Assessment of acute upper respiratory tract infections in children aged 1 to 5 in Chuong My district, Ha Noi city

Journal of military pharmaco-medicine no4-2018

ASSESSMENT OF ACUTE UPPER RESPIRATORY TRACT
INFECTIONS IN CHILDREN AGED 1 TO 5
IN CHUONGMY DISTRICT, HANOI CITY
Tran Thi Nhi Ha*; Quach Thi Can**
Hoang Duc Hanh*; Tran Van Tuan***
SUMMARY
Objectives: To determine the situation of acute upper respiratory infections in children aged
1 to 5 years preschool in Chuongmy district, Hanoi City. Subjects and methods: A crosssectional analytic study on 2,150 children aged 1 to 5 years was carried out from October 2014
to February 2015. These children were chosen randomly from 6 preschools representing three
ecological regions in district. Diagnosis of upper respiratory tract infections (URTI) was based
on the revised WHO guidelines for diagnosis and management of childhood pneumonia. The
data was analyzed using the statistical software Stata. Results and conclusion: The proportion
of URTI was 30.74%, male accounted for 31.65% and female 29.71%. According to month of
birth, we found that children under 24 months, 25 - 36 months, 37 - 48 months and over 48
months had correspoding rate of URTI of 54.88%, 44.13%, 34.73%, 25.10%. Gender, month of
birth, weight at birth, nutritional status, vaccination, passive smoking, types of cooking stoves,
regular caregiver were not associated significantly with URTI.
* Keywords: Acute respiratory tract infections; Upper respiratory infections; Under-five children.

INTRODUCTION
Acute respiratory tract infections (ARI) are
the most common in childhood, comprising
as many as 50% of all illnesses in children
less than 5 years old and 30% in children
aged 5 - 12 years [4]. Multiple factors
determine the frequency and nature of
these illnesses. These include host factors,
environmental factors and infecting agents.
ARIs are divided into URTI and lower

respiratory tract infections. URTI are usually

caused by viruses (germs). There are
over 200 different types of viruses that
cause URTI. ARI is a major cause of
morbidity and mortality worldwide. Each
year, about 1.3 million children under
5 years die from ARI worldwide. ARI
constitutes one third of the deaths in
under five children in low income countries.
The World Health Organization (WHO)
estimated that respiratory infections
account for 6% of the total global burden
of disease [5].

* Hanoi Department of Health
** National Otorhinolaryngology Hospital
*** Vietnam Military Medical University
Corresponding author: Tran Thi Nhi Ha ()
Date received: 27/02/2018
Date accepted: 10/04/2018

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Journal of military pharmaco-medicine no4-2018
URTI has been recognized as one of
the most common medical problems in
daily lives of people worldwide. A strong
confirmation for the prevention of URTI is

rather inadequate, and thus, patients take
preventive measures on the basis of their
own experience or preferences [6]. In
Vietnam, researchers said that ARIs
caused the most mortality in children
under 5 years old [1, 2]. However, the
records about URTIs in Vietnam are still
rare according to the ICD10 classification,
especially in rural areas. This study
therefore aimed at determining the
situation of URTIs in children aged 1 to 5
years followed by ICD10, in Chuongmy
district, Hanoi City.
SUBJECTS AND METHODS
This was a community-based crosssectional analytic study carried out in
winter from October 2014 to February
2015 in Chuongmy district, which is 20 km
away from the west of Hanoi City. It has
an estimated population of about 337,600
inhabitants. Many people's lives rely
heavily on agriculture. At this time-study,
due to low economic income, many
couples had to go to work far away;
these children were taken cared of
by their grandparents or others. In their
surroundings, they have become passive
smokers because of cooking appliances
such as wood, coal or electricity
interspersed with gas, even smoke of
cigarettes... All of this led to passive

