Our aim was to investigate the incidence of respiratory infections in children treated at the Pediatric Department of the University Hospital Mostar during war (1993 and 1994) and after the war (2003 and 2004). In order to collect data we used medical histories of children with respiratory infections. Incidence of respiratory infections in children in war period was 230/1000, while in post-war period it was 190/1000. There was no significant difference in the incidence of respiratory infections in children during war and after the war (p=0.051). We have not found increase in respiratory infections prevalence in children treated during war period at the Pediatric department of University Hospital Mostar, compared to the period after the war. However, we did report certain differences related to age, clinical parameters, seasonal pattern, diagnosis, therapy and mean hospitalization time

Dženis Jelčić

Marija Grle

Tomislav Strinić

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Coll. Antropol. 34 (2010) Suppl. 1: 49–53Original scientific paperRespiratory Infections in Children Hospitalizedat the University Hospital Mostar during War andPost-War PeriodD`enis Jel~i}1, Marija Grle2 and Tomislav Strini}31 Unit for Gynecology and Obstetrics, Health Center Metkovi}, Metkovi}, Croatia2 Department for Pediatrics, University Hospital Mostar, Mostar, Bosnia and Herzegovina3 Department for Gynecology and Obstetrics, University Hospital Center Split, Split, CroatiaA B S T R A C TOur aim was to investigate the incidence of respiratory infections in children treated at the Pediatric Department ofthe University Hospital Mostar during war (1993 and 1994) and after the war (2003 and 2004). In order to collect datawe used medical histories of children with respiratory infections. Incidence of respiratory infections in children in warperiod was 230/1000, while in post-war period it was 190/1000. There was no significant difference in the incidence of re-spiratory infections in children during war and after the war (p=0.051). We have not found increase in respiratory infec-tions prevalence in children treated during war period at the Pediatric department of University Hospital Mostar, com-pared to the period after the war. However, we did report certain differences related to age, clinical parameters, seasonalpattern, diagnosis, therapy and mean hospitalization time.Key words: respiratory infections, children, incidence, war, Bosnia and HerzegovinaIntroductionPatients with acute respiratory infections, especiallythose with infections of upper respiratory tract, are themost common visitors of pediatric departments and otherprimary health care practices. They are the reason forfrequent antibiotic prescription and the main reason formissing from school1,2. The children are more sensitive torespiratory infects than adults. The reason for this couldbe the first contact and inefficient specific immunizationto microbes in early childhood3. The most common respi-ratory microbes are viruses, Mycoplasma and bacteria.The viruses are the main cause for more then 85% of allacute respiratory infections4. Clinically, these infectionsappear within whole spectrum of symptoms and differentstages of illness. Respiratory infections can be dividedinto infections of upper and lower respiratory tract. Theinfections are usually mild catharal infections of upperrespiratory tract caused by viruses and their complica-tions as bacterial superinfections (sinusitis, otitis). Up-per respiratory infections are angina and croup syn-drome, and they appear in several well-defined diseaseswhich include laryngeal diphtheria, acute catarrhal andspastic laryngitis and malignant obstructive laryngo-tracheobronchitis. Acute respiratory infections of lowerrespiratory tract are acute bronchitis, bronchiolitis andpneumonia5. Pneumonia is the most difficult infection ofthe respiratory tract and requests special treatment, al-though it is involved in only 1% of all acute respiratoryinfections5. 