Hospital Based Surveillance for Radiological Pneumonia in children under 5 years of age in Uttar Pradesh and Bihar: Project protocol and preliminary results

Abstract

Background: Pneumonia is responsible for about 2 million deaths in children <5 years, mostly in developing countries like India and within India in the states of Uttar Pradesh (UP) and Bihar. Hence dedicated efforts are required to focus on strategies to reduce pneumonia specific mortality. Methods & Materials: Aim: To estimate the incidence of radiological pneumonia in children <5 years. Objectives: Primary objectives are to estimate the annual incidence of radiological pneumonia in children aged 2 – 59 months in districts of Lucknow and Etawah in UP and Patna and Darbhanga in Bihar. residing in pre-specified district as well as to document clinical and demographic characteristics of cases of WHO defined community acquired pneumonia (CAP) with lower chestindrawing (LCI) and severe CAP by establishment of hospital-based surveillance network. Study design: In a prospective design, hospital-based radiological pneumonia surveillance is being done in Lucknow district and will begin in other 3 from 1.1.16. Cases will be enrolled from network hospitals. Clinical and demographic data will abstracted and chest x-ray (PA) view obtained and archived electronically. An independent panel of radiologists trained in the WHO standard reporting methodology, will interpret x-rays. In Phase I (2015), standard operating procedures were developed and validated as well as web-based data entry software developed by Central Coordinating Unit, King George's Medical University (KGMU),Lucknow. Thereafter in Phase II surveillance will be initiated in three other districts in addition to Lucknow. Sample size: Assuming incidence of radiological pneumonia is 3.0/100 child years and for a margin of error of 1.5, incidence of pneumonia in community of 20/100 child years, alpha level of 0.05 and power of 90% when the estimated population of children <5 years in Lucknow district is 750,000; 693 cases have to be included in radiological surveillance study. Results: Results: Preliminary results will be shared. Conclusion: Implications: Baseline incidence of radiological pneumonia in high infant mortality states will be estimated which could form the basis of taking evidence based informed decisions for instituting control measures.