ORIGINAL

Niger J Paed 2013; 40 (3): 284 –289

Abdulkarim AA

Ibraheem RM

Adegboye AO

Johnson WBR

Adeboye MAN

Childhood pneumonia at the

University of Ilorin Teaching

Hospital, Ilorin Nigeria

DOI:http://dx.doi.org/10.4314/njp.v40i3,16

Accepted: 9th January 2013

Abstract Background/Objectives:

Pneumonia is a leading cause of

morbidity and mortality in chil-

dren and thus this study was de-

signed to document the sociode-

mographic, clinical features as

well as the bacterial agents re-

sponsible for pneumonia in chil-

dren seen at University of Ilorin

Teaching Hospital.

study population. Bacteraemia was

present in 46(27%)children and

Staphylococcus aureus was the

most common organism cultured

from the blood of children with

pneumonia present in 11 (23.9%)

out of the 46 (100.0%) isolates.

Heart failure was associated com-

plication present in 52 of the 60

children with one or more compli-

cations accounting for over 30% of

all patients. Eleven out of the 15

children with lobar pneumonia had

pneumonia-related complications

which was significantly higher

compared to 46 of 157 children

with bronchopneumonia, p=0.003.

The case fatality was 6.6%. Eight

(72.7%) of the children that died

were infants while the remaining

three (27.3%) were aged between

12 and 60 months. The mean dura-

tion of hospitalization among those

who survived of 6.5 ±5.0 days was

significantly lower than the corre-

sponding value of 10.2 ±12.3 days

in those that died, p= 0.042.

Abdulkarim AA (

)

Ibraheem RM, Adegboye AO,

Johnson WBR, Adeboye MAN

Department of Paediatrics,

University of Ilorin Teaching Hospital,

Ilorin, Nigeria

Email aishaakarim@yahoo.com

Tel: +2348033734509

Methodology: A descriptive cross

-sectional study of children aged

one month to 14 years with fea-

tures of pneumonia admitted be-

st

tween July 1 2010 and June 31 ,

2

011 was carried out. Socio-

demograpic data, clinical features,

complications and outcome were

obtained. Chest radiographs and

blood samples for culture of bac-

terial organism and full blood

counts were obtained in all chil-

dren.

Results: Pneumonia accounted for

1

3.3% (167 out of 1254) of the all

admissions during this period.

The male: female ratio was 1.5:1,

and 101(60.5%) of the children

were infants. Bronchopneumonia

was identified in 147(88%)

Conclusion: Pneumonia-related

mortality and morbidity is high in

under-five children, with the infant

age group most affected. Broncho-

pneumonia is the most prevalent

ALRI diagnosis but lobar pneumo-

nia is associated with a higher

mortality.

children, lobar pneumonia in 15

(

9%) while 5(3%) had a combina-

tion of both. Cough, fever, diffi-

culty in breathing, tachypnoea and

chest wall recessions were recog-

nised as clinical features in the

Introduction

remain the most important pathogens documented in

3-6

previous studies. Staphylococcus has a_,₉lso been found

8

Pneumonia continues to be a major contributor to child-

especially in patients with malnutrition. A few studies

hood mortality and_,₂ morbidity in developing countries

in Africa have documented the presence of nontyphoidal

1

including Nigeria.

Pneumonia is responsible for a

salmonella in pat₁ie₀_,n₁₁ts with radiologically confirmed

quarter of all deaths in under-five children. Many of the

deaths occur in those less than 24 months especially in

severe pneumonia.

A number of conditions such as

malnutrition, sickle cell anaemia and Human Immune

deficiency virus infection can₈_,₉a_,₁f₁f_-e₁₃ct the severity and

1

infants. A number of aetiologic agents, viruses and bac-

teria, have been associated with pneumonia, however it

is the bacterial agents that are usually associated with

severe pneumonia and result in complications or deaths.

Streptococcus pneumonia and Haemophilus Influenzae

outcome of pneumonia cases.

Pneumonia is the

second cause of admission and deaths among children

seen at₁₄the University of Ilorin Teaching hospital

(UITH).

