Respiratory problems since birth to 12 years: What is causing morbidity and mortality in Sri Lanka?

Abstract

Background: Respiratory tract disorders cause significant mortality and morbidity in children worldwide. Objectives: To study the pattern of respiratory diseases and its seasonal variation amongst children admitted to hospital and assess causes of mortality due to respiratory diseases especially in children less than 5 years of age. Method: A descriptive study was conducted at the University Paediatric Unit, Colombo North Teaching Hospital during 2010 and 2011. All children below 12 years admitted with respiratory tract disease (ICD- 10 classification) were recruited into the study. Data collection forms were filled by medical officers using patient records. Results: Out of 13,356 admissions, 2,651 (19.8%) were admitted with respiratory disease. Highest number of admissions (30.5%) was in the 1 month to 2 year age group and 4.4% of admissions were neonates. Common causes of admission included unspecified lower respiratory tract infections (LRTI) (44.1%), upper respiratory tract infections (URTI) (25.2%), bronchial asthma (11.5%) and bronchiolitis (7.0%). Incidence of bacterial pneumonia was 0.95%. Admissions due to respiratory diseases peaked in June (2010-20%, 2011-16%). Admissions with bronchial asthma were higher during the first half of year (2010-86.3%, 2011-80.5%). The total number of deaths was 24 and 87.5% of these deaths were in children under 5 years. Out of under 5 year deaths 17 (94.5 %) were early neonatal deaths. The common causes of mortality under 5 years were surfactant deficient lung disease (43%), meconium aspiration syndrome (24%) and severe respiratory failure due to hypoxic ischaemic encephalopathy (19 %). Conclusions: LRTI, URTI, bronchial asthma and bronchiolitis were the main contributory factors to the morbidity. Mortality due to respiratory causes was 0.9 % and was confined mainly to the neonatal period. Common causes of under-5 year deaths were surfactant deficient lung disease, meconium aspiration syndrome and respiratory failure due to hypoxic ischaemic encephalopathy.