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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LOGO INTRODUCTION CONT . . .
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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LOGO INTRODUCTION CONT . . .
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
38
% 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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LOGO METHODS CONT . . .
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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LOGO METHODS CONT . . .
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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