Enver ŞİMŞEK, Ebru YILMAZ, Meltem KARABAY, Yılmaz AVŞAR, Kenan KOCABAY

Deprem bölgesindeki çocukluk çağı pnömonilerinin epidemiyolojik özellikleri

Amaç: İki büyük depreminin gerçekleştiği Düzce ve çevre illerde görülen çocukluk çağı pnömonileri üzerine etkili risk faktörlerinin irdelenmesi. Gereç ve Yöntem: Nisan 1998 ile Mart 2003 tarihleri arasında Düzce Tıp Fakültesi Çocuk Kliniği'nde alt solunum yolu infeksiyonu tanısı konulan 172 (98 [57%] erkek, 74 [43%] kız) çocuk hasta çalışmaya alındı. Alt solunum yolu infeksiyonu tanısı ve tedavisi Dünya Sağlık Örgütü kriterlerine göre yapıldı. Vakalar yaş, cinsiyet, getirildikleri bölge, yaşam koşulları, beslenme şekli, gelişim özelliklerine göre irdelendi. Bulgular: Yüz yetmiş iki hastanın 124'ü (%72) hastaneye yatırılarak, 48'i (%28) ayaktan tedavi edildi. Hastaneye yatırılan 124 hastanın 89'unu (%72) Bolu, Düzce, Adapazarı ve Zonguldak il merkezlerinden, 35'ini (%28) bu illerin kırsal kesimlerinden gelen hastalar oluşturuyordu. Ayaktan izlenen hastaların 32'sini (%66) kırsal kesimden gelen, 16'sını (%34) şehir merkezinden gelen hastalar oluşturuyordu. Hastaların tanı anındaki yaşları 2 hafta ile 17.4 yıl arasında olmak üzere, ortalama (± S.E.M) tanı yaşı 37 (± 7.4) hafta olarak bulundu. Yüz yetmiş iki çocuğun 54'ünde (%31) ağırlık yaşa göre ağırlığın %60 ile %75'i arasında, 26'sında (%15) ise yaşa göre ağırlığın %60'ın altında saptandı. Tanı konulan mevsimlere göre, 84 (%49) çocukta kış, 46 (%27) çocukta ilkbahar, 23 (%13) çocukta yaz ve 19 (%11) çocukta sonbahar mevsiminde tanı konuldu. Ortalama (± S.E.M) pnömoni tedavi süresi, plevral effüzyonu olmayan vakalarda 13 ± 5 gün, ampiyemi olan vakalarda ise 21 ± 8 gündü. Çalışmaya alınan hastalardan 19'u (%11) kaybedildi. Bu vakaların 17'sini (%89) 2 yaş altındaki çocuklar oluşturuyordu. Mortalite ile yaş arasında negatif korelasyon saptandı (r=-0.33, p

Anahtar Kelimeler:

Doğal afetler, Epidemiyolojik çalışmalar, Pnömoni, Risk faktörleri, Çocuk

The epidemiological features of childhood pneumoniae in the earthquake areas

Aim: To analyse the epidemiological features of childhood pneumoniae in Düzce and its neighbouring cities in which the two biggest earthquakes of the last century in Turkey occurred. Material and Methods: From April 1998 to March 2003, 172 children (98 [57%] boys, 74 [43%] girls) who were diagnosed with acute lower respiratory tract infection were enrolled in the study. The guidelines developed by World Health Organization (WHO) were used for clinical diagnosis and case management of pneumonia. Their age, gender, living area, accommodation conditions, feeding method in the infancy period and developing feature of each case were analyzed. Results: Among 172 children, 124 children were followed up as inpatients and 48 children as outpatient. Among the 124 children who were followed up as inpatients, 89 (72%) children were from urban area of Bolu, Düzce, Adapazarı, and Zonguldak, and 35 (28%) patients were from rural areas. Among 48 children that were followed up on an outpatient basis, 32 (66%) children were from rural and 16 (34%) children from urban areas. The mean age of patients at the time of diagnosis was 37±7.4 months (range two weeks to 17.4 years). Of the 172 children, 54 (31%) children were underweight and 26 (15%) children had protein energy malnutrition (PEM). Eighty-four children (49%) were admitted to hospital in winter, 46 (27%) children in spring, 23 (13%) children in summer, and 19 (11%) children in autumn. Recovery period from pneumonia was 13 ± 5 days in children without pleural effusion and 21 ± 8 days in children with empyema and chest tube drainage. Recovery period showed positive correlation with empyema (r=0.50, p<0 .001) and inverse correlation with the age (r=-37, p=0.03). Mortality rate was 19/172 (11%). Of the 19 deaths, 17 cases (89%) were infants. Mortality rate showed inverse correlation with the age of children (r=-0.33, p<0.001). According to multiple logistic regression analysis, the predictive parameters of bad prognosis include to be a child of old-mother, diffuse infiltration on pulmonary x-ray, and high white cell count and sedimentation rate at the time of diagnosis. Conclusion: Unhealthy living conditions are still the major risk factor for pneumonia of childhood in earthquake areas. In earthquake area, many risk factors that have a negative effect on prognosis of childhood pneumonia may be preventable. The transition from unhealthy conditions to permanent and hygienic accommodations may have a lowering effect on the incidence of childhood pneumonia. Regular immunizations, taking in consideration the availability of new generation of vaccines and improving breast-feeding to the desired levels are the other important factors that have a decreasing effect on the incidence of childhood pneumonia.

Keywords:

Natural Disasters, Epidemiologic Studies, Pneumonia, Risk Factors, Child,

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