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Year : 2018  |  Volume : 31  |  Issue : 3  |  Page : 862-866

An overview of respiratory tract infections in preschool children in primary healthcare

1 Family Medicine, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Community Medicine, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
3 Family Medicine, Shernekash Family Health Center, Dekahlia, Egypt

Date of Submission04-Aug-2017
Date of Acceptance08-Oct-2017
Date of Web Publication31-Dec-2018

Correspondence Address:
Mona A Salah
22th El-Salam Street Sernakash City, Mansoura
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_537_17

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The aim of this study was to explore the frequency of upper respiratory tract infections (RTIs) in children in primary healthcare and possible factors affecting their improvement.
RTIs were considered the most common diagnoses among preschool children.
Participants and methods
A cohort retrospective study was conducted on 250 children aged from birth to 5 years old. By reviewing all the health records in the past 6 months, all the children diagnosed with RTIs were invited through their guardians to participate in the study. All the participants' were interviewed and their health records were revised using a checklist to gather their sociodemographic data, diagnosis, and management plan.
The most affected age group was from 1 to 2 years (32.4%). Acute tonsillitis was the most frequent diagnosis (25.6%) followed by influenza (16.4%). Nearly 45.2% of all cases had received antibiotics. Almost 90% of the cases with RTIs were managed in primary care. Among patients who received antibiotics, 47.2% had improved in less than 7 days and 48.5% in more than 7 days, whereas 41.5% did not improve. Receiving health education and following up the patients were significant factors for improvement.
According to these findings, most of the RTIs in preschool children can be managed in primary healthcare (90%). There is a high incidence of antibiotic consumption, leading to increasing bacterial resistance to antibiotics.

Keywords: health education, preschool child, primary healthcare, respiratory tract infections

How to cite this article:
Hegazy NN, Mahrous OA, Salah MA. An overview of respiratory tract infections in preschool children in primary healthcare. Menoufia Med J 2018;31:862-6

How to cite this URL:
Hegazy NN, Mahrous OA, Salah MA. An overview of respiratory tract infections in preschool children in primary healthcare. Menoufia Med J [serial online] 2018 [cited 2020 Feb 28];31:862-6. Available from: http://www.mmj.eg.net/text.asp?2018/31/3/862/248749

  Introduction Top

In developed countries, acute respiratory infections were considered the leading cause of morbidity. The cost of these infections is enormous because of lost earnings and the cost of treatment[1]. One of the most important roles of the primary healthcare providers is the exclusion of ‘red flag’ symptoms that will permit them to appropriately reassure the parents and advise the most suitable regimen according to the guidelines, which includes mainly symptomatic management with antipyretics, adequate fluid administration, and awareness of when to give or not to give an antibiotic, especially in light of the problems that may arise from overuse of antibiotic treatment[2]. Respiratory tract infections (RTIs) were the most common diagnoses in primary care[3]. Preschool children, in particular, experience RTIs[4]. RTI refers to any of a number of infectious diseases involving the respiratory tract. An infection of this type is normally further classified as an upper respiratory tract infection (URTI) or a lower respiratory tract infection (LRTI). LRTIs, such as pneumonia, tend to be far more serious conditions than URTI, such as the common cold[5].

Although there is some disagreement on the exact boundary between the upper and lower respiratory tracts, the upper respiratory tract is generally considered to be the airway above the glottis or vocal cords. This includes the nose, sinuses, pharynx, and larynx[6]. Typical infections of the upper respiratory tract include tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, certain types of influenza, and the common cold[7]. On the contrary, the lower respiratory tract involves the trachea (windpipe), bronchial tubes, the bronchioles, and the lungs. LRTIs were generally more serious than URTIs. They were the leading cause of death among all infectious diseases[8]. The two most common LRIs were bronchitis and pneumonia[9]. Influenza affects both the upper and lower respiratory tracts, but more dangerous strains such as the highly pernicious H5N1 tend to bind to receptors deep in the lungs[10].

The aim of this study was to estimate the frequency of URTI in primary healthcare and possible factors affecting their improvement.

  Participants and Methods Top

The study protocol was approved by the Ethical Committee of Menoufia University. A written consent was obtained from all the participants' guardians after explaining the study objectives. A cohort retrospective was conducted between October 2016 and March 2017 in Family Health Center affiliated to Talkha Health District. The rural family health center was selected by simple random sampling technique of 27 rural healthcare centers in Talkha District, Egypt. All preschool children records in the past 3 months were revised and those who had RTIs were invited to participate in the study through their guardians.

