CHAPTER –II

REVIEW OF LITERATURE
 INTRODUCTION

Researcher always never conducts a study in intellectual vaccum.Research studies

have been undertaken in the context of an existing knowledge base, researcher
undertaken literature review of familiarize him with that knowledge base. The review of
literature as an important step in the development of a researcher project. It helps to gain
information on what has been done before and enlightens about significance of new
studies.

Wood and Haber (2001) stated that the overall purpose of a review of literature is
to develop a strong knowledge base to carry out research project. It reveals appropriate
research question for the discipline, uncovers conceptual and data based knowledge in
relation to a particular problem and uncover new knowledge that can lead to the
development, validation or refinement of theories.

Polit and Hungler (2010) stated that a review of related literature refer to
activities involve in identifying and searching for information on a topic and developing
and understanding of the state of knowledge on that topics as well as to the actual
written summery of the state of art on a research process.

Abdellah and Levine (1979) stated that the review of literature provides a basis
for future investigations. It justifies the need for replication. It throws light on the
feasibility of the study, indicates constraints of data collection and helps to related the
findings from one study to another, with a new to establishing a comprehensive view of
scientific knowledge in a professional discipline from which valid pertinent theories
may developed.

Review of literature is an integral component of any study or research project. It

enhances the depth of knowledge and inspires a clear inside into the problem. Literature
review throws light on the study and their finding reported about the problems
understand study literature related to the early new born care among the postnatal
mothers has been presented under the following categories.
A literature review is the effective evaluation of selected documents on a research
topic.

2.1 Literature related to incidence of upper respiratory tract infection.

2.2 Literature related to knowledge and attitude on prevelance of upper respiratory tract
infection among mothers of under five year children.

2.3 Literature related to various management of upper respiratory tract infection.

2.1 Literature related to incidence of upper respiratory tract infection.

A longitudinal cohort study was conducted for a one year period, comprising a
cumulative sample of children from 3 urban slums of Gulbarga city. History of nasal
discharge, cough, fever, sore throat, breathing difficulty, any discharge from ear alone
or in combination, was used in the recognition of an ARI episode. Respiratory rate
>60/minute (<2 month infants), >50 (2-11 months) and >40(1-5 years) in a child with
cough, cold or fever singly or in combination was considered the criteria for recognition
of pneumonia. Out of the 400 surveyed, ARI was detected among 109 children giving
an incidence of 27.25%. Among these, upper respiratory tract infection among 8%. ARI
was observed among 38.04% of infants, 37.84% of 2-3 year old children, 36.87% of
boys, 40.43% of children born to illiterate father’s, 35.77% of SES class IV 7 40.79% of
SES class V, and 41.89% of children with family history of respiratory illness. All these
data were found to be statistically significant.(2016).

A cohort study was conducted for 106 children in a peri- urban area of Delhi.
This community based prospective study provides information on risk of developing
ARI in tropical peri- urban settings of developing countries. Shows the monthly
incidence of “ARI”( all types including otitis media), “ no pneumonia, cough, and
cold,” “pneumonia,” and “otitis media” among infants and toddlers. The monthly
incidence of aris ranged from a low of 5.2 episodes/100 child-weeks (in may) to a high
of 15.8 (in February). Two peaks were seen with the more prominent peak falling in the
month of February which coincided with spring season. The lesser peak was seen in
November, coinciding with autumn season. Incidence of pneumonia also showed a
fluctuation, ranging from a low of 0.2 episodes/100 child –weeks in may to a high of 1.5
episodes/100 child-week in march (visible as a peak) and November (visible as ales
prominent plateau). (2014)

A descriptive study conducted to correlated acute respiratory tract infection

among under five in selected area of udupai district. 110 mothers and their children
above 1 year were selected for study. Structured interview schedule was used for data
collection. Majority of children that is 60.9% had ARI 4 to 6 times in past 3 months.
During 1 month observation maximum number of children 48.6% had at least suffered
from ARI once. Chi square values computed between occurrence of ARI and selected
variables revealed significant association between occurrence of ARI and in physical
health of in the infant an environment. The study showed that majority of children
suffered 4to 6 times with respiratory tract infection in 3 month of study period (2013)

A questionnaire was filled out for 76 children between 1 and 4 year of age. Two
group were created a URTI grouped and a control group. The URTI group suffered
more from upper respiratory tract infection (19days a month) when compared with the
control group (6days). Further more, this children suffer from fever for 7.4days a
month, thus significantly more then the control group. As a result, this children took
more antibiotics. All the children URTI group had no immunologic abnormalities in
their blood results which could explain the recurrent infections (2012)

ARI is one of the commonest cause of death in children in developing

including India. Out of an estimated 15 million deaths that occur in children under 5
years of age, each year in developing countries, one third are due to ARI. Around one
million pneumonia deaths are a result of measles and diphtheria. ARI is more common
in urban than in rural areas. On an average a child in an urban area may have 5 to 6
episodes of ARI annually. Between 20 percent and 60 percent of paediatric
consultations at health facilities and 30 to 40 percent admissions to hospitals are
attributable to ARI. One in every 30-40 episodes of cough will develop into pneumonia
and without treatment, 10 to 20 percent of pneumonia cases will die. Measles,
whooping cough and diphtheria together account for 15 to 25% of all deaths associated
with ARI. (2008)

7, 50,000 children below five years of age die of ARI. In India every year, i.e.
2000 deaths per day or 85 deaths per hour. The risk of an Indian child dying of ARI is
30-75 times more than that of his counterpart in the developed world. In India, ARI
accounts for 14.3% of deaths during infancy and 15.9% of deaths during the age 1-5
years. A child suffers 5-8 episodes per year in the urban and 2-3 episodes per year in the
rural areas. It is estimated that, annually, there are 2000 million episodes of ARI of
which 1 out of 50 are cases of pneumonia, between 10% and 20% of these die. The
WHO estimates that one third of all deaths in children below the age of 5 years (4.3
million deaths in real terms in 1993) are due to ARI. ARI comprises 25-30% of hospital
consultations and 25% of total hospital admissions. However, the incidence of ARI is
similar in industrialised and developing countries. (2003)

2.2 Literature related to knowledge and attitude on prevelance of upper

respiratory tract infection among mothers of under five year children

Across sectional study conducted in sohag and qena govertment in south of

Egypt the study included 4822 students the prevalence of symptoms of ARI infection in
school children was high (51%). May risk factor were found. The most import factors
were no separation of kitchen, exposure to ARI at school and absence of window in bed
room, improvement of kitchen facility, proper ventilation of houses and school houses
and school classes and housing environment and health education on the preventive
measure of ARI such as living in well ventilated houses, opening the windows,
avoidance of overcrowding and the of the indoor air pollution may help in reduction of
ARI infection among school children.(2016)

A community based cross sectional study was conducted in urban and rural area
of puducherry India data were collected from 509 parents of under five children
regarding ARI incidence along with socio demographic and selected associated factor
.overall prevalence of ARI was observe to be 59,1%with prevalence in urban and rural
area being 63.7% and 53.7%. The prevalence of ARI is high, particularly in urban area
improvement of living condition may help in reduction of ARI in the community.(2015)

A population based analytical cross sectional study was conducted in the urban
slum of Bankura ,west Bengal on the prevalence of ARI and feeding practice
,nutritional and immunization among 152 children under five year of age overall
prevalence of ARI was 44.73%,43.47% male and 45.78% female were affected with
ARI half of infant suffer from ARI (51.21) it was 45.71% in 13-24 month age group
with increased age , prevalence of ARI gradually decreased .present study had identified
a high prevalence of ARI in children less than five years of age .ARI was significantly
associated with immunization status, but not with feeding practices and nutritional
status of the child (2014).

