title: Severe pneumonia in a remote hilly area: integrated management of childhood illness.
abstract: OBJECTIVE
  This study aims to profile children with severe pneumonia in the perspective of Integrated Management of Childhood Illness (IMCI) strategy in a resource-constrained environment.
  
  
  METHODS
  115 consecutive children, aged 2 months to 10 yr, hospitalized with severe pneumonia were prospectively evaluated between May 1997 and June 1998 at a civil hospital in the northern hilly state of India.
  
  
  RESULTS
  All children had tachypnea and lower chest wall indrawing. Grunting was observed in 39.7%, inability to drink in 16.5%, and cyanosis in 1.7% cases. Radiological investigation was carried out only in 90 children that included abnormal chest radiographs (CXRs) in 76.6% cases. Feeding malpractices, vaccination inconsistencies, exposure hazards to smoking, micronutrient as well as macronutrient deficiencies, treatment from unqualified practitioners, inconsequential involvement of health care workers, predominant burden on mothers in the care of sick children, failure to recognize signs and symptoms of pneumonia by parents at home, lack of oxygen facilities, problems of accessibility and less faith on primary health care services were widely prevalent bottlenecks for effective implementation of 3 components of IMCI.
  
  
  CONCLUSIONS
  Our study offers practical insights that can be useful in customizing IMCI to needs of children with pneumonia in a resource-constrained environment.
authors.affiliation: Civil Hospital, Rohru, District Shimla, Himachal Pradesh, India. bhavneetb@yahoo.com
authors.forename: Bhavneet
authors.initials: B
authors.lastname: Bharti
authors.forename: Sahul
authors.initials: S
authors.lastname: Bharti
authors.forename: Vandna
authors.initials: V
authors.lastname: Verma
mesh_terms: D002648:Child; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated; D003710:Demography; D005260:Female; D015276:Health Care Rationing; D006760:Hospitalization; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors