WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Zainab Anwar Ezzat, Amal Ali Mohammed and Hadeel Waadulah Hassawi

ABSTRACT

Background: Pneumonia and other lower respiratory tract infections are the leading causes of death in children worldwide. Chest x-ray is used to confirm the presence of pneumonia, including the extent and location of the infection and its complications. But in resource-poor settings without access to these technologies, suspected cases of pneumonia are diagnosed by their clinical presentation. Objectives: Is to study the validity of association between historical and physical examination findings and radiographic pneumonia in children who present with suspicion for pneumonia in the primary health center. Methods: This case sectional study was carried out in Al Hamdanyia city at Al Hamdanyia, Debaga and Baghdada primary health centers, from beginning of April 2023 to the end of April 2025. Conventional method of sampling was used to include children aged from 1 month to 60 months presented with symptoms and signs of lower respiratory tract infection. Patients with congenital heart disease, foreign body inhalation and children with chronic respiratory diseases such as cystic fibrosis, asthma or bronchopulmonary dysplasia were excluded. The questionnaire form was consisted from three parts. Part one for sociodemographic information such as name, age and sex. Part two for patients’ clinical symptoms such as; cough, difficult breathing, fast breathing, noisy breathing, fever, poor feeding. Part three for the clinical signs such as heart rate, respiratory rate, body temperature, drowsiness, central cyanosis, grunting and strider, nasal flaring, chest in drawing, diminished breath sounds, bronchial breath sounds, wheezes and crackles. Depending on the x-ray findings, patients were categorized into two groups: group 1 (pneumonia) and group 2 (no pneumonia). Results: The study was conducted on 106 children aged between 1 month and 60 months. Male constituted 63 (59.4 %) and female 43 (40.6%) with male to female ratio 1.47:1. Pneumonia was diagnosed by radiographic evidence of infiltrate in 72 (67.9%) subjects, the other 34 (32.1%) subjects did not have radiographic evidence of infiltrate. Up to 50% of patients with pneumonia under 6 months old and up to 55.9 % of patients with no pneumonia under 6 months also. With no statically significant difference regarding ages (P value =0.600). Moreover; no symptom was significantly associated with pneumonia, while; the signs that were found to be significantly associated with pneumonia are tachypnea (P<0.001), tachycardia (P=0.007), temperature ≥ 38C° (p=0.002), grunting (p=0.001) and crackles (p<0.001). Furthermore and regarding symptoms; cough has the highest sensitivity 93.1% followed by difficult breathing 91.7 %. Fast breathing and poor feeding have the highest specificity 32.4% for each. Fast breathing and fever have the highest positive PPV 71.6, 71.4 % respectively. Difficult breathing and fever have the highest NPV 50.0%, 45.5 % respectively. While regarding signs; tachypnea and chest in drawing have the highest sensitivity among the reported signs 75.0% and 72.2% respectively. Tachycardia, strider and grunting have the highest specificity among the reported signs 94.1%, 94.1% and 88.2% respectively. Tachycardia, grunting and crackle have the highest positive predictive value 91.3%, 88.6% and 86.8%. While; tachypnea, crackles and temperature >38° have the highest negative predictive value 53.8%, 50.9% and 44.3%. Conclusion: In the present study none of the clinical criteria has the satisfactory high level of all performance characteristics concurrently. The following signs: tachypnea, tachycardia temperature ≥ 38° C, grunting and crackles were significantly associated with pneumonia. Depending on the finding of the current study it is recommended to use a combination model of signs and symptoms reported in this study by physician to evaluate children under 5 years of age for diagnosis of pneumonia.