Dificuldades em estudo de infecções respiratórias em comunidade no Uruguay

A cohort study on acute respiratory infections, involving 270 children observed by pediatricians in their homes every 10 days over a period of 32 months, gave the opportunity to experience logistic and methodological problems seldom described in the literature. The purpose of this article is to alert researchers as to the difficulties faced when performing community-based studies in developing countries. Although a carefully planned project was undertaken, problem areas included the establishment of the target population, population dynamics, field related problems, laboratory aspects and data management. It is hoped that other investigators may benefit from the extensive experience gained from our program in foreseeing and coping with the difficulties involved.Durante estudo sobre infecção respiratória aguda estudada numa coorte de 270 crianças observadas pelos pediatras, cada 10 dias, durante 32 meses, enfrentaram-se problemas metodológicos e logisticos, poucas vezes descritos na literatura. Considerou-se, portanto, importante alertar outros pesquisadores a respeito das dificuldades apresentadas quando se realiza estudo em nível cumunitário, em um país em desenvolvimento. Apesar do mencionado estudo ter sido planejado com minúcia, enfrentaram-se problemas relativos à população objeto do estudo, à dinâmica populacional, aos aspectos operacionais e ao tratamento da informação. Espera-se que outros pesquisadores possam beneficiar-se da experiência adquirida durante o citado estudo, a fim de evitar ou prever as dificuldades analisadas

Difficulties encountered in a community-based study of acute respiratory infections in Uruguay

A cohort study on acute respiratory infections, involving 270 children observed by pediatricians in their homes every 10 days over a period of 32 months, gave the opportunity to experience logistic and methodological problems seldom described in the literature. The purpose of this article is to alert researchers as to the difficulties faced when performing community-based studies in developing countries. Although a carefully planned project was undertaken, problem areas included the establishment of the target population, population dynamics, field related problems, laboratory aspects and data management. It is hoped that other investigators may benefit from the extensive experience gained from our program in foreseeing and coping with the difficulties involved

Total enrolled cases, incidence rates, x-ray classification by years pre and post PCVs implementation.

<p>*Incidence is calculated by 100,000 person-year.</p

Incidence comparison between vaccine targeted and non-targeted age groups.

<p>Incidence comparison between vaccine targeted and non-targeted age groups.</p

Non-consolidated pneumonia incidence per 10⁵ by age groups and observation period.

<p>Non-consolidated pneumonia incidence per 10⁵ by age groups and observation period.</p

Consolidated pneumonia incidence per 10⁵ by age groups and observation years.

<p>Consolidated pneumonia incidence per 10⁵ by age groups and observation years.</p

Consolidated pneumonia hospitalizations: cases and incidence pre and post by age groups.

<p>Consolidated pneumonia hospitalizations: cases and incidence pre and post by age groups.</p

Etiologia e severidade de pneumonia adquirida comunitariamente em crianças uruguaias: um estudo de 4 anos

The 4-year study (1987-1990) covered the major clinical-epidemiological characteristics of pneumonia in children as diagnosed at the emergency service of the Children's Hospital, as well as etiologies, and factors involved in the most severe cases. Etiology was determined in 47.7% of the 541 pneumonia cases, involving 283 pathogens of which 38.6% were viruses and 12.6% bacteria. Viral and mixed etiologies were more frequent in children under 12 months of age. Bacteria predominated in ages between 6 and 23 months. Among the viruses, respiratory syncytial virus predominated (66%). The bacterial pneumonias accounted for 12.2% of the recognized etiologies. The most important bacterial agents were S. pneumoniae (64%) and H. influenzae (19%). H. influenzae and mixed infections had a relevant participation during the 1988 season, pointing to annual variations in the relative participation of pathogens and its possible implication in severity of diseases. Correlation of severity and increased percentage of etiological diagnosis was assessed: patients with respiratory rates over 70 rpm, or pleural effusion and/or extensive pulmonary parenchyma compromise yielded higher positive laboratory results. Various individual and family risk factors were recognized when comparing pneumonia children with healthy controls.O estudo de quatro anos de duração (1987-1990) abarcou as principais características clínico-epidemiológicas de pneumonia em crianças, tal como foi diagnosticado no serviço de emergência do Hospital Infantil, e também as etiologias e fatores implicados nos casos mais severos. Determinou-se a etiologia em 47.7% dos 541 casos de pneumonia, que incluíam 283 patógenos, dos quais 38.6% eram virus e 12.6% bactérias. Observou-se etiologia viral e mista mais freqüentemente nas crianças de menos de 12 meses. A etiologia bacteriana prevaleceu nas idades entre 6 e 23 meses. Com relação aos virus, a predominância foi de RSV com prevalência de 66% do total de virus. Os mais importantes agentes bacterianos foram S. pneumoniae (64%) e H. influenzae (19%). O H. influenzae e as infecções mistas incidiram significativamente durante 1988 assinalando variações anuais na severidade das doenças. Observou-se correlação entre a gravidade dos casos e a alta porcentagem de diagnóstico etiológico: pacientes com ritmos respiratórios mais altos que 70rpm, derrame pleural ou com comprometimento extenso de parênquima pulmonar, apresentaram maior índice de positividade laboratorial. Reconheceu-se vários fatores de risco individuais e familiares ao comparar crianças com pneumonia com controles sadios