95% of all pneumonias in small children inworld appear in developing countries, such as Bosnia andHerzegovina. Etiological diagnosis of respiratory infec-tions is rarely established in developing countries, there-fore World Health Organization (WHO) recommends pri-mary healthcare physicians to make a diagnose on thebasis of clinical parameters. WHO suggests appropriatetreatment of respiratory infections which will develophealth care and decrease the mortality6.The awareness of rational antibiotics prescription of-ten lacks in reference to acute infections of the upper re-spiratory tract, which then leads to unnecessary use ofantibiotics in treatment of viral respiratory infections7,8.70% of all per oral antimicrobial drugs are used for treat-49Received for publication March 13, 2009ment of acute respiratory infections4. Researches provethat the number of prescribed antibiotics annually in-creases with age and with years of physicians workexperience7,9. Irrational prescribing of antibiotics causeresistance of pathogenic microorganisms which may cau-se epidemics or even pandemic measures in future, andtoday it is already a significant problem in the world7,10.Inflammatory mediators that are involved in acute respi-ratory infections during the development of the respira-tory tract can leave long-term consequences on pulmo-nary functions5,11,12. In the world, acute respiratory infec-tions are the leading cause of mortality in children youn-ger than 5 years old5. Most of these deaths are caused bypneumonia and bronchiolitis5,13. Stated facts imply thatprevention of these infections in children is extremelyimportant. Hygiene dietetic regime (hand washing andappropriate food) and separating sick children from heal-thy, if possible, lays the foundation of prevention of acuterespiratory infections3,14. The aim of this study was toshow prevalence of acute respiratory infections in chil-dren treated at the University Hospital Mostar.Materials and MethodsThis cross-sectional study was performed at the Clinicfor Pediatrics, University Hospital Mostar during two pe-riods: during the war (1993 and 1994) and after the war(2003 and 2004). In war period the number of hospital-ized children was 1107 and 273 children with acute respi-ratory infections were included in the study. In after thewar period the number of hospitalized children was 2774and 527 had respiratory infections and were included inthe study. The data were obtained from medical historiesof the children treated at the Department of Pediatrics,University Hospital Mostar. The used parameters wereage, gender, blood examination (sedimentation of eryth-rocytes and leukocytes), body temperature, annual sea-sons and mean hospitalization time. In data evaluationC-reactive protein was excluded because it was not usedduring the war period. The data have been processed us-ing the program SPSS 10.0 for Windows and interpretedwith descriptive statistics. For statistical analyses weused c²-test and F-test. The statistical significance for alltests was p<0.05.ResultsIn this study it has been proven that there is no statis-tically significant difference in incidence of respiratoryinfections in children during war and after the war (Ta-ble 1). Number of upper respiratory infections per 1000hospitalized children decreased in post-war period butthe number of lower respiratory infections did not change(Table 1).Considering the age, children were divided in fourgroups: newborns (0–28 days), infants (1–12 months), lit-tle children (2–6 years) and school children (7–19 years).Number of newborns statistically decreased and numberof little children with respiratory infections increased inpost-war period (Table 2).There was no statistically significant gender differ-ence in incidence of respiratory infections in children inthese two periods (Table 3). The number of children withpositive laboratory parameters (SE11 mm/h, L10´109/L)increased in post-war period, while the number of febrilechildren (Tax38 °C) with respiratory infection remainedthe same two other periods (Table 4). Considering sea-sons, the number of children with respiratory infectionshas increased in winter and fall in period after the war(Table 5).The number of children with the diagnosis of angina,acute pharyngitis and acute