REVIEW OF RELATED LITARATURE

In the year 2005 and 2006, a study conducted by the Department of Health identified respiratory infectionssuch as pneumonia, bronchitis, influenza and

tuberculosis among the top leading causes of morbidity in the Philippines. The World Health Organization defines respiratory infections as those that affect the air passages, including the nasal passages, the bronchi and the lungs. They range from acute infections, like pneumonia and bronchitis, to chronic conditions such as tuberculosis. They can also be classified as either upper respiratory tract infections (URTI) or lower respiratory tract infections (LRTI). URTIs affect the anatomical organs and structures above the glottis or vocal cords (nose, sinuses, pharynx and larynx) and include conditions such as tonsillitis, influenza and pharyngitis. Lower respiratory tract

infections have effects on the trachea, bronchial tubes, bronchioles and the lungs. These include bronchitis and pneumonia which are the two most common LRTIs. Robert Beaglehole et al. writing in The World Health Report, a publication of the World Health Organization, named LRTIs as the leading cause of death among all infectious diseases (Beaglehole, et al., 2004). In the Philippine setting, Tupasi, et al. described the incidence of acute respiratory tract infections in an article published in Reviews of Infectious Diseases. In this longitudinal study conducted in a depressed community in Metro Manila, the researchers determined the incidence to be 6.6 per child-year and noted a peak agespecific incidence occurring in those children 6-23 months old. The crude mortality rate

was found to be 14.3 per 1000 children and a corresponding acute respiratory infectionspecific mortality rate of 8.9 per 1000. Romares and colleagues also reported a high incidence of respiratory tract infections, including tuberculosis with concomitant skin infections, among street children in Zamboanga City (Romares et al., 2006). These observations emphasize the importance of an in-depth analysis as to the risk factors involved in the high frequency of occurrence of respiratory tract infections among children. A study conducted by Selwyn from the School of Public Health at the University of Texas analyzes the epidemiology of respiratory tract infections among young children. This research compares all the findings from ten developing countries. Incident rates from six of the community-based studies ranged from 12.7 to 16.8 new episodes of acute respiratory infections per 100 child-weeks at risk and rates of lower respiratory tract infection ranged from 0.2 to 3.4 new episodes per 100 child-weeks at risk. In the same paper, an interesting finding was observed by the author; that the risk factors for respiratory tract infections exhibited different patterns of association with the infection in different studies. Selwyn therefore noted that these provide an important springboard and an interesting and useful data on the epidemiologic dynamics of respiratory tract infections in general (Selwyn, 1990). In an attempt to study the pattern of acute respiratory tract infection among children, the same aforementioned study by Tupasi and colleagues determined some important risk factors for acute respiratory tract infections. Age less than two years, malnutrition, household crowding, and parental smoking were identified as top contributors to a significant increase in risk of acquiring the infections.

In an almost similar study, Lucero et al., focused on malnutrition as a risk factor for acquiring respiratory tract infections and came up with some interesting results. Malnutrition measured by weight-for-age Z-scores of less than -3 Standard Deviation and less than -2 Standard Deviation from the National Center for Health Statistics median reference population was associated with the following significant relative risks of morbidity: 1.24 (95% confidence interval [CI] = 1.14, 1.34) and 1.14 (95% CI = 1.08, 1.19), respectively, for ARI; and 1.9 (95% CI = 1.46, 2.39) and 1.2 (95% CI = 1.03, 1.47), respectively, for acute lower respiratory tract infection (ALRI). More importantly, the paper also showed that the significance of these risk ratios remains even when adjusted for age, crowding and parental smoking. These still holds true after again adjusting for significant predictors of mortality including clinical complications, concurrent measles, severe infections, and female gender; and for clinical factors, including extent of pneumonic infiltrates, dehydration, and hepatic enlargement. Incidentally, malnourished children with severe acute lower respiratory tract infections had a two to threefold increase risk of dying as compared to healthy children. The authors concluded by emphasizing the importance of nutritional intervention in the control of morbidity and mortality among patients with respiratory tract infections (Lucero, 1990). While the studies mentioned above are sufficient in form and substance, one cannot help but notice the period by which the studies had been undertaken. It is noteworthy to infer that more accurate and reliable results might be obtained if an almost similar epidemiologic study will again be conducted. In this said study, a much better method is also proposed which will not only analyze the epidemiologic data, risk

factors, et. cetera on a specific group of people but will also compare it with the results taken from another group of people. The results on the study of Lucero and colleagues will not only be updated but will be enhanced by dividing the subjects into two specific groups: those living in the streets and those living in an orphanage. This strategy not only provides a vehicle for comparative analysis of the results, it also provides for a review on the primary risk factors involved by also giving emphasis on one specific factor: crowding in orphanages. There had been no actual Philippine data on the frequency of respiratory tract infections on orphanages. However, previous researchers had recognized the significant risk of a spread of infection in closely crowded locations like the orphanages. In fact, a study by Fautino published in the Philippine Journal of Pediatrics reported on the intestinal parasitism among children living in a Philippine orphanage. A direct fecal smear was done among children 1 to 12 years of age and revealed a 33% incidence of parasitism. In almost one-fourth of the subjects, multiple-parasitism was observed leading to the authors conclusion on the high frequency of occurrence of intestinal diseases among children living in an orphanage. On the other hand, a 1998 study by Torres underscored the state of malnourishment and poor health of street children as a result poor diet and long waking hours spent at work. These data are gathered from Metro Manila, Olongapo and Davao City. Connolly and Franchet writing on the Encylopedia of Public Health reiterate the risk for respiratory infections of the almost 220, 000 (as of 1998) street children residing in Manila.

Therefore, aside from providing a tool for a good comparative analysis and careful review on the primary risk factors for respiratory tract infections, this study will also attempt to emphasize the importance and underscore the urgency of the need to focus on these respiratory tract infections. For a country with a very limited budget for health, results on the comparative analysis may also provide the departments and agencies concerned with valuable knowledge and data set which might be useful in proper rationing of medicines, vaccines and human resources. Also, the study will try to provide recommendations and plan of actions that would be implemented in an attempt to give importance on this problem with respiratory tract infections.