2

85

The challenge of inadequate and supportive laboratory

services in developing countries cannot be overempha-

sized, hence it is important to follow disease burden in

the community and in hospital settings using clinical

features and parameters less reliant on the laboratory.

This study was designed to document the sociodemo-

graphic data, clinical features as well as the bacterial

agents responsible for pneumonia in children seen at

All subjects had blood specimen obtained for blood cul-

ture and total blood counts. Other relevant tests such as

haemoglobin electrophoresis, HIV screening and pleural

fluid analysis were done only when indicated. The sub-

jects were treated with the most appropriate medication

according to the current institutional guidelines.

Data was collected with the aid of a pre-coded study

proforma and analysis was carried out with a micro-

computer using the Epi info version 6.0 software pack-

ages. The chi-square and student t-tests were used to

identify significant differences for categorical and con-

tinuous variables respectively. A p-value of <0.05 was

considered significant.

st

University of Ilorin Teaching Hospital between 1 July

2

010 and 30th June 2011. The outcome in all cases was

also documented.

Materials and Method

Study Design

This was a prospective, cross-sectional, mainly descrip-

tive study of children aged one month to fourteen years

who were admitted to the Emergency Paediatric Unit

Results

Background characteristic of study population

(

2

and Niger.

EPU) of the₁ UITH which serves the state population of

During the study period, a total of 1254 patients were

admitted to the EPU and 167 (13.3%) were diagnosed

with pneumonia. Of these recruited 167 subjects, 101

1

.4 million

and adjoining states of Ekiti, Osun, Oyo

(

60.5%) were infants and 80.3% were below 24 months.

Sample size

The mean age of the subjects was 14.8±16.1 months,

with a range of 1-110 months. The Male: Female ratio

was 1.5:1. The distribution of the social class of the chil-

dren with pneu₁₈monia using classification modified by

Ogunlesi et al is as shown in Table 1 with 40 (24.0%)

in social classes I and II and 127(76.0%) in the lower

three social classes.

The formula used for estim₁a₅ting the minimum sample

size is the Fisher’s formula and with reference to the

prevalence of 11.1% from a previous study, a mini-

mum total of 151 subjects were recruited for the study

and at the end of study period 167 patients were en-

rolled.

1

6

Table 1: Sociodemographic data of study population

Ethical clearance

Variable

Frequency Percentage Cumulative percent

Age (months)

Ethical clearance was duly obtained from the Ethics and

Research Committee of the UITH. In addition, informed

consent was obtained from the individual parent/

guardian or subject as appropriate, after a clear explana-

tion of the objectives and logistics of the study to them.

1-<12

12- <24

101

33

17

7

3

6

60.5

19.8

10.2

4.1

1.8

3.6

60.5

80.3

24- <36

90.5

94.6

96.4

100.0

3

4

6-<48

8<60

>

Gender

Male

60

Subject recruitment

100

67

59.9

40.1

59.9

100.0

All consecutive children who presented at the EPU of

UITH initially with symptom complex of pneumonia,

with or without features of measles or pertussis and in-

trathoracic complications like pleural effusion, in a child

presenting with cough, fever, difficulty with breathing

of less than 28 days duration with (a) age-specific in-

crease in respiratory rate(tachypnoea) (b) lower chest

wall indrawing (c) inabil₇ity to feed or drink, with or

Female

Social Class

SCI

SCII

SCIII

SCIV

SCV

16

24

60

44

23

9.6

14.4

35.9

26.3

13.8

24.0

59.9

86.2

100.0

1

without central cyanosis. All subjects had chest radio-

Clinical features of the patients with pneumonia

graphs and the presence of one or more of the chest ra-

diographic features of patchy, segmental or lobar con-

solidation, +/- a positive air bronchogram and +/- pleural

effusion was used to confirm the diagnosis. The radio-

graphic findings were corroborated by at least one radi-

ologist. All subject recruitment was done at presenta-

tion. Children that had previously been recruited for the

study who re-present to the unit with symptom recrudes-

cence are excluded from the study.