bronchitis decreased, andthose with diagnose of croup syndrome, bronchopneumo-nia and pleuropneumonia increased in period after war(Table 6). The number of children with respiratory infec-tions treated with penicillins, cephalosporins and sym-ptomatologic therapy increased in period after the war(Table 7). Mean hospitalization time increased in chil-dren with diagnose of acute rhinosinusitis, acute rhino-pharyngitis and bronhopneumonia in period after thewar (Table 8).Discussion and ConclusionBecause of specific socioeconomic conditions increa-sed incidence of respiratory infections in children was ex-pected during the war. People of Mostar were fighting forexistence and living conditions were minimal15. Provi-sion of adequate shelter, food, water and sanitation wasD`. Jel~i} et al.: Respiratory Infections in Children, Coll. Antropol. 34 (2010) Suppl. 1: 49–5350TABLE 1INCIDENCE OF RESPIRATORY INFECTIONS DURING WAR AND PERIOD AFTER THE WAR IN CHILDREN HOSPITALIZED AT THECLINIC FOR PEDIATRICS OF THE UNIVERSITY HOSPITAL MOSTARPeriodChildren with respiratory infections (N)Hospitalizedchildren (N)Children with respiratory infections N/1000hospitalizedURT LRT A URT LRT AWar 155 118 273 1187 131 99 230After the war 220 307 527 2774 79* 111† 190‡URT – upper respiratory tract; LRT – lower respiratory tract; A – all children with respiratory infections* c2=12.88; p<0.001† c2=0.69; p=0.408‡ c2=3.81; p=0.051impossible. Other possible reasons for expecting increasein incidence of respiratory infections in children in thewar are stress, overcrowding and malnutrition6,14,16,18.Results of this research show that there was no statisti-cally significant difference in incidence of respiratory in-fections of children during the war and after war period.These results are not in correlation with similar re-searches in world that show increased incidence of respi-ratory infections in children in war conditions17,18. Thenumber of newborns in post-war period decreased. Inci-dence of respiratory infections in little children increasedin period after the war, and incidence in other age groupsdid not change. Respiratory infections were most fre-quent in little children which correlates with similar re-searches in Senegal, Asia and Latin America19–21. No stati-stically significant difference was found between chil-dren in two periods in relation to gender, although respi-ratory infections were more frequent in boys which cor-relates with world data22. In both periods respiratory in-fections in children were most frequent in winter whichcorrelates with studies performed in Canada, North Ame-rica and Russia23–25. In this study it was found that num-ber of children with acute tonsillopharyngitis, acute phar-yngitis and acute bronchitis has decreased in the periodafter the war. Most probable reason was better organiza-tion and availability of primary health care, so that thechildren with this diagnosis were treated in primaryhealth care. Incidence of children with diagnosis croupsyndrome, bronchopneumonia and pleuropneumonia rea-ched statistically significant increase in period after thewar. We assume that the reason for this is better as wellas available health care and diagnostic procedure. Fewernumber of children was treated with penicillins duringperiod after the war. Because of resistance, physicians allover the world prescribe new generations of antibiotics,for example cephalosporins. Maybe, this is the reasonwhy incidence of children treated with cephalosporins in-D`. Jel~i} et al.: Respiratory Infections in Children, Coll. Antropol. 34 (2010) Suppl. 1: 49–5351TABLE 4LABORATORY PARAMETERS IN CHILDREN WITH RESPIRATORY INFECTIONSNumber (%) used clinical parametersPeriodS L T<11mm/h 11mm/h Did not measure <10´109/L 10´109/L <38 °C 38 °CWar 25 (9.2) 221 (81.0)* 27 (9.9) 63 (23.1) 210 (76.9)† 123 (45.1) 150 (54.9)‡After war 86 (16.3) 398 (75.5)* 43 (8.2) 259 (49.1) 268 (50.9)† 203 (38.5) 324 (61.5)‡All 111 (13.9) 619 (77.4) 70 (8.8) 322 (40.3) 478 (59.8) 326 (40.8) 474 (59.3)S – sedimentation of erythrocytes; L – leukocytes; T – body temperature*c2=7.32; p=0.006†c2=50.82; p<0.001‡ c2=3.18; p=0.074TABLE 5DISTRIBUTION OF CHILDREN WITH RESPIRATORY INFEC-TIONS ACCORDING TO SEASONSChildren in periodsSeasonWN (%)AWN (%)Spring 66 (24.2) 136 (25.8)Summer 53 (19.4) 98 (18.6)Fall 90 (33) 120 (22.8) *Winter 64 (23.4) 173 (32.8) †All 273 (100) 527 (100)W – war period; AW – period after the war* c2=7.60; p=0.005.