PREVALENCE OF VIRAL LOWER RESPIRATORY TRACT INFECTION IN CHILDREN UNDER FIVE YEARS IN KENYATTA NATIONAL HOSPITAL

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BACKGROUND
Acute lower respiratory tract infection (ALRI) is a major cause of morbidity and mortality worldwide, more so in developing countries. A number of studies in various parts of the world indicate that viruses play a major causative role in childhood ALRI and the incidence is reported to be increasing. The main purpose of the study was to determine the prevalence of viral etiology in ALRI and the concerned virus strains. Some are preventable through chemoprophylaxis or immunoprophylaxis and costs attributable to care could be averted. It was hoped that the
results of the study would be of use in local guidelines on management of ALRI.

METHODS
Over a three-month period, 285 children less than five years presenting with ALRI at pediatric filter clinic and pediatric general wards in Kenyatta National Hospital (KNH) were identified using World Health Organization (WHO) criteria for diagnosis of ALRI. A definitive diagnosis was made by culture and then direct immunoflorescence of nasopharyngeal aspirates. Blood cultures were also taken for those with pneumonia to rule out bacterial co-infection.

RESULTS
The study subjects had a median age of 8 months (IQR 4-17.5), with 65% of the children less than 1 year of age. Of the patients recruited, 55% were males. Pneumonia was the most common type of ALRI present in 193 (68%) of children. This was followed by bronchiolitis in 81 (28%) cases and laryngotracheobronchitis (LTB) in 11 (4%) of cases. One fifty four (154) children were found to have viruses in their nasopharyngeal aspirates giving a prevalence of 54%. The most prevalent virus was respiratory syncytial virus (RSV) present in 49 (32%) of the total viral isolates. This was followed by parainfluenza virus present in 43(28%) of the isolates. Other viruses identified in decreasing order of frequency were, enterovirus in 38 (25%), influenza 14 (9%), unknown 14(9%) and adenovirus 12(8%). Ninety (47%) of the children with pneumonia had positive viral isolates and the commonest viral type isolated was enterovirus. Fifty six (69%) of the children with bronchiolitis had positive viral isolates and the commonest viral type isolated was RSV while 8 (73%) of the children with LTB had positive viral isolates and the commonest virus isolated was parainfluenza.

CONCLUSIONS.
The prevalence of viral infection among children less than five years presenting with ALRI at KNH is 54%. And the commonest viral type isolated was RSV.