Acute Respiratory Infection and Pneumonia in India: A Systematic Review of Literature for Advocacy and Action: UNICEF-PHFI Series on Newborn and Child Health, India.
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Date
2011-03
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Abstract
Background: Scaling up of evidence-based management of childhood acute respiratory infection/pneumonia, is a public
health priority in India, and necessitates robust literature review, for advocacy and action.
Objective: To identify, synthesize and summarize current evidence to guide scaling up of management of childhood acute
respiratory infection/pneumonia in India, and identify existing knowledge gaps.
Methods: A set of ten questions pertaining to the management (prevention, treatment, and control) of childhood ARI/
pneumonia was identified through a consultative process. A modified systematic review process developed a priori was
used to identify, synthesize and summarize, research evidence and operational information, pertaining to the problem in
India. Areas with limited or no evidence were identified as knowledge gaps.
Results: Childhood ARI/pneumonia is a significant public health problem in India, although robust epidemiological data is
not available on its incidence. Mortality due to pneumonia accounts for approximately one-fourth of the total deaths in
under five children, in India. Pneumonia affects children irrespective of socioeconomic status; with higher risk among
young infants, malnourished children, non-exclusively breastfed children and those with exposure to solid fuel use. There
is lack of robust nation-wide data on etiology; bacteria (including Pneumococcus, H. influenzae, S. aureus and Gram
negative bacilli), viruses (especially RSV) and Mycoplasma, are the common organisms identified. In-vitro resistance to
cotrimoxazole is high. Wheezing is commonly associated with ARI/pneumonia in children, but difficult to appreciate
without auscultation. The current WHO guidelines as modified by IndiaCLEN Task force on Penumonia (2010), are
sufficient for case-management of childhood pneumonia. Other important interventions to prevent mortality are oxygen
therapy for those with severe or very severe pneumonia and measles vaccination for all infants. There is insufficient
evidence for protective or curative effect of vitamin A; zinc supplementation could be beneficial to prevent pneumonia,
although it has no therapeutic benefit. There is insufficient evidence on potential effectiveness and cost-effectiveness of
Hib and Pneumococcal vaccines on reduction of ARI specific mortality. Case-finding and community-based management
are effective management strategies, but have low coverage in India due to policy and programmatic barriers. There is a
significant gap in the utilization of existing services, provider practices as well as family practices in seeking care.
Conclusion: The systematic review summarizes current evidence on childhood ARI and pneumonia management and
provides evidence to inform child health programs in India.
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Keywords
Action, Advocacy, ARI, Child health, Pneumonia, Systematic reviews
Citation
Mathew Joseph L, Patwari Ashok K, Gupta Piyush, Shah Dheeraj, Gera Tarun, Gogia Siddhartha, Mohan Pavitra, Panda Rajmohan Subhadra Menon. Acute Respiratory Infection and Pneumonia in India: A Systematic Review of Literature for Advocacy and Action: UNICEF-PHFI Series on Newborn and Child Health, India. Indian Pediatrics. 2011 Mar; 48(3): 191-218.