Respiratory tract infection in children in

developing country

ABSTRACT
With a high infectivity and fatality rate, pulmonary tuberculosis is a dangerous respiratory
illness brought on by a tuberculosis bacterial infection in the lungs. Early-stage symptoms of
pulmonary tuberculosis can include a cough, sputum, low fever, and exhaustion. These
symptoms can be readily misinterpreted as other respiratory conditions, delaying the optimal
time for treatment and putting patients' lives in peril.These seemingly different health
determinants are actually a result of deeper, more fundamental elements that could be
referred to as the "determinants of determinants." These essential health determinants include
aspects of the nation. It is believed that by identifying and concentrating efforts on these
variables, the prevalence of ARI will decline and developing nations would be able to meet
the under-5 mortality target. under-5 mortality goal. This study intends to investigate the
relationship between ARI in children under the age of five and national characteristics such
as income inequality—the unequal distribution of wealth within the nation—national per
capita GDP—the value of goods and services produced in a year divided by the population at
midyear—and health expenditure—the percentage of GDP allotted to health services, which
is determined by established standards. A significant contributing cause to the exacerbation
of acute respiratory infections in underdeveloped nations in recent times is the pandemic of
acquired immunodeficiency syndrome (HIV/AIDS).

Introduction
The United Nations (UN) has less than a year remaining to accomplish the Millennium
Development Goals. Together, we set these objectives in order to guarantee the welfare of
people everywhere. They were intended to end poverty, promote growth, and lessen
inequality. The fourth target, "reduce child mortality," is to cut the death rate for children
under five by two thirds by the year 2015. Global under-5 child mortality decreased by nearly
half between 1990 and 2012, from 90 deaths per 1000 live births to 48 deaths per 1000 live
births.Worldwide, acute respiratory infections are the leading cause of morbidity, and in
underdeveloped nations, pneumonia is one of the leading causes of death for children under
the age of five. There are a number of known risk factors for respiratory infections in
underdeveloped nations, including low birth weight, malnutrition, poverty, limited family
income, low parental education levels, and not breastfeeding. Another significant aspect that
has exacerbated the issue of acute respiratory infections in children in recent years.
The pandemic of HIV/AIDS, also known as acquired immunodeficiency syndrome, primarily
affects underdeveloped nations. Since determining the cause of pneumonia can be
challenging in underdeveloped nations, the World Health Organization advises diagnosing
the illness primarily on clinical signs.The well-established conclusion that no one sign, or
even combination of indications, reliably identified children with pneumonia was verified by
a systematic evaluation of a large number of studies addressing the usefulness of a wide
variety of symptoms in accurately identifying infants with pneumonia [4]. The World Health
Organization's (WHO) respiratory rate-based approach significantly overestimates the
frequency of pneumonia, as pointed out in an editorial [5]. However, it was intended to
guarantee the early administration of antibiotics in low-resource nations in an attempt to
reduce the high mortality rates. The editorial continues by stressing the importance of
immunization and the demand for more accurate point-of-care diagnostics, maybe built
around metabolomics techniques [6]. The systematic review's findings call into severe doubt
the reliability of recommendations like the pediatric pneumonia guidelines published by the
British Thoracic Society, which essentially ignore data demonstrating the low specificity of
clinical assessment.
Children's respiratory tract infections (RTIs) are among the most frequent causes of medical
consultations.1 A combination of rhinitis, cough, sore throat, wheeze, and fever is typically
the first sign of an RTI. Just a small percentage of these illnesses in children require hospital
admission; the great majority are treated in the primary care context.
Finally, developing laboratory facilities is imperative for all nations with high rates of Hib
illness. Depending on the nation, the GAVI task force on Hib vaccination issued a number of
recommendations. In order to assure continued support for such vaccination campaigns,
countries that have adopted the Hib vaccine should concentrate on recording its effects and
use the data to inform national authorities, development partners, and other institutions
involved in public health. The introduction of Hib vaccines in GAVI-eligible countries is
frequently impeded by a lack of local data and a lack of knowledge about regional data.
Subregional meetings are one way they can solve these concerns, since country specialists
can examine and share information from other countries. Furthermore, the majority of nations
must conduct economic assessments using standardized instruments.determine the prevalence
of Hib meningitis in particular locations. Protocols based on surveillance for meningitis
invasive illness may not be able to adequately record the occurrence of Hib disease in
countries where the disease burden is still unknown. They must investigate the viability of
applying different approaches, such as vaccine-probe trials, to quantify the burden of disease.

