Pediatric Respiratory System Diseases

The research methodology was based on obtaining information from Hospital Infantil Robert Reid Cabral, as well as reliable sources that were found on the web, most of them from data bases. Much of the epidemiology found in this research was based on both the information found field on HIRRC, along with other researches that included medical examinations and studies. Information has been obtained from the years 2006 up to 2019, in able to obtain a wider spectrum of the conditions of respiratory diseases in the Dominican Republic, in order to make data more reliable. The data collection comes from these obtained sources.

A ground researcher was able to visit Hospital Infantil Robert Reid Cabral and spoke to four doctors, three from the pulmonology department and one doctor in the emergency room in order to analyze the prevalence of respiratory diseases in the Dominican Republic. According to these doctors, more than 60 percent of pediatric patients that arrive to the emergency room present a respiratory condition, as a primary or secondary cause. This data alone shows that respiratory diseases are among the most common in the Dominican Republic’s population. Still according to HIRRC, asthma is the most common cause of hospitalizations in the pulmonology department. It accounts for about 70 to 80 percent. However, recently, they have only obtained few cases of asthma because there are other conditions that have been more prevalent because of the time of years. Asthma is more likely to occur in boys than in girls, only until they get to puberty. In the puberty years, the ratio of males to females with asthma levels. Recently, because it is winter, over 60% of hospitalizations in pneumology were due to bronchiolitis. Winter means more viral infections. Later on in this research, the most common causes of bronchiolitis will be studied. Children that develop bronchiolitis are more likely to develop asthma later on in life according to the experience of these doctors that have seen patients from their early years. Also, young children are more likely to develop this condition. Not seen as often in older children and young adults. This is because older children have most likely been exposed to the virus and so are less likely to incubate the disease. Other common causes of emergencies and hospitalizations due to respiratory conditions are pneumonia and atypical respiratory diseases, among others. ​These are the prevalence of respiratory diseases according to HIRRC in the last few months. According to an article from el dia from 2009, there were around 300 daily cases arriving at HIRRC due to respiratory diseases (El Dia, 2009).

According to an article by Paniagua published by CDN in 2016, between 40 and 60 percent of all emergencies admitted in Hospital Materno infantil San Lorenzo de los Mina and in Maternidad Infantil de Boca Chica are due to pediatric respiratory diseases (Paniagua, 2016). Also the following information comes from a study made by the Department of Pediatrics, Robert Reid Cabral Children's Hospital Affiliated to the University Iberoamericana Unibe School of Medicine and by the Department of Pediatrics, Shanghai Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. This cross sectional study was done on 600 children 3 to 11 years old were they aimed to study the prevalence of asthma and its risk factors in the Dominican Republic. (Mejias & Ramphul, 2018). According to their findings 22% (132 children) of children studied (300 children 3-11 y/o) were diagnosed with asthma (Mejias & Ramphul, 2018). Other important findings were:

According to age

• 14 aged between 3-5 years (9.3%)
• 33 aged between 5-7 years (22.0%)
• 43 aged between 7-9 years (28.6%)
• 42 aged between 9-11 years (28.0%)

According to gender

• 59 males (19.7%)
• 73 females (24.3%)

Family history

• 30 had a family history of asthma •
• 43 had a family history of allergy child number
• 42 were first-born children
• 68 were second-born
• 22 were the third or higher child in the family

Environmental exposures

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• 48 of the asthmatics also had at least one pet at home
• 44 children with asthma were exposed to gas as a fuel source at home
• 88 had an electric source in the kitchen for cooking
• 60 exposed to tobacco smoke

Prevalence of conditions ​

• 98 children (74.2%) had 1-3 episodes of wheezing /12 months ​ ​
• 34 (25.8%) had more than three/ 12​ Months​ ​
• 103 children (78.0%) suffered from rhinitis​ ​
• 93 (70.5%) were diagnosed with atopic rashes/ 12 months

This study confirms that asthma is the most prevalent case of respiratory diseases in the Dominican Republic.

A research also by Hospital Infantil Robert Reid Cabral, aimed to investigate the most common cause of bronchiolitis in the Dominican Republic. A total of 114 children from 0-24 months of age were admitted with diagnosis of bronchiolitis & acute respiratory infection. According to this study, the main cause of bronchiolitis was the Respiratory syncytial virus (RSV) with 48 percent of all the cases (54 children). Other significant information is that in most cases, 62 percent of the 54 cases, the affected individuals were males. 76 percent of the children affected were younger than 4 months old, confirming the information obtained by the field researchers at HIRRC. All 54 cases were affected between the months October to January also confirming that in winter, children are more likely to develop bronchiolitis. Their sign and symptoms were that 52 showed cough and respiratory distress, 46 showed wheezing, and 41 showed subcostal retraction. (Gómez-Alba, Feris-Iglesias, Florén, Sánchez, Fernández, 2006)

According to Feris-Iglesias, Fernández, Sánchez, et al.2014 the following are the main causes of Pneumococcal Pneumonia in the Dominican Republic (Pneumonia with effusion): (Feris-Iglesias, Fernández, Sánchez, et al.2014).

