Assessment of common infections related to steroidal treatment among children in selected hospitals, in view to develop an information booklet

Introduction

The immune system is smart and has the ability to learn the “face” of a germ and remember it. Once your immune system has successfully battled it, most people are less susceptible to recurring infections caused by that germ. An immunodeficiency happens when your body lacks the ability to produce antibodies which attach to germs and destroy them.1 Secondary Immunodeficiencies result from various conditions including cancer therapies, bone marrow transplantation and immune-modulating drugs used to treat a variety of autoimmune conditions. People with immunodeficiency get the same kinds of infections other people get ear infections, sinusitis and pneumonia. The difference is their infections occur more frequently, are often more severe, and have a greater risk of complications.2

Corticosteroids are potent drugs used in management of various inflammatory and autoimmune disorders. Corticosteroids inhibit the immune system and increase susceptibility to infections including those associated with live vaccines. Infection can spread rapidly, may have an atypical presentation and the severity may be masked. A regular dose of corticosteroids for 1-2 weeks can make the patient prone to infection.1

Need of the Study

As per researchers view, in paediatric units there are patients with various steroid treatment comes repeatedly with various types of infection and after going through researches, researcher being child health nurse is motivated to assess common infections among children on steroidal treatment and provide education through information booklet regarding common infections in and its care.

Similar study was conducted on Infections in children with Nephrotic syndrome by Department of Paediatric Medicine, National Institute of Child Health, Karachi. All children with nephrotic syndrome who had various infections during the study period were evaluated for the activity of disease and type of infections. Out of 62 children with nephrotic syndrome having infections, 45 (72.58%) were boys and 17 (27.42%) girls in a ratio of 2.5:1. Out of them 53 (85.45%) were known nephrotic and 36 (58%) of them were on steroid therapy. Nine were new cases and had not received steroids. A total of 74 episodes of infections were observed in 62 children. Acute respiratory infections (ARI) and skin infections were the most common (29.27% and 27.02% respectively) followed by diarrhoea (13.51%), UTI (12.5%) and peritonitis (10.81%). Two patients had pulmonary tuberculosis and 3 patients had more than one infection (cellulitis, peritonitis and pneumonia). All children with cellulitis and peritonitis were in active disease, whereas more than 80% of patients with ARI, diarrhoea and UTI were having either relapse or had recent onset of disease. According to study ARI, cellulitis and diarrhoea were most common infections in nephrotic syndrome followed by UTI and peritonitis. 3

Objectives of the Study

Materials and Methods

Findings

Distribution of samples (children) based on demographic data.

According to developmental stage 51.7% of samples were Schooler and 48.3% of them were Pre-schooler.

According to gender 66.7% of samples belong to male gender and 33.3 % belongs to female gender.

According to duration of steroidal treatment 41.7% of respondents were taking steroidal treatment for 4-6 months, 36.7% of the respondents were taking treatment for 1-2 months and 21.7% of the respondents were taking treatment for 2-4 months.

According to number of times of previous hospitalisation 66.7% of samples are having 1-time previous hospitalization and 15% of the samples were having more than 3 times of previous hospitalization, 11.7 % of the samples were having 3 times previous hospitalization and 6.7% of the respondents were having 2 times previous hospitalization.

According to education of parents 33.3 % of parents had secondary education, 23.3% of the parents had primary education, 20% of the parents had non- formal education, 11.7% of the parents had higher secondary education and 11.7 % of the parents were graduated.

Analysis of data related to common infections related to steroidal treatment among children.

Majority 38.3% of them had respiratory tract infection followed by 21.7% of them had skin infection, 13.3% of the children had gastrointestinal tract infection and 1.7% of them had Urinary tract infection.

Figure 1

Common infections related to steroidal treatment

Analysis of data related to association between selected demographic variables and study findings

Duration of steroidal treatment and education of the parents were found to have significant association with gastrointestinal tract infection among children. Developmental stage of child and duration of steroidal treatment were found to have significant association with respiratory tract infection among children. None of the demographic variable was found to have significant association with urinary tract infection among children. Developmental stage of child and Education of the parents were found to have significant association with skin infection among children.

Limitations

Recommendations

On the basis of the findings of the study following recommendations have been made for further study.

Conclusion

Most common infection due to steroidal treatment among children is respiratory tract infection. Majority 38.3% children had respiratory tract infection followed by 21.7% of them had skin infection, 13.3% of the children had gastrointestinal tract infection and 1.7% of them had Urinary tract infection. Relationship between presence of common infections and system is significant.

Conflict of Interest

The authors declare that there are no conflicts of interest in this paper.

Source of Funding

None.