Of 582 attendees, 268 children were eligible to participate in the study. Eight guardians were not present at the time of the study and 10 had refused to participate, which left with 250 participants. All the 250 participants' health records were revised using a predesigned checklist followed by guardian's meetings to fill any missing data if required.

The checklist entails two parts: the first part for the sociodemographic data and the second part for the diagnosis and the management. The second part included six items related to documented data in the child family health record: complaint, diagnosis, treatment, receiving health education, follow-up, and prognosis. All the documented data were revised with the guardians.

The diagnosis, treatment, receiving health education, and follow-up parameters were based on the recommendations of the family physician national guideline of the Ministry of Health and Population[11]. The prognosis was determined according to the record whether the child was referred, came to his follow-up after 7 days improved or not improved.

Statistical design

Data were analyzed with SPSS, version 21 (SPSS Inc., Chicago, Illinois, USA). Qualitative data were described using number and percent. Association between categorical variables was tested using χ2-test. Significant variables on univariate analysis of the predictors were entered into logistic regression model using the forward Wald statistical technique to predict the most significant determinants and to control for possible interactions and confounding effects.

Level of significance

For all aforementioned statistical tests done, the threshold of significance is fixed at 5% level (P value). The results were considered as follows:

  1. Nonsignificant when the probability of error is more than 5% (P > 0.05)
  2. Significant when the probability of error is less than 5% (P ≤ 0.05)
  3. Highly significant when the probability of error is less than 0.1% (P ≤ 0.001).

  Results Top

Most of the studied children were females and were within the age group of 1–2 years. Most of their mothers had basic education and were not working [Table 1].
Table 1: Sociodemographic data of the studied group

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Acute tonsillitis was the prevailing diagnosis (25.6%) followed by influenza (16.4%), acute URTI and acute laryngitis (12%), asthma (10%), and LRTI and acute otitis media (9%) [Figure 1].
Figure 1: Frequency of respiratory problems among the studied group.

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Among the examined group, female children were more affected than male (52.8%). The most affected age group was 1–2 years (32.4%), which was statistically significant (P = 0.011). Basic education was the most common level of education between father and mother (80.4 and 53.6%, respectively). Mother education was a statistically significant factor in the improvement of children (P < 0.001). Children of the nonworking mother were more improved than children of working mother. Most cases were managed in primary healthcare, and ∼10% of cases were referred, which was statistically significant (P < 0.001). Moreover, guardians perceiving health education was a significant statistical factor in the improvement [Table 2]. The improvement frequency among different diagnoses [Figure 2]. Protective factors that was statistically significant and account for the improvement from illness were receiving health education and follow-up [Table 3].
Table 2: Relation between sociodemographic data complaint, diagnosis, and prognosis

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Table 3: Logistic regression analysis of independent predictors of improved cases

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Figure 2: Improvement duration among different diagnoses of respiratory tract infections. RTI, respiratory tract infections.

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  Discussion Top

In our study, the most affected age group was from 1 to 2 years (32.4%). These results agree with the fact that their immune system is less mature and less capable of handling these infections than in older children, as documented by Bruijnzeels et al.[3]. It was found that the mother's education and occupation play a significant role in the improvement process, which is in agreement with the other study conducted previously by Allahony et al.[12].

Our study had demonstrated an overall antibiotic prescription rate of 48.5% for RTIs in preschool children in primary care which was different from that done by Wang et al.[13] who revealed 35% as the overall antibiotic prescription rate for RTIs in preschool children in primary care.

In our study, children with parents who received health education had shown much improvement (82.1%) than other patients (P < 0.001). These results agree with the study done by Wang et al.[13]. Poor adherence to medication in the current study may be owing to parents not being informed or instructed properly on the importance of completion of an antibiotic regimen. In addition, not completing a full course of antibiotics may be derived from a cultural belief that drug use should be stopped when symptoms subside. Parents who had received health education had shown a better adherence to therapy and a better prognosis. If the evidence-based management guidelines were followed, antibiotics should have been withheld from all patients with acute URI, acute bronchitis and bronchiolitis, the common cold, influenza, serous otitis media, and acute laryngitis. One could also withhold antibiotics from 85% of those with acute tonsillitis or pharyngitis, as reported by Van der Linden et al.[14].

