Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma
Loading...
Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Pneumonia is considered the major cause of mortality among children with acute respiratory disease
in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the
magnitude of asthma and pneumonia among “under-fives” with cough and difficulty breathing, based on stringent
clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. We enrolled 614 children aged 2–59 months with cough and difficulty breathing. Interviews, physical
examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for
Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified
by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or
bronchiolitis were collectively referred to as “asthma syndrome” due to challenges of differentiating the two conditions
in young children. Three pediatricians reviewed each participant’s case report post hoc and made a diagnosis
according to the study criteria.
Results: Of the 614 children, 41.2% (95% CI: 37.3–45.2) had asthma syndrome, 27.2% (95% CI: 23.7–30.9) had
bacterial pneumonia, 26.5% (95% CI: 23.1–30.2) had viral pneumonia, while 5.1% (95% CI: 3.5–7.1) had other
diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as
asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9–97.5) had a prescription for antibiotics,
87.7% (95% CI: 83.1–91.5) for bronchodilators and 43.1% (95% CI: 36.9–49.4) for steroids.
Although reports indicate that acute respiratory symptoms in children are predominantly due to
pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to
misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia
in Uganda.
Description
Keywords
Citation
Nantanda R, Tumwine JK, Ndeezi G, Ostergaard MS (2013) Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma. PLoS ONE 8(11): e81562. doi:10.1371/journal.pone.0081562