†c2=9.66; p=0.019TABLE 3DISTRIBUTION OF CHILDREN WITH RESPIRATORY INFEC-TIONS ACCORDING TO GENDERChildren in periodsGenderWN (%)AWN (%)Male 159 (58.2) 309 (58.6)Female 114 (41.8) 218 (41.4)All* 273 (100) 527 (100)W – war period; AW – period after the war*c2=0.01; p=0.915TABLE 2DISTRIBUTION OF CHILDREN WITH RESPIRATORY INFEC-TIONS IN AGE GROUPSChildren in periodsAge groupWN (%)AWN (%)Newborns (0–28 days) 29 (10.6) 22 (4.2) *Infants (1–12 months) 63 (23.1) 102 (19.4)Little children (2–6 years) 133 (48.7) 310 (58.8)†School children (7–19 years) 48 (17.6) 93 (17.6)All 273 (100) 527 (100)W – war period; AW – period after the war*c2=12.53; p<0.001.† c2=7.43; p=0.006creased in period after the war. Awareness among doc-tors about the judicious use of antibiotics and patient ed-ucation all over the world will reduce inappropriate useof antibiotics. Incidence of children treated only withsymptomatic therapy increased in period after the war,therefore we can say that the Clinic for Pediatrics of theUniversity Hospital Mostar is improving the trend of ra-tional antibiotic prescribing. Mean hospitalization timeof children with diagnosis of acute rhinosinusitis, rhino-pharyngitis and bronchopneumonia decreased in the post--war period. These results are opposite to those fromstudy performed in Guinea where mean hospitalizationtime was shorter during armed conflict18. Mean hospi-talization time of children with respiratory infections islonger in war and after the war period than in the world.Mean hospitalization time for children with pneumoniain war period was 15.0±4.9 days, in period after the war11.7±4.7 days and in the world 326 to 5 days27. Mean hos-pitalization time for children with infections of lower re-spiratory tract was 9.3±3.7 to 15.0±4.9 days, while in sim-ilar study performed in Dallas, Texas, mean hospitaliza-tion time for children with infections of lower respiratorytract was 5 days27. The most important conclusion of thisstudy is that there was no statistically significant differ-ence in incidence of respiratory infections in childrenduring war and period after the war.D`. Jel~i} et al.: Respiratory Infections in Children, Coll. Antropol. 34 (2010) Suppl. 1: 49–5352TABLE 6DISTRIBUTION OF CHILDREN WITH RESPIRATORY INFECTIONS ACCORDING TO DIAGNOSISChildren in periodsDiagnosisWN (%)AWN (%)Acute rhinosinusitis and acute rhinopharyngitis 58 (21.2) 97 (18.4)Acute sinusitis 4 (1.5) 17 (3.2)Acute tonsillopharyngitis (angina) and acute pharyngitis 91 (33.3) 85 (16.1)*Croup syndrome 2 (0.7) 21 (4.0)†Acute bronchitis 32 (11.7) 26 (4.9)‡Acute bronchiolitis 2 (0.7) 12 (2.3)Bronchopneumonia 72 (26.4) 224 (42.5)§Pneumonia 12 (4.4) 12 (2.3)Pleuropneumonia 0 33 (6.3)||All 273 (100) 527 (100)W – war period; AW – period after the war* c2=31.02; p<0.001† c2=15.70; p<0.001‡ c2=12.32; p<0.001§ c2=20.076; p<0.001| c2=17.830; p<0.001TABLE 7DISTRIBUTION OF CHILDREN WITH RESPIRATORY INFEC-TIONS ACCORDING TO THERAPYChildren in periodsTherapyWN (%)AWN (%)Penicillins 202 (74.0) 320 (60.7)*Cephalosporins 15 (5.5) 72 (13.7)†Aminoglycosides 9 (3.3) 5 (0.9)Macrolides and lincosamides 21 (7.7) 29 (5.5)Sulfonamides and trimethoprim 13 (4.8) 10 (1.9)Symptomatic therapy 13 (4.8) 91 (17.3)‡All 273 (100) 527 (100)W – war period; AW – period after the war*c2=13.97; p<0.001†c2=37.35; p<0.001‡c2=58.50; p<0.001TABLE 8COMPARISON OF HOSPITALISATION MEAN TIME OFCHILDREN HOSPITALIZED WITH RESPIRATORY INFECTIONSX±SDDiagnosis W AWAcute rhinosinusitis and acuterhinopharyngitis 8.4±3.8 6.5±3.4*Acute sinusitis 11.5±6.2 8.6±4.4Angina and acute pharyngitis 9.1±3.6 8.8±3.6Croup syndrome 4.5±4.5 5.0±3.9Acute bronchitis 9.3±3.7 9.9±4.5Acute bronchiolitis 12.5±4.9 10.0±4.1Bronchopneumonia 13.4±4.8 10.2±3.5†Pneumonia 15.0±4.9 11.7±4.7Pleuritis || – 13.8±6.0W – war period; AW – period after the war* F=10.59; p=0.001† F=35.95; p<0.001R E F E R E N C E S1. BUTLER CC, HOOD K, KINNERSLEY P, ROBLING M, PROUTH, HOUSTON H, Fam pract, 22 (2005) 92. — 2. KUZMAN I, Akutne re-spiratorne infekcije-naj~e{}e bolesti ~ovjeka. PLIVAmed, accessed 06.07.2005. Available from: URL: http://www.plivamed.net/?section=home&spec=3&offset=10&=t&id8884&show=1. — 3. MARDE[I] D, Bolesti di{nihorgana. In: MARDE[I] (Ed) Pedijatrija ([kolska knjiga, Zagreb, 2000).