A Cross sectional study of 436 under five children diagnosed with ARI was carried
out in three hospitals in elugu. Participants were consecutively enrolled after being
diagnosed as a case of ARI. 61.5% (268/436) Cases of acute upper respiratory tract
infection. Children less than 20 months accounted for and 64.5% (173/268) cases of
upper respiratory tract infections. ARI are affected by socio demographic and socio
culture risk factor, which can be modified with simple strategies. It is recommended that
control program for ARI should be multifaceted with a strong political will.(2014)

Community based cross sectional study was under taken in 21 registered urban
slum of Guwahati in Assam to determine the prevalence and risk factor associated with
ARI among 370 under five children from 184 household and 370 families .the
prevalence of ARI was found to be 26.22% in infant female children were more
affected.The present study had identified high prevalence of the disease among under
five . It also pointed out various socio demographic ,nutritional and Environmental
modifiable risk factor which can be tackled by effective education of the
community.(2013)

A cross sectional study covering 450 under five children living in urban and rural
area Meerut district. Prevalence of ARI was found to be 52% it was higher in children
with lower socio economic status (35.89%), illiterate mother (49.14%), overcrowded
condition (70.94%), inadequate ventilation (74.35%), and use of smoking challah
(56.83%) Malnutrition (26.49%),and prenatal smoking (78.20%). The present study
found that low socioeconomic status, maternal illiteracy, poor nutritional status,
overcrowding, indoor air pollution and parental smoking behavior were the significant
social and demographic risk factors responsible for ARI in under-five children.(2012)

The purpose of this study was to find out the current pattern and prevalence of
acute upper respiratory tract infections in children at Nepal Medical College Teaching
Hospital in Katmandu, Nepal. A retrospective study was done in 73 children, admitted
to the Pediatric ward over a period of one year from January 2010-December 2010. This
study showed, 52.0% children below two years of age had acute upper respiratory tract
infections, 31.6% had acute bronchiolitis. The prevalence of infections was 58.9% in
male children. The occurrence of infections was common in January and April month.
Pneumonia was detected in 37.7% children with malnutrition. The most common
presenting symptoms was fever observed in 90.4%, cough in 71.2% and fast breathing
in 34.2% children. Out of which 43.8% had pneumonia and 4.1% had
bronchiolitis.(2011)

A community based cross sectional study was done in urban and rural field
practice area of Melmaruvathur Adhiparasakthi institute of medical science and research
Melmaruvathur kancheepuram Tamil nadu ,south India . A study covering the
population of 500 under five children .Overall, Prevalence of ARI was found to be 27%.
The present study had identified low socioeconomic status as important determinants
for ARI. Intervention to improve this modifiable risk factor can significantly reduce the
ARI burden among children. (2009-2010)

A cross sectional study was covering 500 under five children living in urban and
rural area of Ahmedabad district Prevalence of ARI was found to be 22% it was higher
in low social class .Prevalence of ARI was lower in urban area (17.2%),as compare to
rural area (26.8%).A study conclude that In rural area it is more because of lack of
availability of basic health service , lack of awareness and other associated factors like
overcrowding, low socio-economic status,absence of cross ventilation ,indoor air
pollution are responsible factor.(2008-2009)

A prospective longitudinal study was carried out in children enrolled from two
rural Indian villages at birth and followed weekly for the development of ARI,
classified as upper respiratory infection, acute upper respiratory infection (AURI), or
severe AURI. 281 infants enrolled in 39 months and followed until 42 months. Dg 440
child years of follow-up there were 1307 aris, including 236 auris and 19 severe auris.
Virus specific influence rates per 1000 child years for RSV were total ARI 234, AURI
39, and severe AURI. These data will be useful for vaccine design, development and
implementation purposes(2007)

A comparative longitudinal study was carried out among pre-school children (3-5
years) who were selected from private pre-primary school of urban area (155)
&anganwadi (157) of urban slum area of karad town and followed for the period of one
year. Mother/ guardian/ teacher was interviewed by using pre tasted Performa during
this period out of all 97.4% of private pre-primary school children had 1.8
episodes/child/year of ARTI compared to Anganwadi children where all of them had
2.5 episodes/child/year of ARTI. Maximum number of children from private pre-
primary schools from urban area also suffered with at least one episode of acute
respiratory tract infection compared to Anganwadi children from urban slum areas.
(2004)

2.3 REVIEW OF LITERATURE RELATED TO VARIOUS MANAGEMENT

OF UPPER RESPIRATORY TRACT INFECTIONS.

