ACUTE LOWER RESPIRATORY INFECTION IN GUARANI INDIGENOUS CHILDREN, BRAZIL

ABSTRACT Objective: To describe the clinical profile and treatment of Brazilian Guarani indigenous children aged less than five years hospitalized for acute lower respiratory infection (ALRI), living in villages in the states from Rio de Janeiro to Rio Grande do Sul. Methods: Of the 234 children, 23 were excluded (incomplete data). The analysis was conducted in 211 children. Data were extracted from charts by a form. Based on record of wheezing and x-ray findings, ALRI was classified as bacterial, viral and viral-bacterial. A bivariate analysis was conducted using multinomial regression. Results: Median age was 11 months. From the total sample, the ALRI cases were classified as viral (40.8%), bacterial (35.1%) and viral-bacterial (24.1%). It was verified that 53.1% of hospitalizations did not have clinical-radiological-laboratorial evidence to justify them. In the multinomial regression analysis, the comparison of bacterial and viral-bacterial showed the likelihood of having a cough was 3.1 times higher in the former (95%CI 1.11-8.70), whereas having chest retractions was 61.0% lower (OR 0.39, 95%CI 0.16-0.92). Comparing viral with viral-bacterial, the likelihood of being male was 2.2 times higher in the viral (95%CI 1.05-4.69), and of having tachypnea 58.0% lower (OR 0.42, 95%CI 0.19-0.92). Conclusions: Higher proportion of viral processes was identified, as well as viral-bacterial co-infections. Coughing was a symptom indicative of bacterial infection, whereas chest retractions and tachypnea showed viral-bacterial ALRI. Part of the resolution of non-severe ALRI still occurs at hospital level; therefore, we concluded that health services need to implement their programs in order to improve indigenous primary care.

摘要 目的：描述居住在里约热内卢州至南里奥格兰德州境内各村落、因急性下呼吸道感染（acute lower respiratory infection，ALRI）住院的巴西瓜拉尼原住民5岁以下儿童的临床特征与治疗方案。方法：本研究共纳入234名儿童，其中23例因数据不全被排除，最终纳入211例儿童进行分析。研究人员通过标准化病历采集表从病历档案中提取相关数据。基于喘息症状记录与X线检查结果，将ALRI划分为细菌性、病毒性及病毒-细菌性混合感染三类。采用多项回归模型进行双变量分析。结果：研究对象的年龄中位数为11个月。全部样本中，ALRI病例分类为病毒性（40.8%）、细菌性（35.1%）及病毒-细菌性混合感染（24.1%）。经核查，53.1%的住院病例无临床、影像学及实验室检查证据支持其住院指征。多项回归分析结果显示：对比细菌性与病毒-细菌性感染组，细菌性感染患儿出现咳嗽的风险升高3.1倍（95%CI：1.11~8.70），而出现胸廓凹陷的风险降低61.0%（OR=0.39，95%CI：0.16~0.92）；对比病毒性与病毒-细菌性感染组，病毒性感染患儿为男性的概率升高2.2倍（95%CI：1.05~4.69），而出现呼吸急促的风险降低58.0%（OR=0.42，95%CI：0.19~0.92）。结论：本研究发现病毒性感染及病毒-细菌性混合感染的占比相对较高。咳嗽可作为细菌性感染的指示性症状，而胸廓凹陷与呼吸急促则提示病毒-细菌性混合感染性急性下呼吸道感染。仍有部分非重症急性下呼吸道感染的处置需在医院层面开展，因此研究认为医疗服务机构需优化相关服务项目，以改善原住民群体的初级卫生保健水平。