Symptoms at presentation

Fever was present in 129 (77.2%) of the children, while

cough was present in 115 (68.9%) of the children as the

single most common respiratory symptom. Table 2

below shows other constitutional and respiratory symp-

toms that were present in patients recruited during the

study. The duration of symptoms at presentation ranged

from one day to 10 days. The duration of symptoms in

2

86

1

01(60.6%) children was of three or less days before

Table 4: Diagnosis by age groups

presentation, 46 (27.6%) children had symptoms for 4-7

days, while 20 (12.0%) had symptoms for 8 days or

more.

Variable

Age (months)

Bronchopneumonia

No (%)

LP

No (%)

BP + LP

No (%)

1

-<12

2- <60

90 (53.9%)

52 (31.1%)

9 (5.4%) 2 (1.2%)

6 (3.6%) 2 (1.2%)

Table 2: Symptoms at presentation

Variable

Frequency

%

Cumulative

%

>60

5 (3.0%)

0

1 (0.6%)

Constitutional symptoms

Fever

Bacteraemia in children with pneumonia

129

24

6

77.2

14.4

3.6

77.2

Diarrhoea

Vomiting

Rashes

Others (convulsion,

altered consciousness)

Respiratory symptom

Cough

Difficult breathing

Noisy breathing

Fast breathing

91.6

95.2

97.6

Forty-six (27.5%) children with pneumonia had positive

blood cultures, while 121 (72.5%) children had blood

cultures which yielded no growth. 39 (25%) of the 156

children with a full recovery from the pneumonia had

bacteraemia which compared with 7 (63.6%) of the 11

children with pneumonia who died had bacteraemia was

significant, p=0.011.

4

2.4

4

2.4

100.0

115

42

6

68.9

25.1

3.6

68.9

94.0

97.6

100.0

4

2.4

Organisms in children with pneumonia

Staphylococcus aureus was cultured from the blood of

1

1 (23.9%) out of the 46 (100.0%) children with posi-

tive culture. Klebsiella species was isolated in 8

17.4%); coliforms and coagulase negative staphylococ-

Physical Signs at presentation

(

Eight (4.8%) children had an axillary temperature re-

cus in 7 (15.2%) each; micrococcus and non-haemolytic

streptococcus were the least common yield, each present

in three (6.5%) isolates. A mixed growth was isolated in

o

cording of less than 36.5 C, 33 (19.8%) recorded tem-

o

peratures between 36.5 to 37.4 C, 70 (41.9%) between

o

3

7.5 and 38.5 C, while 56 (33.5%) children recorded

7

(15.2%) of the 46 patients with positive culture.

o

temperature readings of more than 38.5 C. Six (3.6%)

children were lethargic while two (1.2%) were irritable,

five (3%) were unconscious. Three (1.8%) children had

a maculopapular rash. Ninety-six (57.5%) of the chil-

dren were well hydrated, sixty-four (38.3) were dehy-

drated, and seven were unspecified. The respiratory

signs present include tachypnoea in 143 (85.6%), crepi-

tations in 154 (92.2%), thoracic recessions in 133

Complications/co-morbidities

A total of 60 (35.9%) cases developed one or more com-

plications. Heart failure was seen in 52 (86.7%) of the

6

3

0 children with one or more complications making

1.1% of the 167 subjects recruited. Five patients (3%)

each had pleural effusion and pneumothorax, 4 (2.4%)

had acute renal failure and all these patients had vomit-

ing and diarrhoea. Three (1.8%) had hypoglycaemia.

Eleven (73.3%) out of the 15 children with lobar pneu-

monia had pneumonia-related complications compared

to 46 (29.3%) of 157 children with bronchopneumonia,

p=0.003.

(

79.6%), nasal flaring in 134 (80.2%), and diminished

breath sounds in 89 (53.4%). These findings are shown

in table 3.

