title: Community-acquired pneumonia in children: quantifying the burden on patients and their families including decrease in quality of life.
abstract: OBJECTIVE
  Childhood respiratory infections have an important impact on society and are a frequent cause of physician visits, consumption of antibiotics and over-the-counter drugs, work loss, and reduction of quality of life. The aim of this study was to assess the burden of community-acquired pneumonia (CAP) on children and their families, including quantification of expenses and decrease in quality of life.
  
  
  METHODS
  Patients <3 years old with pneumonia were enrolled in 3 sites in southern Israel: pediatric wards, the pediatric emergency department, and a primary health clinic. In the primary health clinic, the diagnosis was based on clinical judgment, and in the hospital the diagnosis was based on the World Health Organization Standardization of Interpretation of Chest Radiographs for the diagnosis of CAP in children. Data regarding the children's medical history and various aspects of direct and indirect burden were gathered every 2 to 3 days during the 29 days of follow-up. The patients' parents were asked to give the names of 2 healthy children who could serve as controls from among the child's friends, neighbors, or day care center attendees.
  
  
  RESULTS
  Two-hundred thirteen children with pneumonia were enrolled: 34 (16.0%) in the pediatric wards, 73 (34.2%) in the pediatric emergency department, and 106 (49.8%) in the primary pediatric clinic. The control group consisted of 99 children. During the 29 follow-up days, hospitalized children had the most severe and prolonged symptoms, followed in decreasing order by children seen at the emergency department, primary health clinic, and controls: The mean +/- standard deviation (SD) of febrile days was 4.9 +/- 2.8, 4.8 +/- 3.1, 3.3 +/- 2.5, and 1.4 +/- 3.3, respectively (statistically significant between any patient group and the control group). The mean duration of respiratory distress +/- SD was 3.8 +/- 5.6, 2.8 +/- 4.4, 2.2 +/- 4.4, and 0.4 +/- 1.8 days, respectively (statistically significant between any patient group and the control group). The median duration of nonroutine days as judged by the parents was 13, 8, 7, and 0, respectively. The mean number of workdays lost by working mothers +/- SD was 4.2 +/- 4.8, 2.0 +/- 2.6, 1.7 +/- 1.9, and 0.2 +/- 0.9, respectively (between any patient group and the control group). The quality-of-life-questionnaire analysis reveals statistically significant differences with regard to all 11 questions asked between any of the patient groups and the control group. There was a clear trend toward decreasing quality of life from the control group to the primary health clinic, pediatric emergency department, and pediatric wards groups.
  
  
  CONCLUSIONS
  CAP in children causes a significant burden on both patients and their families, including substantial expenses, loss of routine, and decrease in quality of life.
authors.affiliation: Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shoham
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.forename: Zvika
authors.initials: Z
authors.lastname: Liss
authors.forename: Tomer
authors.initials: T
authors.lastname: Shagan
authors.forename: Orly
authors.initials: O
authors.lastname: Zamir
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
mesh_terms: D017028:Caregivers; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000191:economics; D017281:Cost of Illness; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D016524:Parental Leave / Q000706:statistics & numerical data; D011014:Pneumonia / Q000191:economics; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires