Chest radiograph findings in children aged 2–59 months hospitalised with community-acquired pneumonia, prior to the introduction of pneumococcal conjugate vaccine in India: a prospective multisite observational study. Issue 5 (7th May 2020)

• Record Type: Journal Article
• Authors: Awasthi, Shally; Rastogi, Tuhina; Mishra, Neha; Chauhan, Abhishek; Mohindra, Namita; Shukla, Ram Chandra; Agarwal, Monika; Pandey, Chandra Mani; Kohli, Neera; Study Group, CAP
• Is Part Of: BMJ open. Volume 10:Issue 5(2020)
• Publication Date: 2020-05-07
• Subjects: chest radiographs -- hospitalised community-acquired pneumonia -- under-5 -- Streptococcus pneumoniae -- India; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-034066
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: The current study was a hospital-based surveillance of cases hospitalised with WHO-defined community-acquired pneumonia in children aged 2–59 months, to assess the radiological abnormalities in chest X-rays and to identify the demographic and clinical correlates of specific radiological abnormalities, in residents of prespecified districts of Uttar Pradesh and Bihar, India. Design: Prospective, active, hospital-based surveillance. Setting: Multisite study conducted in a network of 117 secondary/tertiary care hospitals in four districts of Uttar Pradesh and Bihar, India. Participants: Included were children aged 2–59 months, hospitalised with community-acquired pneumonia, residing in the project district, with duration of illness <14 days and who had not been hospitalised elsewhere for this episode nor had been recruited previously. Main outcome measure: Concordant radiological abnormalities in the chest X-rays. Results: From January 2015 to April 2017, 3214 cases were recruited and in 99.40% (3195/3214) chest X-rays were available, among which 88.54% (2829/3195) were interpretable. Relevant radiological abnormalities were found in 34.53% (977/2829, 95% CI 32.78 to 36.28). These were primary end point pneumonia alone or with other infiltrates in 22.44% (635/2829, 95% CI 20.90% to 23.98%) and other infiltrates in 12.09% (342/2829; 95% CI 10.88% to 13.29%). There was a statistically significant interdistrict variation in radiological abnormalities. Statistically significantly higher proportion of abnormal chest X-rays were found in girls, those with weight-for-age z-score ≤−3SD, longer duration of fever, pallor and with exposure to biomass fuel. Conclusions: Among hospitalised cases of community-acquired pneumonia, almost one-third children had abnormal chest radiographs, which were higher in females, malnourished children and those with longer illnesses; and an intra-district variation was observed.