Etiology:
Determining the cause of pediatric pneumonia is a challenging task, particularly in
underdeveloped nations where access to advanced diagnostic instruments, such as invasive
pulmonary biopsies and lung aspirations, is limited. Nevertheless, some research has
indicated that Staphylococcus aureus, Haemophilus influenzae, and S. pneumoniae are the
primary microorganisms accountable for lower respiratory infections.

Lower Respiratory Tract Infection

Pneumonia, bronchiolitis, and bronchitis are lower respiratory infections. Origin: Bacteria or
viruses are the causative agents of lower respiratory infections. Most occurrences of
bronchiolitis and bronchitis are caused by viruses. Streptococcus pneumoniae is the most
frequent bacterial cause of community-acquired pneumonias. Agents like Mycoplasma
pneumoniae, Chlamydia spp., Legionella, Coxiella burnetii, and viruses are responsible for
atypical pneumonias. Gram-negative bacteria predominate along with staphylococci in the
protean etiology of nosocomial pneumonias and pneumonias in
immunocompromised patients.

Pathogenesis: Hematogenous seeding, aspiration, or inhalation are the ways by which

organisms enter the distal airway. The pathogen grows within or on top of the epithelium,
resulting in inflammation, increased secretion of mucus, and compromised mucociliary
function, among other possible effects on lung functions. In cases of severe bronchiolitis,
airway obstruction may result from epithelial necrosis and inflammation obstructing tiny
airways.

Clinical Manifestations: Cough, fever, tachypnea, chest discomfort, and sputum

production are among the symptoms. Non-respiratory symptoms like disorientation,
headaches, myalgia, stomach discomfort, nausea, vomiting, and diarrhea can also be present
in patients with pneumonia.
Microbiologic Diagnosis: Bacteria, fungi, and viruses are cultured from sputum
specimens. In most cases, nasal washing culture is adequate for infants with bronchiolitis. For
legionellosis, fluorescent staining technique can be applied. For the study of various bacteria,
fungi, viruses, and rickettsiae, blood cultures and/or serologic techniques are employed. Both
antibodies and microbial antigens can be detected using enzyme-linked immunoassay
techniques. An expedient diagnosis may be provided by using a polymerase chain reaction or
DNA probe to find nucleotide fragments specific to the microbial antigen under investigation.

Prevention and Treatment: The majority of viral infections are treated with
symptomatic measures. Antibiotics are used to treat bacterial pneumonias. For those who are
at high risk, a polysaccharide vaccine against 23 serotypes of Streptococcus pneumoniae is
advised.

Upper Respiratory Infections:

Based on their anatomical involvement and symptomatology, respiratory tract infections are
categorized. Pharyngitis, laryngotracheitis, epiglottitis, and the common cold are examples of
acute upper respiratory infections (URI). Although epiglottitis and laryngotracheitis can be
dangerous conditions in children and premature infants, these infections are typically benign,
transient, and self-limited. URI is linked to a variety of etiologic agents, such as bacteria,
fungi, viruses, and mycoplasma. Fall and winter, when school starts, are peak seasons for
respiratory illnesses, as indoor crowding makes them easier to spread.

Pneumonia: Pneumonia can be caused by viruses or bacteria. Haemophilus influenzae,

primarily type b (Hib), or Streptococcus pneumoniae (pneumococcus) are the most common
causes of bacterial pneumonia. Staphylococcus aureus or other streptococci can also
infrequently cause bacterial pneumonia. Most occurrences of bacterial pneumonia are caused
by just 8 to 12 of the several varieties of pneumococcus, while the exact forms might differ
between adults and children as well as across different geographical areas. Atypical
pneumonias are caused by several organisms, including Chlamydia pneumoniae and
Mycoplasma pneumoniae. It is unclear how they contribute to serious illness in children
under five in impoverished nations.
Due to the lack of sensitivity and specificity in existing methods for determining bacterial
etiology, it is challenging to estimate the burden of LRIs caused by Hib or S. pneumoniae.
Pharyngeal cultures' findings don't always identify the pathogen causing the LRI. Although
lung aspirate specimen bacterial cultures are frequently regarded as the gold standard, they
are not useful in the field. While studies by Adegbola and others (1994), Shann, Gratten, and
others (1984), and Wall and others (1986) suggest that Hib accounts for 5 to 11 percent of
pneumonia cases, Vuori-Holopainen and Peltola's (2001) review of several studies indicates
that S. pneumoniae and Hib account for 13 to 34 percent and 1.4 to 42.0 percent of bacterial
pneumonia, respectively.

Bronchiolitis: In the first year of life, bronchiolitis is more common, and in the second and
third years, it is less common. Clinical manifestations include wheezing, fever in one-third of
cases, fast breathing, and lower chest wall indrawing (Cherian and others 1990). There is an
inflammatory blockage of the tiny airways, which causes the lungs to hyperinflate, and lung
segments collapse. Healthcare professionals may have challenges in distinguishing between
bronchiolitis and pneumonia due to the similarities in signs and symptoms. A description of
the seasonality of RSVs in the area and the ability to recognize wheezing are two
characteristics that might be useful. RSVs can cause up to 70 to 80 percent of LRIs during
high season, and they are the primary cause of bronchiolitis globally (Simoes 1999;
Stensballe, Devasundaram, and Simoes 2003). According to Van den Hoogen et al. (2001),
the human metapneumovirus has been found to induce bronchiolitis that is identical to RSV
illness. Influenza viruses and parainfluenza virus type 3 are two more viruses that can cause
bronchiolitis.
Influenza
Despite the fact that influenza viruses often cause URIs in adults, they are now known to be a
significant contributor to LRIs in children and may even be the second most common cause,
behind RSVs, of hospitalization for children suffering from an ARI (Neuzil and others 2002).
Even though influenza is thought to be uncommon in underdeveloped nations, there is still
much to learn about its epidemiology. It is unknown how frequently influenza causes
fatalities in youngsters. Type A and type B influenza viruses can cause seasonal outbreaks
and sporadic infections, respectively. In a few Asian nations, the avian influenza virus has
recently resulted in infection, illness, and death in a limited number of people, including
children. Its likelihood of appearing in pandemics or human outbreaks is uncertain, but it
might have disastrous effects in underdeveloped nations and be a global health danger (Peiris
and colleagues, 2004). Type A virus strains will most likely mutate to produce new strains, as
happened with the Asian and Hong Kong pandemics in the 1950s and 1960s.

HIV Infection and Low-Risk Infants

Eighty-five percent of the 3.2 million children living with HIV/AIDS worldwide are in Sub
Saharan Africa (UNAIDS 2002). Thirty to forty percent of pediatric admissions in southern
Africa are HIV-related LRIs, with a case-fatality rate of fifteen to thirty-four percent. This is
significantly higher than the five to ten percent of children who are not HIV-positive (Bobat
and others 1999; Madhi, Petersen, Madhi, Khoosal, and others 2000; Nathoo and others
1993; Zwi, Pettifor, and Soderlund 1999). In over half of newborns with HIV, the
opportunistic illnesses pneumocystis jiroveci and CMV are significant (Jeena, Coovadia, and
Chrystal 1996; Lucas and others 1996). More than 70% of HIV-positive malnourished

children have gram-negative bacteria (Ikeogu, Wolf, and Mathe 1997). Although S.
pneumoniae and S. aureus were added as significant pathogens, patient studies have
demonstrated the common connection of these bacteria (Gilks 1993; Goel and others 1999).
There was a 41.7-fold increase in HIV-positive children compared to uninfected children in
the first South African assessment on the overall burden of invasive pneumococcal disease
(Farley and others 1994).

Laryngotracheobronchitis (croup), bacterial tracheitis, and epiglottitis

Croup is regarded as an upper respiratory illness in which the subglottic area of the airway
becomes narrowed due to widespread inflammation, exudate, and edema. It usually appears
in the second year of life and is characterized by a brassy, seal-like, barking cough, hoarse
voice, and restlessness. The median age at presentation in a study including 327 children
hospitalized with croup was 16.7 months.In certain instances, the primary symptoms of croup
may be preceded by a slight cough, coryza symptoms, and a prodrome of low-grade pyrexia.
Some children may develop inspiratory stridor, which becomes noticeable when the
youngster cries or becomes agitated.