Table 3: Distribution of physical signs in children with

Pneumonia

Signs

Frequency (%)

Five (45.5%) of 11 children with lobar pneumonia with

complication had more than one pneumonia-related

complication which was significantly higher compared

to seven (15.2%) with more than one complication

among the 46 children with bronchopneumonia who had

pneumonia-related complication, p=0.045 (see table 5)

Co-morbidities in the children with pneumonia included

measles present in 4 (2.4%) children, underlying

congenital heart disease in 6 (3.6%) children, three of

whom had Down’s syndrome, and 11 (6.6%) had HIV

infection

Crepitations

Tachypnoea

Nasal flaring

Thoracic recessions

Diminished BS

Grunting

Abnormal percussion note

Central cyanosis

Tracheal deviation

Bronchial BS

154 (92.2%)

143 (85.6%)

134 (80.2%)

133 (79.6%)

89 (53.4%)

53 (31.7%)

29 (17.4%)

13 (7.8%)

7 (4.2%)

6 (3.6%)

69 (41.3%)

Hepatomegaly

Diagnosis

Bronchopneumonia accounted for 147 (88.0%), Lobar

pneumonia 15 (9%), and 5 (3%) had a combination of

bronchopneumonia and lobar pneumonia. The diagnosis

in study subjects is displayed below with respect to the

age group

2

87

Table 5: Complication based on type of pneumonia

Discussion

Type of pneumonia

Pneumonia is a leading cause of disease and death

among children worldwide and the greatest burden of

disease is in Und_,₂er Fives in developing countries, in-

Variable

Broncho-

pneumonia

N

LP

N

BP + LP

N

P

1

Complication

Present

Absent

No. of complication

One

More than one

cluding Nigeria. At the study site, pneumonia consti-

46

101

11

4

3

2

0.003

tuted close to 15% of all paediatric admissions through

the EPU over a 12 month period. Pneumonia affects the

extremes of life more than other age groups as was

documented in this study where two third of all patients

were infants and 80% were below 24 months. The

39

7

6

5

2

1

0.045*a

a: compares BP with a combination of LP and BP+LP

: Fischers Exact test

lowest three social classes were affected most by the

disease. These fin₃d_,₇in_,₁g₂s_,₁₆are in agreement with those of

*

previous workers.

It therefore means that

Outcome of pneumonia

measures for the control of pneumonia in childhood

must focus on the first four years of life.

A case fatality of 6.6% (11 deaths) was recorded in this

study. One hundred and fifty-six (93.4%) recovered

from the illness. Ten (90.9%) of the children that died

were male, while one (9.1%) was a female. Eight

72.7%) of the children that died were infants while the

remaining three (27.3%) were aged between 12 and 60

months.

In developing countries, the operational definition of

pneumonia adopted by WHO are based on easily recog-

nisable clinical parameters- signs and symptoms- and

(

5

,17,

The

said to be reliable for diagnosing the disease.

most frequent constitutional symptom in the current

study population was fever which was present in more

than three quarter of the cases. Diarrhoea was found in

Outcome based on diagnosis and presence of

complications

1

5% and this reflects₂t₀h_,₂e₁ immunologic nature of the gut

especially in children. The paucity of cases with rash

case definition for measles was used) was because of

(

A percentage mortality of 13.3% was recorded among

children with lobar pneumonia compared to the 6.1%

mortality recorded in those with bronchopneumonia.

The difference was not however statistically significant,

p=0.469 as shown in table 6.

A mortality of 13.3% was recorded in those with pneu-

monia-related complication compared to the mortality of

.8% recorded in those who had no pneumonia-related

the successful measles vaccination campaigns₂that domi-

2

nated the last three years before the study. this is in

contrast with the findings of earlier workers in Ibadan

who found measles to be a significant association in

8

pneumonia cases. Cough and difficulty in breathing are

the main respiratory symptoms documented. The main

respiratory signs were tachypnoea, nasal flaring, chest

wall recessions and crepitations. These clinical parame-

ters except for crepitations are indeed useful for diagno-

sis of pneumon₅_,i₁a₇ at all levels of health care in develop-

2

complication at presentation. This contrast was signifi-

cant statistically at p=0.018 as also seen below in table

6

.

ing countries.