smoking.
186

Sample size calculation: Chose 6 targeted
communes representing 3 ecological
regions. In each commune, all children
who met selective criteria and did not
violate exclusion criteria were enrolled in
preschools. The sample size was calculated
using the formula for epidemiological
description of cross sectional study. A
pre-study showed the prevalence of URTI
in children under 5 years in Backan 2010
was 36.1% [2] From formula, we
calculated sample size was 2,124. 2,150
children were included in the study.
Study procedure: Participants were
recruited between 8 am and 5 pm from
Friday (12 - 12 - 2014) to Saturday (13 12 - 2014) from all of the preschools. Out
of 2,150 children, 1,147 boys and 1,003
girls were recruited and their parents were
interviewed. The parents or guardians of
the child were informed about the study at
the waiting room and then were interviewed.
Findings from the consultation were used
and additional information was obtained
from a complementary history and physical
examination.
Data collection: Examination data was
collected by doctor from Vietnam National

Children's Hospital. Case definition for
URTI was based on the ICD10 [7].
Data management: Data was entered,
cleaned and analyzed using the statistical
software Microsoft Excel 2016 and
analyzed by SPSS software and p-value
less than 0.05 was considered statistically
significant, OR (odds ratio) and confidence
interval 95% also was measured


Journal of military pharmaco-medicine no4-2018
RESULTS

Figure 1: Incidence of symptomatic acute upper respiratory infections.
According to the figure, we found that the most symptoms of URTI were runny nose
(39.12%), cough (37.81%); others were less common.
Table 1: Prevalence of acute URTI in children by gender.
Boys
(n = 1,147)

Girls
(n = 1,003)

Total
(n = 2,150)

n (%)

n (%)

n (%)

None URTI

784
(68.35)

705
(70.29)

1489
(69,26)

URTI

363
(31.65)

298
(29.71)

661
(30.74)

Gender

p

χ²

0.332

0.942

The proportion of URTI were 30.74%. However, the difference URTI between boys
and girls was not statistically significant.
Table 2: Prevalence of acute URTI by age group (n = 2,150).
≤ 24
months
(n = 82)

25 - 36
months
(n = 281)

37 - 48
months
(n = 452)

> 48
months
(n = 1335)

Total
(n = 2,150)

n (%)

n (%)

n (%)

n (%)

n (%)

None URTI

37
(45.12)

157
(55.87)

295
(65.27)

1000
(74.90)

1489
(69.26)

URTI

45
(54.88)

124

(44.13)

157
(34.73)

335
(25.10)

661
(30.74)

Cough and cold

18
(21.95)

42
(14.95)

71
(15.71)

251
(18.08)

Rhinitis

31
(37.8)

89
(31.67)

96
(21.24)

177
(13.26)

Index

p

χ²

< 0.001

69.47

382
(17.77)

> 0.05

4.90

393
(18.38)

< 0.001

79.85

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Journal of military pharmaco-medicine no4-2018
Allergic rhinitis

13
(15.85)

41
(14.59)

55
(12.17)

117
(8.78)

226
(10.64)

< 0.001

13.11

Pharyngitis

24
(29.27)

75
(26.69)

84
(18.58)

169
(12.66)

352
(16.37)

< 0.001

46.86

VA inflammation

20
(25.32)

45
(16.73)

49
(11.37)

96
(7.63)

210
(10.30)

< 0.001

41.58

Tonsillitis

15
(18.99)

59
(21.38)

81
(18.54)

154
(12.20)

309
(15.04)

< 0.001

21.76

82

281

452

1335

2,150

Total

The proportion of children with URTI increased with age groups. The children with
age of 48 - 60 months occupied 62.09%, while this rate was 3.8% in under 24-month
children. When calculated in terms of disease incidence in each group, the data is
reversed with age. This means that the older they are, the lower rate of URTI is. This is
also true for the rate of specific diseases such as pharyngitis, rhinitis...
Table 3: Prevalence of acute URTI in order: months of birth; birth weight; feeding
status and vaccination (n = 2,150).
Criteria

Months of
birth

Birth weight

Feeding
status

Vaccination

The first one
(n = 1,125)

URTI

None URTI

n

%

n

%

365

32.44

760

67.56

p

0.073

nd

The 2 one and over
(n = 1,025)

296

28.88

729

71.12

< 2.5 kg
(n = 71)

20

28.17

51

71.83

≥ 2.5 kg
(n = 2,079)