Although viruses like influenza A are also known to produce viral croup, parainfluenza virus
is the primary cause of croup.Even if the kid and parents find these symptoms upsetting, the
child is typically not very sick and can be treated in the community with supportive care. Just
the barking cough in children can be successfully treated at home with rehydration,
antipyretics (especially ibuprofen for its anti-inflammatory qualities), and a safety net
recommendation to seek emergency medical attention if the child worsens or develops
stridor. The kid's parents should be encouraged to relocate them to a location where the child
can breathe in cool air to lessen upper airway irritation, as this may assist to relieve the child's
symptoms if they return.
Prevention:
The World Health Organization estimates that 11 million children died before they turned
five years old in 2003; 2 million of those deaths were due to diarrhea, 2.1 million to
pneumonia, and another million to malaria. Right now, 26% of children under the age of two
worldwide lack the tetanus, diphtheria, and pertussis vaccinations; 28% do not receive oral
rehydration therapy for diarrhea; 52% do not take vitamin A supplements; 32% do not have
access to iodized salt; 58% are not breastfed during their first few months of life; 5% suffer
from malnutrition; and 40% do not receive a suitable pneumococcal treatment. Sixty percent
of the recorded deaths are caused by all of this.

vaccination:
A variety of recommendations, which differ based on the nation, were given by the GAVI
task force on Hib immunization. In order to assure continued support for such vaccination
campaigns, countries that have adopted the Hib vaccine should concentrate on recording its
effects and use the data to inform national authorities, development partners, and other
institutions involved in public health. The introduction of Hib vaccines in GAVI-eligible
countries is frequently impeded by a lack of local data and a lack of knowledge about
regional data. Subregional meetings are one way they can address these concerns, allowing
country experts to analyze and share information from other countries.

GAVI adopted a proactive stance and, in 2003, launched an initiative based at the Johns
Hopkins School of Public Health in Baltimore to implement an accelerated development and
introduction program for pneumococcal vaccines (the PneumoADIP; see
http://www.preventpneumonia.org). This was based on experience introducing Hib and
hepatitis B vaccines. The goal of the initiative is to assist the administration of pneumococcal
vaccinations and to establish and explain their worth. Creating local evidence regarding the
prevalence of disease and the possible impact of vaccines on public health is necessary to
determine the vaccine's usefulness. Improved disease surveillance and pertinent clinical
studies in a few chosen lead nations can help achieve this goal.

Treatment:
Part of the plan to reduce mortality from ARIs is the diagnosis and appropriate treatment
provided by primary healthcare providers, especially in rural regions. The WHO has created
clear and straightforward criteria to help identify children with lower respiratory tract
infections who need to be treated with antibiotics. For children with pneumonia, the current
recommendations are injectable penicillin or chloramphenicol, and co-trimoxazole twice
daily for five days. Studies looking into alternatives to the antibiotics currently used in ARI
case management have been prompted by issues with growing co-trimoxazole resistance and
needless referrals of kids with any kind of chest wall indrawing. According to one study
(Catchup Study Group, 2002), amoxicillin and co-trimoxazole are equally effective for
treating non-severe pneumonia; however, amoxicillin is twice as expensive as co
trimoxazole. Research conducted in Bangladesh, India, and Indonesia suggests that for
children with non-severe pneumonia, three days of oral co-trimoxazole or amoxicillin is just
as beneficial as five days of either medication (Agarwal et al., 2004; Kartasasmita, 2003).
Addo-Yobo and colleagues' (2004) multicenter trial comparing oral amoxicillin to injectable
penicillin for children with severe pneumonia finds comparable cure rates.