The use of cough and difficult/fast

Table 6: Outcome based on diagnosis and presence of compli-

cations

breathing for identifying and treating or referring cases

at primary and secondary levels must be strengthened

using the Integrated₃management of childhood illnesses

Recovery

No (%)

Death

No (%)

Fisher exact derived

p-value

2

Parameter

(IMCI) guidelines. This will help reduce delays in

treatment/referral and also reduce complications.

Consequently, death and hospitalizations from pneumo-

nia will reduce. Furthermore, where adequate microbio-

logic support is not available, non-aetiologically proven

disease burden of pneumonia can be followed in devel-

oping countries using these clinical parameters. This is

indeed important as Nigeria moves to introduce Haemo-

philus influenzae and pneumococcal vaccines into the

routine immunization programme.

Diagnosis

Bronchopneumonia

Lobar pneumonia

BP + LP

Complication

Present

Absent

No. of complication

None

138(93.9)

13(86.7)

5(100.0)

9(6.1)

2(13.3)

0(0.0)

0.469

52(86.7)

104(97.2)

8(13.3)

3(2.8)

0.018

0.009

104(97.2)

42(89.4)

10(76.9)

3(2.8)

5(10.6)

3(23.1)

One

More than one

Duration of hospitalization among children with

Pneumonia

Bacteraemia was found in 27.5% of all cases and thi₂s₄_-i₂s₆

comparable to the findings of earlier workers.

Staphylococcus aureus, was the most commonly iso-

lated organism and this finding is similar to₈t_,h₁₆e findings

The overall mean duration of hospitalization among the

children with pneumonia was 6.8±5.8 days. The mean

duration of hospitalization among those who survived of

of earlier workers in Ilorin and elsewhere.

And to-

gether with Klebsiella species (these were not charac-

terised further because of laboratory constraints) these

two organisms formed more than 40% of the isolates.

Significant number of coliforms and coagulase negative

staphylococcus were also isolated. In contrast to some

6

.5 ±5.0 days was significantly lower than the

corresponding value of 10.2 ±12.3 days in those that

died, p= 0.042.

2

88

workers in Nigeria and other developing countries,

Streptococcus pneumoniae, Haemophilus influenzae,

Salmonella typhi and non-ty₆_,p₁₀h_,₁o₃i_,₂d₄a_,₂l₅_,s₂₇almonella were not

health care workers will ensure prompt treatment/

referral; hence reduce the chances of complications and

death. Sustainable and widely accessible immunization

programme that will control vaccine-preventable dis-

eases such as measles, tuberculossis and pertussis, as

well as the inclusion of Streptococcus pneumoniae and

Haemophilus influenzae antigens in the given vaccines,

will also see the prevention of diseases associated with

these organisms. The emergence of a Staphylococcus

aureus vaccine will be a welcome addition to the meas-

ures against pneumonia in the near future. There is a

need to improve the socioeconomic status of many fami-

lies in order to reduce the risk of disease. The need for

health systems strengthening in order to improve aetio-

logical diagnosis of pneumonia; institutionalize disease

surveillance, and monitor and supervise all control and

prevention activities cannot be overemphasized. It is

only with these approaches that pneumonia associated

mortality and morbidity can be averted.

documented in this study.

The absence of

two key organisms of pneumonia, Streptococcus pneu-

moniae and Haemophilus influenzae, from the isolates

profile is most likely a reflection of the limited micro-

biologic support for the isolation of these organisms at

the study site. However, extrapolated data from similar

settings referenced above provide evidence of the impor-

tance of these organisms in causing invasive childhood

diseases and pneumonia, and the need for collaboration

between study sites. Bacteraemia was associated with

increased mortality in the study population. This is more

a consequence of the major organisms isolated in this

study which result in severe disease.

Bronchopneumonia was the most common form of dis-

ease found in our patients and the most frequent compli-

cation in the group studied was heart failure. This is

5

, 11, 15-

consistent with the findings of other workers.

16

.Other potentially life-threatening complications seen

Authors contribution

in the cases were hypoglycaemia and renal failure in

patients who had diarrhoea and vomiting. Management

of patients with pre-renal renal failure and pneumonia

can present challenges with fluid therapy as adequate

renal perfusion needs to be achieved quickly. Pleural

effusion and pneumothorax were seen in a few cases.

