Inian Joumal of Community Medicine Vol. XXVI, No.1, Jan-Mar., 2001 ALONGITUDINAL STUDY ON ARI AMONG RURAL UNDER FIVES Nilanjan Kumar Mitra Deptt. of Community Medicine, North Bengal ‘Sushrutnagar, Dist, Abstract: Medical College, Darjecling, West Bengal Research questions: 1. What is Acute Respiratory Infection (ARI) morbidity among underfive children in rural areas? 2. What are the epidemiological factors associated with such ARI (Objectives: 1"Te determine the ARI mocbih morbidity? among children of less than S years of age 2. To evaluate the role of some epidemiological factors with respect to ART morbidity Siudy design: Longtadinal stud Scting: Durgarampur illage; Singur Block; District Hooghly Pantetpans: Children aged less than yeas. Sty variables: Socio-economic clas, Ieray stats of mother, age, sex, bith weight birth order, nutritional and immunization status ‘ofthe children, Vitamin A prophylaxis coverage, infant feeding practices, overcrowding and indoor smoke pollution. ‘Outcome vanables: Episodes of Acute Respiratory Infections. Statistical analysis: Ineidence density and risk tatio analysis, Methods. 63 children were followed up with periadic home visits at wo weeks interval for 6 months. Frequency of ARI episodes were sudied and association sith study variables were analyzed. Results: Overall incidence density rate of ARI episodes was 19.57 (C.L-15.60-24 57) /100 person-months ask. Incidence was highest in nfanes (23 9/100 person-months). Risk ratio analysis showed tht low socio-economic class, low bifth weight, under-nutnition of the child, inadequate immunization, children not exclusively breastfed and indoor smoke pollution were significantly associated with inereasing number of ARK episodes ‘Conclusion: The study strongly points toward the importance of hasic health promotional measures lke proper infant feeding practices, ‘proper nuteition ofthe child, improved general conditions of living in prevention and control of ARI. Key Words: Longitudinal study, ARI, Under-five children Introduction: ‘Acute Respiratory Infection (ARI) is an acute infection of any part of the respiratory tract and related structures including paranasal sinuses, middle ear and pleural cavity. It includes all infections of less than 30 days duration except those of the middle ear where the duration ‘of acute episode is less than 14 days'. ARI constitutes a leading cause of morbidity and mortality especially in children. Of the 15 million child deaths in the world annually, ART alone accounts for 4 million”. ART accounted for 30-60% of pediatric outpatient auendance and 20-30% hospital admissions", ARI also leads 10 significant disability in the form of chronic illnesses like deafness, breathing difficulty ete. in the children, Inspite of increasing public health importance, management and control of ARI remains a neglected entity in most of the National MCH activities including recently introduced RCH programme. One of the main reasons apart from operational constraint is lack of community based epidemiological surveillance related to the magnitude and risk factors on ARI. So, generating a thorough database in rural population through longitudinal studies and its appropriate analysis emerges as a necessity This longitudinal study was formulatea with the objective to determine the ARI morbidity among rural ‘underfives and to study some of the epidemiological factors responsible for such morbidity. Material and Methods: ‘All (63) children less than 5 years of age, living in the village of Durgarampur (population - 548) in Singur Block ‘of District Hooghly were included in the study. The entire study area was divided into four sectors and the families were numbered, Each family contained the sector code followed by a numerical code, The children of the studyIndian Journal of Community Medicine Vol. XXVI, No.1, Jan-Mar, 2001 area were also numbered after the sector and family code. ‘The new births occurring during the study period were not considered, so also the shifted age of children included in the study were not considered forthe purpose of clarity and convenience. During the first visit, baseline data was collected through interviews in the local language on pre-tested proforma. The study group was followed up at hhome at two weeks interval, for a period of six months (from January to June, 1997) in order to examine the children for ARI and collect history of an ARI episode (from the mother) during the preceding days. History of nasal discharge (watery/mucous), cough, fever, sore throat, breathing difficulty, any discharge from ‘earetc.- alone or in combination was used in recognition of ‘an episode of ARI and confirmed subsequently by physical ‘examination of the child, wherever possible. An absence of symptoms for three days or mote is the criterion used to differentiate one episode from another’, The tools used in this study were a pre-designed and pre-tes.:d schedule, weighing machine, stethoscope and a digital watch. Nutritional status was assessed as per IAP classification and Modified Prasad's Scale’ was followed for determination for socio-economic status ‘As the statistical analysis of this study was based on episode incidence’, measures of disease occurrence as well 35 measures of association were expressed in more appropriate terms of incidence density and risk ratio Aincidence density among exposed/incidence density mong non-exposed) respectively. Results: Table I: Age-sex distribution of ARI episodes. ‘Age Males Females Total (in years) No. Episodes ID/I00PM* No. Episodes ID/IOOPM* Episodes ID/100 PM* or 9 1B 240 7 10 23.8 2B 239 12 7 1 166 4 8 333 1s 27 23 5 8 266 5 8 266 16 266 3 4 2 833 6 5 138 1 16 45 " 4 6.06 5 9 300 B 135 Total 36 34 157 27 40 246 74 196 *ID/100 PM - Incidence density/100 person-months. 36males and 27 females made up the study group. All 63 children were followed up regularly for six months. During the total period of observation 74 episodes of ARI were encountered which amounted to 1.17 episodes of ARI per child during this petiod. Overall incidence density of ‘ARI episodes was found to be 19.57/100 person months. Using Poisson distribution’, 95% confidence interval ‘ARI among rural undertves around incidence density rate was 15.60-24-57/100 person ‘months at risk. Incidence density of ARI episodes for males, and females were 15.74 and 24.6 respectively. But sex difference was not significant at 95% confidence limits Highest number of ARI episodes (incidence density 239/100 person months) was recorded among infants (Table , Mira NK{cian Journal of Community Medicine Vol. XVI, No.1, Jan.-Mat., 2001 ‘Table II: Risk ratio for some selected risk factors of ARI. ‘Study variables No.of children No.of episodes Riskratio 9S%CLofRr. pvalue (n=74) (Rr) Socio-economic class (o=63) (per capita monthly income) SRs.1000- 9 ea 3.19 <0.05 > Rs.1000/- 24 2 ‘Smoke nuisance (n=63) Present 50 66 215 1.03-4.46 <0.05 Absent B 8 Birht weight (n=63) <25 Kgs, 19 48 425 262-682 <0.05 32.5 Kgs. “4 26 Nutritional status (n=63) Normally nourished 25 18 2.04 119-345 <0.0s Malnourished 38 56 Immunisation status (n=63) Fully immunized 56 55 2.76 162-462 <0.05 Partially immunized 7 9 Infant feeding” (n=27) Exclusively breastfed 8 4 387 118-128 <0.05 [Not exclusively breastfed 9 34 Weaning at appropriate age 2 9 257 096-50 >0.05 Weaning at inappropriate age 18 2» Mothers’ literacy status (n=63) Miterate 41 52 127 0.77-2.09 30.05 Literate 2 2 Overcrowding (n=63) Present 45 35 0.86 05-144 2005 Absent 18 9 Birth order (n=63) 12 36 a 107 0.67-1.68 005 >2 27 3 Vitamin A prophylaxis’ (o=16) With full coverage 9 6 1.50 0703.1 >0.05 Without full coverage 7 7 ‘Infant feeding practices asked for children <2 years; **Vitamin A prophylaxis was assessed for children of 4-5 years of age. ARI among rural undertives 10 Miva