When there is a sufficient supply, the World Health Organization advises giving oxygen to
children who exhibit severe pneumonia symptoms and signs. If there is not enough oxygen
available, the recommendation is to give oxygen to children who exhibit any of the following
symptoms: cyanosis, inability to eat or drink, respiratory rate greater than or equal to 70
breaths per minute, or severe chest wall retractions (WHO 1993). For toddlers under two
months old, the recommended oxygen administration rate is one liter per minute; for older
children, the rate should be one liter per minute. Due to the high cost and limited availability
of oxygen, particularly in remote rural areas of developing nations, the World Health
Organization suggests using basic clinical symptoms to identify and treat hypoxemia.

Prevention and Treatment of Pneumonia in HIV-Positive Children

The WHO panel's current guidelines for prophylaxis against Pneumocystis jiroveci and for
treating pneumonia in children who test positive for HIV are as follows (WHO 2003).mild
pneumonia up to the age of five. As long as it is inexpensive or the child has been receiving
co-trimoxazole prophylaxis, oral amoxicillin should be used instead of oral co-trimoxazole as
the first-line antibiotic.extremely serious or severe pneumonia. For infants under two months
old, standard WHO case-management protocols ought to be followed. Injectable antibiotics,
treatment for Pneumocystis jiroveci pneumonia, and initiating prophylactic Pneumocystis
jiroveci pneumonia are advised for children between the ages of 2 and 11 months.
Pneumocystis jiroveci pneumonia therapy and injectable antibiotics are the mainstays of
treatment for children aged 12 to 59 months. Children born to HIV-positive mothers should
get prophylactic treatment against Pneumocystis jiroveci pneumonia for 15 months;
unfortunately, this prescription has rarely been followed.

Clinical research:
as metabolomics matures, sequencing and omics platforms may begin to play a major role in
diagnostics, influencing research in the microbiome field. A study in which whole-genome
sequencing results indicated that the risk of within-clinic transmission of Mycobacterium
abscessus appears to be very low (despite the fact that a sibling pair carried genetically
identical organisms) and a report of whole-exome sequencing being used to increase the
ability to identify the underlying genetic defect in those with primary ciliary dyskinesia [30]
are two more examples of powerful gene-sequencing techniques introduced into the clinical
space.
In conclusion, studies from the past year have once more shown the stark contrast between
respiratory mortality rates for newborns and early children in nations with high and low
resources. While efforts to develop better preventative strategies will continue to center on
the traditional primary respiratory pathogens, host-microbiome interactions are becoming
more and more important in the development and/or maintenance of chronic disease. The last
ten years have seen a significant advancement in sequencing technology, which has made this
possible and will eventually lead to the creation of new strategies for the management and
prevention of acute and chronic respiratory illnesses.

Conclusion:
In conclusion, RTIs for children are frequently used in clinical settings. Community health
professionals are crucial in providing children with comfort, offering advice on symptom
management, and making early referrals when more advanced medical attention is required.
In a hospital setting, nurses must provide a comprehensive care plan that addresses both
physical and psychological issues. In certain areas of respiratory care, the function of nurse
specialists is becoming more and more acknowledged, and it still has to be expanded in both
primary and secondary care. The importance of health promotion to inform families and
increase vaccination uptake—which helps avoid serious RTIs like pneumonia and
epiglottitis—is part of this growing role.

Result:
Efforts to improve access to healthcare, promote vaccination programs, enhance sanitation practices,
and address underlying socioeconomic factors are essential in reducing the burden of respiratory
infections in:respiratory tract infections in children in developing countries can have several
consequences, including increased morbidity and mortality: due to limited access to healthcare,
proper nutrition, and sanitation, respiratory infections can lead to more severe illnesses and higher
rates of complications, including pneumonia, which can be life-threatening in children.impact on
growth and development: frequent infections can hinder a child's growth and development, both
 physically and cognitively. malnutrition and recurrent illnesses can impair overall health and delay
milestones educational implications. families may face financial strain due to healthcare costs, lost
wages from caretakers needing to stay home with sick children, and expenses related to medications
and treatment public health challenges: inadequate healthcare infrastructure and limited resources in
developing countries can make it challenging to control and prevent the spread of respiratory
infections, leading to broader public health concern efforts to improve access to healthcare, promote
vaccination programs, enhance sanitation practices, and address underlying socioeconomic factors
are essential in reducing the burden of respiratory infections in children in developing country
respiratory tract infections in children in developing countries can have several consequences,
include increased morbidity and mortality:

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