The presence of complications was associated with sig-

nificantly higher morbidity and mortality and must be

managed at specialist centres. There were co-morbid

conditions in more than 10% of the cases. Measles, HIV

infection, congenital heart diseases with or without

Down’s syndrome were the associated conditions.

All authors contributed to the study protocol, data col-

lection, data analysis and the correspondence author did

the final draft of this paper.

Conflict of Interest: None.

Funding: None

Acknowledgement

All the consultants, residents and entire nursing staff of

the EPU are acknowledged. Dr. Oyinloye IO, consultant

radiologist is also acknowledged for his contribution.

Indeed authors are indebted to the parents who con-

sented to be part of this study

In Nigeria, the standard management plans to identify

and treat children must be followed to reduce the risk of

complications. Capacity building of different cadres of

References

1

.

WHO. Global under-five mortality

trend, 1980-2011 and gap for

achieving theMDG 4 target. Child

Health: World Health Organisa-

tion, 2012.

Aderele WI, Johnson AW. Pneu-

monias. In: Azubuike JC,

Nkanginieme KEO, eds. Paediat-

rics and Child Health in aTropical

Region. 2nd ed. Owerri: African

Educational Services; 2007:425-

4. Forgie IM, O’Neill KP, Lloyd-

7. Fagbule D, Parakoyi DB, Spiegel

R. Acute respiratory infections in

Nigerian children: Prospective

cohort study of incidence and case

management. J Trop Pediatr

1994;40:279-84.

Evans N, Leinonen M, Campbell

H, Whittle HC, et al. Etiology of

acute lower respiratory tract infec-

tions in Gambian children: I. Acute

lower respiratory tract infections in

infants presenting at the hospital.

Pediatr Infect Dis J 1991;10:33-

41.

5. Rudan I, Boschi-Pinto C, Biloglav

Z, Mulholland K, Campbell H.

Epidemiology and etiology of

childhood pneumonia. Bull Wld

Hlth Organ 2008;86:412-16.

6. Falade A, Mulholland E, Adegbola

R, Greenwood BM. Bacterial iso-

lates from blood and lung aspirate

cultures in Gambian children with

lobar pneumonia. Ann Trop Paedi-

atr 1997;17:315-19.

2

.

8.

Johnson A-W.B.R, Osinusi K,

Aderele W I, Gbadero DA, Olaleye

OD, Adeyemi-Doro F.A.B. Etio-

logic Agents and Outcome Deter-

minants of Community-Acquired

Pneumonia in Urban Children: A

Hospital-Based Study. Journal of

the National Medical Association

2008;100(april):370 -85.

4

1.

3

.

Forgie I.M, O’Neill K.P, Lloyd-

Evans N, Leinonen M, Campbell

H, Whittle H.C, et al. Etiology of

acute lower respiratory tract infec-

tions in Gambian children: II.

Acute lower respiratory tract infec-

tion in children ages one to nine

years presenting at the hospital.

Pediatr Infect Dis J 1991;10:42-7.

9.

Adegbola R.A, Falade A.G, Sam

B.E, Aidoo M, Baldeh I, Hazlett D,

et al. The etiology of pneumonia in

malnourished and well-nourished

Gambian children. Pediatr Infect

Dis J 1994;13:975-82

2

89

1

0. Graham SM, Molyneux EM,

Walsh AL, Cheesbrough JS, Moly-

neux ME, Hart C. Nontyphoidal

Salmonella infections of children

in tropical Africa Pediatr Infect

Dis J 2000;19:1189-96.

1. Victora C.G, Fuchs S.C, Flores

A.C, Fonseca W, Kirkwood BR

Risk factors for pneumonia among

Brazilian children in a metropoli-

tan area. Pediatrics 1994;93:977-

16. Fagbule D, Adedoyin MA, Nzeh

DA. Childhood pneumonia in the

University of Ilorin Teaching Hos-

pital. Nig J Paed 1987;14:73-78.