Our study had confirmed that most RTIs were managed in primary care, and only 10% of RTIs in preschool children resulted in the referral to secondary care. As RTIs were very common conditions among preschool children, the number of referrals is, however, high. These findings were different from the study conducted by Jansen et al.[15] on Dutch preschool children in Netherlands University Medical Center Utrecht Primary Care, where only 2.2% of RTIs in preschool children were referred to secondary care, precisely otolaryngology and pediatrician. This difference could be because of different guidelines in the countries.

  Conclusion Top

Despite most episodes of RTI among preschool children being managed in primary care, there was a large antibiotic consumption and many referrals. Receiving health education and following up the patients could be important improvement factors. Thus, more attention needs to be paid to the possible role of preventive therapies such as immunization and health education of parents. Most RTIs were managed in primary care which supports that such preventive strategies may substantially reduce the primary healthcare burden of these infections in young children.


The authors are grateful to all participants in the studied primary healthcare facilities, for their invaluable help in facilitating data collection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Schaad U. Prevention of pediatric respiratory tract infections: emphasis on the role of OM-85. Eur Respir Rev 2005; 14:74–77.  Back to cited text no. 1
Paul S, O'Callaghan C, McKee N. Effective management of lower respiratory tract infections in childhood. Nurs Childr Young People 2011; 23:27–34.  Back to cited text no. 2
Bruijnzeels M, Foets M, van der Wouden J, van den Heuvel W, Prins A. Everyday symptoms in childhood: occurrence and general practitioner consultation rates. Br J Gen Pract 1998; 48:880–884.  Back to cited text no. 3
Leder K, Sinclair MI, Mitakaki TZ, Hellard ME, Forbes A, Fairley CK. A community-based study of respiratory episodes in Melbourne, Australia. Aust N Z J Public Health 2003; 27:399–404.  Back to cited text no. 4
Van Riel D, Munster VJ, De Wit E, Rimmelzwaan GF, Fouchier RA, Osterhaus AD, et al. H5N1 virus attachment to lower respiratory tract. Science 2006; 312:399.  Back to cited text no. 5
Eccles MP, Grimshaw JM, Johnston M, Steen N, Pitts NB, Thomas R, et al. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implement Sci 2007; 2:26.  Back to cited text no. 6
Pokorski M. Respiratory infections. NY, USA: Springer; 2015.  Back to cited text no. 7
WHO. The world health report: 2004: changing history. Geneva: World Health Organization; 2004. pp. 120–124.  Back to cited text no. 8
Antibiotic Expert Group. Therapeutic guidelines: antibiotic. 13th ed. Florida, USA: Therapeutic Guidelines Limited, North Melbourne; 2006.  Back to cited text no. 9
Hak E, Rovers MM, Sachs AP, Stalman WA, Verheij TJ. Is asthma in 2–12 year-old children associated with physician-attended recurrent upper respiratory tract infections?. Eur J Epidemiol 2003; 18:899–902.  Back to cited text no. 10
Ministry of Health and Population, Egypt. Practice Guidelines for Family Physicians . Vol. 1. Available from: http://www.mohp.gov.eg/UserFiles/LibraryFiles/339699.pdf. [Last accessed on 2017 July].  Back to cited text no. 11
Allahony DM, Hegazy NN, Kasemy ZA, Bahgat EM. Mothers' perception toward neonatal jaundice in Kafr El-batanoon village, Menoufia, Egypt. MMJ 2016; 29:743–748  Back to cited text no. 12
Wang EE, Einarson TR, Kellner JD, Conly JM. Antibiotic prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections. Clin Infect Dis 1999; 29:155–160.  Back to cited text no. 13
Van der Linden M, van Suijlekom-Smit L, Schellevis F, van der Wouden J. Second National Study on diseases and operations in general practice: the child in general practice. Translated from Dutch. Child in General Practice 2005; Eur J Public Health 2005;15:59-65.  Back to cited text no. 14
Jansen AG, Sanders EA, Schilder AG, Hoes AW, De Jong VF, Hak E. Primary care management of respiratory tract infections in Dutch preschool children. Scand J Prim Health Care2006; 24:231–236.  Back to cited text no. 15


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3]


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