The aims of the study to explore the management of respiratory tract infection in
young children from multi-disciplinary perspective using a cross sectional qualitative
research design based on the theoretical domains framework and the capability,
apportunity and motivation-B model. In depth interview were conducted with 30
primary care providers to explore their knowledge, views and management of
respiratory tract infection in children, interviews focused on symptomatic management,
over the counter medications and antibiotics use, and data were thematically analysed.
The study findings the showed that factors such as primary care providers time
constraints, parental anxiety, general practitioners perceptions on what parents want,
perceived parental pressure, and fear of losing patient were some of the reasons why
primary care providers did not always adhere to guide line recommendation. The
findings of this research will inform the development of intervention to better manage
respiratory tract infection in young children.

Drug utilization study was conducted to evaluate the pattern of antibiotics use in
Medicine Department of a Krishna Hospital, Karad, and Maharashtra, India. 200 case
records were examined, of which 56.5% were URTI (nonspecific URTI), 28% were
sinusitis, pharyngitis and CSOM accounted for 24% and 7% respectively. Female
accounted for 64% and male for 36% of total cases. The World Health Organization
(WHO) indicators (utilization in defined daily doses (DDD); DDD/1000inhibitant/day)
were used and the ATC/DDD method was implemented. The most frequently
prescribed antibiotic was Azithromycin, followed by ceftriaxone(2014)

Review on cross sectional study consisting of children under the age of five years,
who suffered from acute respiratory tract infection and hospitalization at pediatric clinic
of Dr. Mintohardjio navy hospital, Jakarta. The data were collected from patient
medical records retrospectively. The assessment of antibiotic prescribing pattern for
children younger than 5 years was carried out based on the Indonesian guideline of
antibiotic use in acute respiratory tract infection in children. A total of 96 patient
enrolled in this study consisted of 53.1% males and 46.9% females. The type of acute
pharngotonsilitis (95.8%), acute pneumonia (3.1%) and acute laryngitis (1.1%). The
most commonly used antibiotic were ceftriaxone (42.5%), cefotaxim (30.0%),
gentamicin (6.3%), cefadroxil (5.0%), cefixime (5.0%), sulfamethoxazole-
trimethoprim(5.0%), amoxicillin(2.5%), thiamphenicol(2.5%), and chloramphenicol
(1.3%).(2012)

On the basic scientific research demonstrated that vitamin D has an importantanti

- infective role. Review of the relevant literature on the influence of vitamin D on innate
immunity and respiratory tract infection .Vitamin D is involve in the production of
defensing and cathelicidin – antimicrobial peptides that provide a natural defense
against potential microbiological pathogens. Vitamin D supplementation increased of
upper respiratory tract infection Vitamin D appears to play an important role in the
regulation of innate immunity in the upper respiratory tract. Optimal Vitamin D levels
and appropriate dosing schedules have yet to be determined.(2010)