17. WHO. Acute respiratory infections

in children: case management in

small hospitals in developing

countries- a manual for doctors

and senior health workers. WHO/

ARI/90.5.1990:1-69

18. Ogunlesi TA, Dedeke IOF, Ku-

poniyi OT. Socioeconomic classi-

fication of Children attending spe-

cialist Paediatric Centres in Ogun

state, Nigeria. Nigerian Medical

Practitioner 2008; 54(1):21-25

19. Johnson WBR, Aderele WI, Osi-

nusi K, Gbadero D. Acute lower

respiratory infections in hospital-

ised urban pre-school Nigerian

children: a clinical overview. Afr J

Med 1994;23(2):127-38.

20. Ojuawo A, St Louis D, Lindley

KJ, Milla PJ. Non-infective colitis

in infancy: evidence in favour of a

minor immunodeficiency in its

pathogenesis. Arch Dis Child

1997; 76:345-348

21. Ojuawo A, Milla PJ, Lindley KJ.

Serum immunologlobulin and

immunoglobulin G subclasses in

children with allergic colitis.

24. Obaro S, Lawson L, Essen U, Ibra-

him K, Brooks K, Otuneye A,

Shetima D, Ahmed P, Ajose T,

Olugbile M, Idiong D, Ogundeji D,

Ochigbo C, Olanipekun G, Khalife

W, Adegbola R. Community ac-

quired bacteraemia in Young chil-

dren from central Nigeria. A pilot

study. BMC infect Dis. 2011;

11:137.

25. Falade AG, Lagunju IA, Bakare

RA, Odekanmi AA, Adegbola RA.

Invasive pneumococcal disease in

children aged <5years admitted to

3 urban hospitals in Ibadan. Clin

Infect Dis 2009; 1:48 suppl 2S190-

196

8

5.

2. Oyejide C, Osinusi K. Acute respi-

ratory tract infections in children

in Idikan community, Ibadan, Ni-

geria: Severity, risk factors and

frequency of occurrence. Rev Inf

Dis 1990;12:1042–46.

3. Berkley JA, Lowe BS, Mwangi I,

Williams T, Bauni E, Mwarumba

S, et al. Bacteremia among chil-

dren admitted to a rural hospital in

Kenya. N Engl J Med 2005;352:39

26. Falade AG, Ayede

AI.Epidemiology, aetiology and

management of childhood acute

community acquired pneumonia in

developing countries- a review.

Afr J Med Med Sci. 2011; 40(4):

293-308

27. Nielsen MV, Sarpong N, Krum-

kamp R, Dekker D, Loag W, Ame-

masor S, Agyekum A, Marks F,

Huenger F, Krefis AC, Hagen RM,

Adu-Sarkodie Y, May J, Schwartz

NG. Incidence and characteristics

of bacteraemia among children in

rural Ghana. PLoS ONE 7

-47.

4. Adedoyin OT, Johnson WBR,

Ojuawo A, Mokuolu OA, Ernest

SK, Abdulkarim AA, Adesiyun

OO, Adegboye OA, Adeboye

MAN, Afolabi JK, Bidmus RM,

Bello OA, Ayeni S. Distribution

of major cases and Major contribu-

tors to mortality at the department

of paediatrics, University of Ilorin

Teaching Hospital, Ilorin. Ilorin

Annual Paediatric Digest.

WAJM 1998; 17:205-209

(9):e44063.doi10.1371/

journal.pone.0044063

22. WHO. Global eradication of mea-

sles: report by the secretariat. Ge-

neva, Switzerland. 2010; 3-7.

available at http://apps.who.int/gb/

ebwha/pdf_files

23. WHO, UNICEF, Federal Ministry

of Health, Nigeria. Integrated

Management of CHildhood Illness.

Assess and Classify the sick child

2

010;188.

1

5. Araoye MO. Subjects Selection.

In: Araoye MO, editor. Research

methodology with statistics for

health and social sciences. 1st ed.

Ilorin: Natadex 2003:115 – 21.

2

months up to 5years. 2007; 7-14