— 4. KUZMAN I, Akutne respiratorne infekcije: dijagnosti~ke i terapijskesmjernice za ambulantno lije~enje. PLIVAmed, accessed 06.07.2005. Ava-ilable from: URL: http://www.plivamed.net/?section=home&spec=3&off-set=10&cat=t&id=8891&show=1. — 5. RUDAN I, TOMASKOVI] L, BO-SCHI-PINTO C, CAMPBELLH, Bull World Health Organ, 82 (2004) 895.— 6. CASHAT-CRUZ M, MORALES-AGUIRRE JJ, MENDOZA-AZIPIRIM, Semin Pediatr Infect Dis, 16 (2005) 84. — 7. ARNOLD SR, TO T, MCISAAC WJ, WANG EE, J Pediatr, 146 (2005) 222. — 8. NAMBIAR S,SCHWARTZ RH, SHERIDAN MJ, Arch Pediatr Adolesc Med, 156 (2002)621. — 9. AKKERMAN AE, KUYVENHOVEN MM, VAN DER WOU-DEN JC, VERHEIJ TJ, Br J Gen Pract, 55 (2005) 114. — 10. KUZMAN I,Streptococcus pneumoniae. In: KUZMAN I (Ed) Pneumonije (Medicinskanaklada, Zagreb, 1999). — 11. GERN JE, ROSENTHAL LA, SORKNESSRL, LEMANSKE RF JR, J Allergy Clin Immunol, 115 (2005) 668. — 12.SUTHERLAND ER, BRANDORFF JM, MARTIN RJ, J Asthma, 41(2004) 863. — 13. CETINKAYA F, GOGREMIS A, KUTLUK G, Indian JPediatr, 71 (2004) 969. — 14. TURNER RB, Pediatr Ann, 34 (2005) 53. —15. AUGUSTINOVI] A, Mostar: ljudi, kultura, civilizacija (Hrvatska kul-turna zajednica FbiH, Mostar, 1999). — 16. TOOLE MJ, WALDMAN RJ,JAMA, 270 (1993) 600. — 17. MORIKAWA M, J Trop Pediatr, 47 (2001)379. — 18. SODEMANN M, VEIRUM J, BIAI S, NIELSEN J, BALE C,SKYTTE JAKOBSEN M, Acta Paediatr, 93 (2004) 959. — 19. ETASO JF,HESRAW JY, DIALLO JP, NDIAYE JL, DELANHAY V, Int J Epidemiol,33 (2004) 1286. — 20. SINGH V, Pediatr Respir Rev, 6 (2005) 88. — 21.FUCHS SC, FISCHER GB, BLACK RE, LANATA C, Pediatr Resp Rev, 6(2005) 83. — 22. LIEBERMAN D, LIEBERMAN D, FRIGER MD, J In-fect, 39 (1999) 134. — 23. CRIGHTON EJ, MOINEDDIN R, MAMDANIM, UPSHUR RE, Epidemiol Infect, 132 (2004) 1167. — 24. STRALIO-TTO S, SIQUEIRA MM, MACHADO M, MAIA MRT, Mem Inst OswaldoCruz, 99 (2004) 883. — 25. GOLOVANOVA AK, IURLOVA TI, Vestn RossAkad Med Nauk, 9 (1994) 8. — 26. AURANGZEB B, HAMEED A, J CollPhysicians Surg Pak, 13 (2003) 704. — 27. MICHELOW IC, OLSEN K,LOZANO J, ROLLINS NK, DUFFY LB, ZIEGLER T, Pediatrics, 113 (2004)701.D`. Jel~i}Medical Center Metkovi}, Ante Star~evi}a 12, Metkovi}, Croatiae-mail: dzenis_jelcic@net.hrRESPIRATORNE INFEKCIJE U DJECE LIJE^ENE U SVEU^ILI[NOJ BOLNICI MOSTAR TIJEKOMRATA I POSLIJERATNOG RAZDOBLJAS A @ E T A KCilj ove studije je bio istra`iti zastupljenost respiratornih infekcija u djece lije~ene na Odjelu za dje~je bolesti KBMostar tijekom rata (1993. i 1994. godina) i poslijeratnog razdoblja (2003. i 2004. godina). Obuhva}ene su dvije skupinedjece s respiratornim infekcijama lije~ene na Odjelu za dje~je bolesti KB Mostar u razdoblju 1993. i 1994. godine te2003. i 2004. godine. U cilju skupljanja podataka kori{tene su povijesti bolesti djece s respiratornim infekcijama lije~enena Odjelu za dje~je bolesti KB Mostar. U~estalost respiratornih infekcija u djece u ratnom razdoblju je 230/1000, a uposlijeratnom razdoblju 190/1000 hospitaliziranih. Pokazalo se da nema statisti~ki zna~ajne razlike izme|u navedenihskupina odnosno da nema zna~ajnog smanjenja broja bolesnika u poslijeratnom razdoblju (c2=3,810; p=0,051). Tije-kom ratnog razdoblja nismo na{li ve}u zastupljenost respiratornih infekcija u djece lije~ene na Odjelu za dje~je bolestiKB Mostar u odnosu na poslijeratno razdoblje. Uspore|uju}i promatrana razdoblja utvrdili smo odre|ene razlike udjece s respiratornim infekcijama s obzirom na dob, klini~ke parametre, godi{nja doba, dijagnozu, lije~enje i duljinuboravka u bolnici.D`. Jel~i} et al.: Respiratory Infections in Children, Coll. Antropol. 34 (2010) Suppl. 1: 49–5353

Respiratory Infections in Children Hospitalized at the University Hospital Mostar during War and Post-War Period

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