Pilot study of the homoeopathic treatment of recurrent Upper Respiratory Tract

Infections (urtis) in children below the age of 5 years was carried out using the data
consisting of detailed case series with before and after comparison in respect of 30
patients collected during 2006. The study was carried out as part of a research project at
a private Homoeopathic Medical College and Post-Graduate Institute. The number of
attacks of the urtis during the 6 months period preceding the date of commencement of
the homoeopathic treatment (Control value) and 6 months period following the date of
commencement of treatment (Treatment value) were compared. The results of the study
indicated statistically significant differences (p < 0.001%, t-test and Wilcox on non-
parametric test) in the two data sets in favour of homoeopathic treated cases. The results
of the study indicate the utility of the homoeopathic remedies prescribed based on the
concept of individualization in the treatment of urtis in children vis-à-vis improving the
prescribing skills particularly with respect to the process of selection and types of
medicines.(2010)
 “Complementary, holistic and Integrative medicine for the common Cold”. The
study review examines popular complementary, Alternative medicine (CAM) therapies
used to alleviate symptoms of the common cold in children. Natural health products
(which include herbals (Ex: Ginger, Echinacea, Eucalyptus) honey, vitamins,
homeopathic and traditional medicines) are used widely for prevention and treatment of
common cold. Study has investigated the efficiency and safety of Echinacea in the
prevention and treatment of colds in pediatric patients. The first was randomized
controlled trail (RCT) in which 430 children (ages 1 to 5 years) received on herbal
preparations containing 50 mg/ml of Echinacea and 10 mg/ml of vitamin C over a 12
week period during the winter. Children had significant reductions in the number of
illness episodes (55% reduction(2008).

The study was “Evaluate the efficacy and tolerability of bovine colostrum
(pediment) in preventing upper respiratory tract infections in children”. 605 children (1-
8 years) having recurrent episodes of respiratory tract infections received bovine
colostrum (pediment) for 12 weeks. Total number of episodes of recurrent infections,
hospitalization care, overall wellbeing, and addressed event were assessed at every 4
weeks. It was highly effective in the prophylactic treatment of recurrent upper
respiratory tract infections in reducing. Result concluded that episodes of upper
respiratory tract infection reduced significantly 91.19% at the end of therapy.(2006)

The review of randomized control trials conducted in southern Africa that

The Infectious Diseases Society of Southern Africa held national guideline for the
management of urtis. Penicillin remains the drug of choice for tonsillopharyngitis.
Single-dose parenteral
Administration of benzathine penicillin is effective, but many favor oral administration
twice daily for 10 days. Amoxicillin remains the drug of choice for both AOM and
ABS. . A dose of 90 mg/ kg/day is recommended in general, which should be effective
for pneumococci Alternative antibiotic choices are given in the guideline with
recommendations for their specific indications. These antibiotics include amoxycillin-
clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents
and the respiratory fluoroquinolones(2004)
. Review of management of upper respiratory tract infection .a prospective, open,
randomized study of 179 children, most respiratory tract infection despite this, they are
associated with high antibiotic prescription rate children with AOM who received pcm
had some less pain. Antibiotic where prescribed in 45% of visits mostly pcv(60%) and
doxycycline (18%). Visiting for AOM and tonsillitis declined by > 10% years but
prescription rate of antibiotic remain unchanged, for sore throat 65% received
antibiotics in 40% of cases.CRP was analyzed in 36% of consultations for RTI.(2002)

Health behaviour of rural mothers to acute respiratory infections in children in

Gondar, Ethiopia”. During 1990, medial students interviewed 132 mothers with at least
1 child younger than 5 years old living in the villages so researcher could assess the
mother’s knowledge, attitudes and practices regarding acute respiratory infections (ARI)
in their children. Most mothers recognized that respiratory rate (77.3%), high fever
(76.5%) and decreased feeding (62.8%) were important signs of Pneumonia. Only
35.6% would take their child with these symptoms to a nearby health center. Other
common treatments were taking the child to a traditional healer (64.4%) and applying
butter and herb to the chest via a massage at home (95.5%). Traditional practices were
the predominant interventions proposed by the mothers for mild ARI (Ex: Cold, Sore
throat and ear discharge(1995)

“Acute respiratory infections in children a study of knowledge and practices of

mothers in rural Haryana”. 304 mothers were interviewed. 23% recognized pneumonia
by fast breathing. 11.2% recognized severe pneumonia chest in drawing and 1.3% knew
the infective origin of ARI. Most were convinced about the continuation of breast
feeding, but 70% advised restricting food, the use of herbal tea in ARI was widely
prevalent. Result concluded that primary health center was the most frequented place
for treating ARI and mother-in-law was the most important person in making
management decision for the child.(1992)