Study Design: Cross sectional, observational, clinic based study.

Study Setting: Immunization clinic under aegis of the Department of Community Medicine, Calcutta National Medical College and Hospital.

Study Population: Under-5 children attending the Immunisation Clinic(exclusion criteria-children below 6 months).

Study Duration: 6 months (01/07/2005-31/12/2005).

Sampling: a) Sampling size determination-Since the incidence of ARI in a developing country like India is approximately 20%, the required sample size using the formula -4pq/lXl works out to be 1600 where p= prevalence rate ie, 0.2, q= 1-p ie, 0.8 and l= maximum allowable rate =10% of p. Since the study period was short, I collected the data of 264 children attending the Immunisation Clinic ie, 16.5% of the total sample size.

Method of Sampling: All the children under 5 years of age attending the Clinic were listed in the OPD register from which every alternate child was chosen by simple random sampling.

Tools and technique: The basic tools of the study were A pre-designed questionnaire. The Immunisation Card of the children. The techniques employed included- An interview of the person accompanying the child, preferably the mother . Viewing of the health records of the child.

Terms and definitions: 'Absence of separate kitchen' implies that cooking is done in living space. 'Absence of smoke outlet' means the lack of chimney exhaust or ventilator in the house. Socio-economic status of the family was assessed using the Inflation Rate Adjusted Modified Kuppuswamy Scale used in India for the purpose.

Limitations of the study: 1) As it was a hospital based study, the original ARI status in the urban community could not be assessed. 2) As the duration of study was short, many of the factors that may have influence on ARI could not be considered. 3) As it was a cross-sectional study, during its short span seasonal variation in incidence of ARI could not be considered. 4) The type of ARI and its severity ie, pneumonia or not could not be ascertained as the informants(mostly mothers of the children) were not aware of the clinical signs important to mark pneumonia and 'no pneumonia'. 5) Statistical tests of significance were not conducted on the data collected and so the associations shown in the study are only apparent associations. 6) As data was collected about the attacks of ARI during the last 6 months, which is an extensive period of time, the chance of recall bias was present in the study.

Figure 1

Table 1: Age and Gender distribution of study population according to ARI status

Interpretation: From Table I it is evident that within the study population, age specific attack rate of ARI decreased with increasing age of the child in both sexes and the worst sufferers were in the age group 6-11 months in both sexes, but considering all the age groups, sex specific attack rates were more in males than in females.

Figure 2

Table 2: Distribution of study population according to religion and their ARI status.

Interpretation: From Table II it was seen that attack rate of ARI was maximum among Muslim children, followed by Hindus and much lower attack rate among Christian children.

Figure 3

Table 3: Distribution of study population according to no. of family members and ARI Status

Interpretation: From Table III it is evident that apparently there is a gradual increase in attack rate of ARI with increase in the no. of family members. Combined with the constraints of the living area, it translates into a fact that gradually increasing overcrowding predisposes to ARI.

Figure 4

Table 4: Distribution of study population according mother's education status and their children's ARI status

Interpretation: From table IV it is evident that attack rate of ARI in children of illiterate mothers was the highest and it decreased gradually with increasing educational status of the mother.

Figure 5

Table 5: Distribution of study population according to socio-economic status in relation to ARI

Interpretation: From Table V we observe that lower the socio-economic status, higher was the attack rate of ARI.

Figure 6

Table 6: Distribution of study population according to type of fuel used and ARI status

Interpretation: Attack rate of ARI was least with electric oven and highest with coal oven.

Figure 7

Table 7: Distribution of study population according to some relevant socio-economic status and their ARI rates

Interpretation: Indoor smoking caused more ARI as did absence of separate kitchens.

Figure 8

Table 8: Distribution of study population according to child rearing factors and their and their ARI status

Interpretation: Absence of exclusive breast feeding, complete immunization, and weaning at younger age predisposed to greater attack rates of ARI

Summary

A cross-sectional observational study was undertaken among the under-5 children attending the immunization clinic at Calcutta National Medical College and Hospital with the objective of estimating the attack rates of ARI in those children. The study also attempted to seek out the relation of different socio-economic, environmental and cultural factors on occurrence of ARI . Data was collected from 264 children and analyzed as

1) Age specific attack rates of ARI decreased with increasing age of the children. Among all age groups, sex specific attack rates were more in males.

2) Crowding with increasing number of family members tended to predispose to ARI.

3) Increased educational status of the mother appeared protective.

4) Lower socioeconomic status appeared conducive to ARI.

5) Increased smoke from cooking or smoking made attacks of ARI more common.

6) Child rearing factors like exclusive breast feeding and complete immunization apparently protected from ARI attacks.

7) Among followers of different religious practices, Muslims had highest no. of attack rates among their children.

What this paper adds: Apparent associations of ARI in the Under 5 children in an Urban setting of India, and introduces a line of thought as regards how to circumvent them.

Health policy implications: Existing health policy shortcomings and ways to improve the shortcomings.