• Staphylococcus pneumoniae detected in 62 (51.2%) cases​
• Staphylococcus aureus detected in (15.7%)
• Streptococcus pyogenes (1.7%)​
• Streptococcus mitis (0.8%)​
• Candida spp. (0.8%)​
• No aetiology determined (29.8%)

This research was also done in HIRRC. Researchers studied every case of pneumonia from the years 2009 to 2011. All children less than 15 years old that had the need of a thoracocentesis were studied in order to analyze the cause of their pneumonia. A total of 121 patients were studied.

Viral outbreaks and contagious bacterial infections are also very common causes of respiratory diseases in the Dominican Republic. Children are more vulnerable since they have not yet developed a very strong immune system. Risk factors like quality of housing and allergies, to cockroaches for example, also may lead to pediatric respiratory diseases (Barnes, Brenner, 1996). According to the American Journal of Epidemiology, Acute Lower Respiratory Infection in children from charcoal-using households was 1.56 times higher, respectively, than those in children from households using gas. ​Respirable particulate matter existed in higher concentration in houses using charcoal. ​The acute lower respiratory infection was at higher risks when children were more exposed to respirable particulate matter (Bautista, Correa, Baumgartner, Breysse, Matanoski, 2009).

Children arriving to a Primary Care Center (UNAP) receive their attention depending on the severity of their respiratory disease. However, pediatric respiratory diseases are granted priority over the most common health conditions. Only urgent cases will receive attention first if the respiratory condition does not require immediate care. At entrance, children are evaluated by the physician in charge. ​If attention can be provided in the center, the child will most likely receive priority.​ If resources to treat the disease is not available, he or she would be translated to a nearby medical center where specialists are located (2nd or 3rd level).

The public health system in the Dominican Republic can do many things to improve the how respiratory diseases are treated and handled in the country. The following recommendations are made by the group of researchers in charge of this investigation. Reduce risk factors in homes and public places (like charcoal). Raise Awareness and Public knowledge on the topic so people learn to avoid harming lifestyles specially around children​ Train parents to provide asthma first aid if needed. Allow for faster access to medicines and medical attention.​ Promote and help in the reduction of pollution.

References

1. Mejias, S. G., & Ramphul, K. (2018). Prevalence and Associated Risk Factors of Bronchial Asthma in Children in Santo Domingo, Dominican Republic. Cureus, 10(2), e2211. doi:10.7759/cureus.2211apa​
2. Leonelo E. Bautista, Adolfo Correa, Jill Baumgartner, Patrick Breysse, Genevieve M. Matanoski, Indoor Charcoal Smoke and Acute Respiratory Infections in Young Children in the Dominican Republic, American Journal of Epidemiology, Volume 169, Issue 5, 1 March 2009, Pages 572–580, https://doi.org/10.1093/aje/kwn372​
3. Feris-Iglesias, J., Fernández, J., Sánchez, J. et al. Aetiology of paediatric pneumonia with effusion in the Dominican Republic and the potential impact of pneumococcal conjugate vaccines. Pneumonia 4, 8–15 (2014) doi:10.15172/pneu.2014.4/413​
4. Barnes K, C, Brenner R, J: Quality of Housing and Allergy to Cockroaches in the Dominican Republic. Int Arch Allergy Immunol 1996;109:68-72. doi: 10.1159/000237233​
5. Cilloniz, C., Martin-Loeches, I., Garcia-Vidal, C., San Jose, A., & Torres, A. (2016). Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns. International journal of molecular sciences, 17(12), 2120. doi:10.3390/ijms17122120​
6. Thind, A., & Andersen, R. (2003, March). Respiratory illness in the Dominican Republic: what are the predictors for health services utilization of young children? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12600356
7. Gómez-Alba V, Feris-Iglesias J, Florén A, Sánchez J, Fernández J, Características clínico-epidemiológicas de la infección respiratoria aguda (ira) por Virus Sincitial Respiratorio (VSR) en niños menores de dos años: admitidos en el hospital Infantil Dr. Robert Reid Cabral (HIRRC), enero-diciembre 2006 Ciencia y Salud[Internet]. 2018 mayo 1; [citado 2018 agosto 15]; 2(2):[aprox. 0 p.]. Disponible en: https://revistas.intec.edu.do/index.php/cisa/article/view/1182​
8. Paniagua, Y. (2016, May 4). Aumentan casos de niños con enfermedades respiratorias en hospitales - CDN - El Canal de Noticias de los Dominicanos. Retrieved December 3, 2019, from https://cdn.com.do/2016/05/04/aumentan-casos-de-ninos-con-enfermedades-respiratorias/.​
9. El Día (Ed.). (2009, November 12). Enfermedades respiratorias afectan a miles de niños dominicanos. Retrieved December 1, 2019, from https://eldia.com.do/enfermedades-respiratoriasafectan-a-miles-de-ninos-dominicanos/.​
10. Pimentel, R., Peña, E., Herrera, L., & Núñez, R. (2011, September). Perfil de Salud ODM 4: Salud Infantil MINISTERIO DE SALUD PÚBLICA República Dominicana. UNICEF, Organizacion Panamericana de la Salud & Ministero de Salud Publica PDF. Distrito Nacional.