USE OF SIMPLE CLINICAL SIGNS TO PREDICT PNEUMONIA IN YOUNG GAMBIAN CHILDREN - THE INFLUENCE OF MALNUTRITION

The current WHO recommendations for the case management of acute respi ratory infections (ARI) in children aged 2 months to 5 years in develo ping countries use fast breathing (respiratory rate of greater than or equal to 50 per minute in children under 12 months and greater than o r equal to 40 in children aged 12 months to 5 years) and lower chest w all indrawing to determine which child is likely to have pneumonia and should therefore receive antibiotics. We have evaluated these and oth er physical signs in 487 malnourished children and 255 well nourished children who presented with a cough or breathing difficulty. Pneumonia , defined as definite radiological pneumonia or probable radiological pneumonia associated with crackles on auscultation, was present in 145 (30%) of the malnourished children and 68 (26%) of the well nourished children. The respiratory rate predicted pneumonia equally well in th e two groups, but to achieve an appropriate sensitivity and specificit y the respiratory rate cut-off required in malnourished children was a pproximately 5 breaths per minute less than that in well nourished chi ldren. Intercostal indrawing was more common and lower chest wall indr awing was less common in the malnourished children, with or without pn eumonia. These results suggest that fast breathing, as defined at pres ent by WHO, and lower chest wall indrawing are not sufficiently sensit ive as predictors of pneumonia in malnourished children. As the latter are a high-risk group, we should like to recommend that children with malnutrition who present with a cough, fast breathing or difficult br eathing should be treated with antibiotics.