Indian J Pediatr 1990; 57 : 533-535

Knowledge, Attitude and Practices Regarding Acute Respiratory Infections S.K. Kapoor, V.P. Reddaiah and G.V.S. Murthy*

Centrefor Community Medicine, All India Institute of Medical Sciences, New Delhi, *Department of Community Medicine, M.G.1.M.S., Sewagram, Wardha One hundred and six mothers in a rural area were interviewed to determine as to how they recognise pneumonia in children, what therapies they practice with mild acute respiratory illnesses and pneumonias and the feeding practices they adopt. Most mothers recognised pneumonia by noticing fast respiratory rate and difficulty in breathing. More severe cases were recognised by these signs among a higher percentage of mothers. As regards management of mild ARI episodes, more than half the mothers preferred not to give any treatment or use only home remedies. In pneumonias, a majority of them preferred to consult a qualified doctor. Nearly a third of them were of the opinion that they would take the child to hospital if the disease was severe. Regarding feeding practices, most of them stated that they would continue feeding, fluids and breast feeds. Only 10% desired to stop and another 15% would decrease the amounts.

Key Words " ARI, Pneumonia, Knowledge, Practice. Acute respiratory infections (ARI) are responsible for a lot of morbidity and mortality in under-fives. The number of deaths in children in the world due to respiratory infections is estimated to be 4 million} In India 15-25% of deaths in children are reported to be due to A R I ) An early recognition of pneumonia by mothers is important to initiate an early management and pre-

vent mortality. Most of the infections are treated by home remedies in the villages. The restriction on feeding the child can complicate the course of illness. This study was carried out to assess the knowledge, attitudes and practices of rural mothers to determine. (1)

the knowledge regarding recognition of pneumonia in children, (2) the practices regarding management of mild acute respiratory infections and pneumonias, (3) the attitudes to feed during pneumonias.

Reprint requests : Dr. V.P. Reddaiah, Additional Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi-110 029. 533


Vol. 57, No. 4


The mothers were interviewed by a doctor who visited the villages while supervising the workers. The responses were recorded on a pretested proforma. The only criteria was that the respondent had children below five years and not necessarily had a recent attack of ARI in her children. Respiratory rate of more than 50 per minute in a child having symptoms of cough, cold or fever singly or in combination is the criteria for pneumonia. Where as in a child with pneumonia, presence of chest indrrawing, cyanosis, loss of consciousness, inability to drink water and convulsions suggests severe pneumonia. RESULTS Table I presents the responses to the question as to how the mothers recognise pneumonia and severe pneumonia in underfives. Majority of them stated increased respiratory rate (59.4%) and difficulty in breathing (43.4%) as important signs. Other less common signs described were noises from the chest (23.4%) high fever (11.3%) excessive crying (11.3%), nasal flare (8.5%), cough (7.5%), blocked chest (3.8%). Increased respiratory rate (81.1%), difficulty in breathing (66.0%), crying with pain in chest (45.3%), chest indrawing (35.8%) and noises from the chest (29.2%) are the most common signs for recognising the severe episodes by mothers. Management of ARI by mothers is presented in Table 2. Management of mild ARI (cough and cold) is done using home remedies by 51.9% of the mothers; small number (8.5%) responded that no treatment was required. There were 44.3% who preferred to take the advice of a doctor. Treatment of pneumonia was done as

T~r~ 1. Mothers' Recognition of Pneumonia and Severe Pneumonia (%) Symptoms


Severe pneumonia

1. Increased resp/ratory rate



2, Difficulty in breathing








29 2,

6. Bad cough



7. High fever




Excessivecrying with chest pain

4. Chest indrawing 5. Noises from chest

8. Inability to drink


9. Nasal flare


10. Blocked chest



11. Cough



12. Running nose


13. Doctor



14. Do not know



15. Blocked nose



T~ts 2. Treatment of ARI Preferred by Mothers

Type of treatment

Cough Pneu- Severe cold monia pneumonia J

Home treatment



2.8 0.9 11.9









N o treatment


Cough syrup As advised by doctor R.M.P. Went to hospital


advised by the doctor was stated by 92.5% of the women. But those who would go to hospital constituted 25.5% whereas 70:8% would do as advised by the doctor in ease of severe pneumonia. Regarding breast feeding, 89.6% mothers said they would continue whereas 10.4% said they would stop it. When asked regarding the feeding (other than breast feeding) during the attack of pneumonia, 74.5% said they would continue, 15.1% would reduce and 8.5% would stop food. Similarly 72.6% would continue giving fluids as before. But 10.4% said that they would stop whereas 16.0% would reduce. DISCUSSION The observation that many mothers recognised pneumonia by rapid respiratory rate (59.4%) and difficulty in breathing (43.4%) indicates that mothers were fairly certain when their child had penumonia. These two signs accounting for 81% and 66% respectively in severe pneumonia emphasises the fact that mothers were able to identify moderate and severe pneumonia reasonably well. Though chest indrawing was a criteria for severe pneumonia only 35.8% mothers recognised it. Crying with chest pain was offered as a sign in severe eases by 45.3%. Kumar et aP described in their study that rapid breathing was recognised by 23.8% mothers but breathing difficulty by 57.4%. This reveals that there are differences in recognising pneumonia or severe pneumonia and there is a need for educating the community regarding the criteria for recognition of severity. As regards the management of mild ARI, more than 50% said they would provide home treatment. This is acceptable as mild ARI does not need any treatment. In


case o f pneumonia and severe pneumonia, 92.5% and 70.8% stated that they would follow the advice of the doctor. They preferred a Registered Medical Practitioner available locally, whereas 25.5% said that they would take the child to the hospital if they considered the episode to be severe. This is a very healthy practice as these cases need hospitalization. A good attitude was observed regarding feeding of children during pneumonia. There were more than 70% who would continue feeding which was in contrast to the findings of Kumar et al.3 However, emphasis on continuing feeding during sickness needs to be laid in health education programmes. Regarding breast feeding only 10.4% claimed restriction which was far less than that reported by Kumar et al. 3

On the whole the study shows that the majority of mothers in this area have a fairly good knowledge regarding recognition of pneumonias and follow healthy practices for their management. But education programmes have to be carried out to further improve the status. ACKNOWLEDGEMENTS The authors thank the Indian Council of Medical Research, New Delhi, for the grant received as part of a multicentric study. REFERENCES

1. Herzu Leowski. Mortality from acute respiratory infections in children under five years of age : Global estimates. World Health Star Q 1986; 39 : 138-144. 2. Office of the Registrar General, India, Survey of cause of deaths (Rural) Annual Report. 1985. Series No. 18. 3. Kumar V, Kumar L, Mand Met al. Child care practices in the management of acute respiratory infections, hzdian Pediatr 1984; 21 : 15-20.

Knowledge, attitude and practices regarding acute respiratory infections.

One hundred and six mothers in a rural area were interviewed to determine as to how they recognise pneumonia in children, what therapies they practice...
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