uttar Pradesh and Bihar is high, being much higher in infants. Hence there is an urgent need for introduction of preventive strategies, improving health seeking behavior and quality of care for CAP.
在发展中国家，包括印度，社区获得性肺炎（CAP）是五岁以下儿童死亡的主要原因。因此，本前瞻性研究旨在评估印度北部四个地区（2-59 个月）儿童的 CAP 发病率。
在勒克瑙农村进行了一项横断面调查，使用聚类抽样技术评估过去 12 个月中住院的 CAP 病例比例（住院率）。另一项前瞻性研究旨在评估 2016 年同一地区住院的 CAP 病例数。为此，建立了一个收治儿童的医院监测网络。符合世界卫生组织定义的 CAP 且病程少于 14 天的病例符合纳入标准。获得了父母的知情书面同意。开发了一种数学模型，以考虑一年内住院的病例数，假设其等于住院率，并以勒克瑙区为参照，对每个区的医院每儿童人口进行校正，来估计每个区的 CAP 发病率。采用 2011 年人口普查数据作为分母。
在横断面调查（2016 年 2 月至 5 月）中，纳入了来自 240 个村庄的 3351 名（2-59 个月）儿童。其中，24.58%（824/3351）的儿童在过去 12 个月中患有 CAP，其中 4%（33/824）的儿童住院。计算出的勒克瑙 CAP 发病率为每 1000 儿童年 86.50（95%CI：85.72-87.29）；埃塔瓦 177.01（95%CI：175.44-178.58）；巴特那 207.78（95%CI：207.20-208.37）和达尔班加 221.18（95%CI：220.40-221.97）。婴儿（2-11 个月）的 CAP 发病率几乎是 12-59 个月年龄组的五到十倍。
在北方邦和比哈尔邦，CAP 的发病率很高，婴儿的发病率更高。因此，迫切需要引入预防策略，改善对 CAP 的求医行为和护理质量。
