clove and Pneumonia

Data on the etiologies of pneumonia among children are inadequate, especially in developing countries. The principal objective is to undertake a multicenter incident case-control study of <5-year-old children hospitalized with pneumonia in developing and emerging countries, aiming to identify the causative agents involved in pneumonia while assessing individual and microbial factors associated with the risk of severe pneumonia.. A multicenter case-control study, based on the GABRIEL network, is ongoing. Ten study sites are located in 9 countries over 3 continents: Brazil, Cambodia, China, Haiti, India, Madagascar, Mali, Mongolia, and Paraguay. At least 1,000 incident cases and 1,000 controls will be enrolled and matched for age and date. Cases are hospitalized children <5 years with radiologically confirmed pneumonia, and the controls are children without any features suggestive of pneumonia. Respiratory specimens are collected from all enrolled subjects to identify 19 viruses and 5 bacteria. Whole blood from pneumonia cases is being tested for 3 major bacteria. S. pneumoniae-positive specimens are serotyped. Urine samples from cases only are tested for detection of antimicrobial activity. The association between procalcitonin, C-reactive protein and pathogens is being evaluated. A discovery platform will enable pathogen identification in undiagnosed samples.. This multicenter study will provide descriptive results for better understanding of pathogens responsible for pneumonia among children in developing countries. The identification of determinants related to microorganisms associated with pneumonia and its severity should facilitate treatment and prevention.

Topics: Anti-Bacterial Agents; Bacteria; Brazil; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cambodia; Case-Control Studies; Child, Preschool; China; Clinical Protocols; Developing Countries; Female; Haiti; Humans; India; Infant; Madagascar; Male; Mali; Mongolia; Paraguay; Pleural Effusion; Pneumonia; Protein Precursors; Viruses

The parents 'educational conditions are one of the factors of health inequalities among children. During May 2009, the parents' instruction level of children admitted at the triage unit of a Pediatric Service in Antananarivo, Madagascar was evaluated and related to the severity of their children' health status and to the mode of reference. All the surviving children (from 2 months to 15 years old) were included in this study. Patients were classified by the IMCI guideline and we analyzed the educational level of their mothers. Each patient was classified as severe illness or without severe illness, according to IMCI algorithm. The quality of referring physician was recorded: public physicians, liberal physicians, nurses, or without referral. Among 296 children, 9 (3%) died before admission, 217 (75.6%) were included. Among them, 123 (56.7%) had a severe illness and 38,2% general signs of danger. The severity (92.3 versus 54.4%; P = 0.003), the number of severe dehydration (15.4 versus 3.9%; P = 0,027) and malnutrition (15.4 versus 4.4%; P = 0.039) were related with a poor parents educational level. The referral agents were mostly liberal physicians (56.7%), public physicians (26.7%) or nurses (1.8%). Mothers with higher educational level preferred to attend liberal physicians (58 versus 41.9%; P = 0.1). The reference delay was shorter if there was a severe illness (6.41 versus 19.6 days; P < 0.000) or no medical referral (51.1 versus 24.4%; P > 0.000). Despite the fact that access to hospital care was respectful of a two-step process (85.3%), the number of patients with severe illness was high among families with low educational level. Theses results suggest to educate in priority the mother with low education, in order to recognize the general signs of danger and facilitate early first health care.

Topics: Adolescent; Algorithms; Anemia; Child; Child, Preschool; Dehydration; Diagnosis-Related Groups; Diarrhea; Educational Status; Emergencies; Emergency Service, Hospital; Female; Fever; Hospitals, Urban; Humans; Infant; Madagascar; Male; Malnutrition; Mothers; Pneumonia; Prospective Studies; Referral and Consultation; Severity of Illness Index; Socioeconomic Factors

The purpose of this report is to describe a study on acute community-acquired pneumonia (CAP) carried out in the Pneumology Department of the Antananarivo University Hospital Center. This prospective one-year study included patients presenting symptoms of acute CAP. Patients with chronic lung disease and tuberculosis were excluded. Study parameters included epidemiological, clinical and laboratory findings as well as data on the efficacy of the therapeutic treatments used. A total of 96 patient charts were analyzed. Males were predominant with a sex ratio of 1.5. Mean age was 41.8 years. A history of pulmonary tuberculosis was noted in 7.2% of cases. Clinical examination showed pulmonary condensation in 93.7% of cases. Radiological examination depicted alveolar syndrome in 97.6%. Betalactamines were the most frequent class of antibiotic agents used for treatment (90.6%). The most frequently prescribed agent was amoxicillin (60.4%) at a dose of 3 g/day. Single-agent therapy was used more often than double-agent therapy (93.7% vs. 6.3%). The oral route was used more frequently than the intravenous route (62.5% vs. 37.5%). The outcome was favorable in 97.9% of cases and lethal in 2.1%. The prevalence of acute CAP in patients hospitalized in our department was low in comparison with that tuberculosis. Since single-agent therapy using amoxicillin at a dose of 3 g/day was effective, this antibiotic can be recommended as the first-line treatment after ruling out tuberculosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Community-Acquired Infections; Female; Humans; Madagascar; Male; Middle Aged; Pneumonia; Prospective Studies; Young Adult