641

30.83

1438

69.17

Breastfeeding
(n = 1,976)

602

30.47

1374

69.53

Lack breastfeeding
(n =155)

52

33.55

103

66.45

Parenting (n = 19)

7

36.84

12

63.16

Full (n = 2,119)

649

30.63

1,470

69.37

Lack vaccination
(n = 31)

12

38.71

19

61.29

0.633

0.574

0.333

The incidence of acute URTI in the 1st child was (32.44%) higher than that in the
2 child (28.88%), but the difference was not statistically significant (p > 0.05). In the
group of children with weight at birth < 2.5 kg, the incidence of URTI was 28.17%,
lower in children ≥ 2.5 kg (30.83%), the difference was not statistically significant
(p > 0.05). In terms of feeding status and vaccination, we had the same results.
nd

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Journal of military pharmaco-medicine no4-2018
Table 4: Prevalence of acute URTI in children by smoking status; type of stoves use
and caregiver (n = 2,150).
URTI

Criteria

Passive
smoking

Types of
stoves
used

Regular
caregiver

None URTI

n

%

n

%

Yes
(n = 1,022)

330

32.29

692

67.71

No
(n = 1,128)

331

29.34

797

10.66

Use only gas or electric stove
(n = 1,048)

324

30.92

724

69.08

Alternate firewood/coal/oil stove
(n = 1,102)

337

30.58

765

69.42

Parents
(n = 2,099)

643

30.63

1456

69.37

Others (n = 51)

18

35.29

33

64.7

p

0.139

0.866

0.476

As shown on table 4, environmental factors such as exposure to wood
smoke, cigarette smoke (passive smoking), types of stoves used, regular caregiver
were not increased significantly (p > 0.05).
DISCUSSION
* Characteristics of age groups of
children participating in the study:
Children's age group are mainly over

48 months, accounting for 65.3%; 31.53%
of children aged 24 - 48 months, only
3.16% of children under 24 months. In fact,
almost preschools currently enroll children
18 months or older.
This study aimed at determining the
proportion of URTIs and identifying some
related risk factors in children under
5 years preschool. A high proportion of
URTI was 30.74%, which was lower than
the study in Uganda [1], Backan
(Vietnam) [2], but consistent with the
study in Hong Kong [9], this may be
related to different place time periods
used in these studies. In Backan, the

weather is usually colder than in Hanoi,
which may lead to higher URTI in
children. WHO said that most children
have about four to six acute respiratory
tract infections each year accounting for a
substantial proportion of consultations to
primary care physicians [10]. In the study,
we also found that, children have URTI 3 5 times each year. The real data will be
showed in other report.
In Vietnam, smoking is men’s habit
and they often smoke in the house, which
makes women and children largely passive
smokers. According to Alexis A. Tazinya,
Gregory E. Halle-Ekane, Lawrence

T. Mbuagbaw et al, the risk factors
significantly associated with ARI were:
infection with HIV, poor maternal education,
passive smoking, exposure to wood smoke
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Journal of military pharmaco-medicine no4-2018
and contact with person with ARI [4]. In
Vietnam, the findings by Nguyen Hoang
Son [3] showed the association between
ARI and smoking. The children whose
families used coal or oil had higher risk of
URTI than those whose families use
electric cooker. However, in our study,
environmental factors such as exposure
to wood smoke, cigarette smoke, types of
stoves, regular caregiver were significantly
increased with the proportion of URTI. On
the other hand, some other factors like
months of birth, birth weight, feeding
status, vaccination aren’t also associated
with statistical significance.
In fact, today, the number of people
smoking and using coal or oil in cooking
has reduced; other stoves like gas… have
been replaced, therefore, we found no
connection between URTI in children. The
further studies should be recommended.
CONCLUSION

The proportion of URTI in preschool
children in Chuongmy district was 30.74%
and that of boys was 31.65% and girls
29.71%. Some risk factors not significantly
associated with URTI were: months of birth,
birth weight, feeding status, vaccination,
passive smoking, types of stoves, regular
caregiver. There should be more studies
on URTI in preschool children.
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