Acute respiratory infections (ARI) were monitored every two weeks in an urban community in Metro Manila, Philippines, to determine the incidence and risk factors for ARI morbidity. Hospitalized children with acute lower-respiratory-tract infection (ALRI) were studied to determine case-fatality rates (CFR) and predictors for mortality. Incidence rates were highest in infants, 3.2-4.0 per person, followed by children one to four years of age, with corresponding rates of 3.0-3.4 per person. The risk factors for ARI morbidity were low socioeconomic status and age less than one year. A CFR of 5% in children with ALRI was observed. Malnutrition and a positive culture of blood were significant risk factors for mortality. These identified risk factors underscore the value of primary health care interventions, such as the standard ARI case management, immunization, health education, promotion of breast-feeding, and vitamin A supplementation, as strategies for reducing ARI mortality in developing countries.

An epidemiological study of acute respiratory infection (ARI) in an urban community showed poor utilization of available health services. This prompted us to undertake this study to identify determinants of child care practices of mothers through a focus group discussion and survey of the knowledge, attitudes and practices of mothers. The results will form the basis of appropriate health education strategy geared towards control of ARI. They showed that, generally, the mothers were unable to recognize a severe infection. Poor diagnostic ability compounded by a limited knowledge of the appropriate management of varying types or degrees of ARI resulted in inappropriate action. Consequently, there was a high rate of self-medication and a low rate of health service utilization. In addition, there was low compliance with childhood immunizations. With these limitations in the mother's knowledge and practices, an education programme utilizing an informative print material was devised to upgrade the mother's ability to recognize signs of ARI and to improve her management of the condition.

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SummaryThis paper describes local understandings of illness and documents treatment-seeking behaviour in Tayabas, Quezon, The Philippines. Data were collected using focus group discussions and narrative interviews with adults, and with mothers of children, who had had confirmed malaria during a two-month surveillance period. Signs and symptoms of malaria are important in directing individual diagnosis, treatment-seeking and therapy. Household therapy with antimalarials, and more commonly antipyretics and herbs, as used before seeking care from either the formal or informal sector. Care outside the home was sought where symptoms continued and/or worsened, with an average period of time from onset of symptoms to presentation to a clinic of six days. Accessibility to clinics is not a problem in the study area and hence the primary reason for delay was propensity to self-treat first and to discontinue medication when feeling better. These factors affect the control of malaria and the potential to reduce transmission. Better advice to the community regarding the importance of diagnosis and compliance with antimalarial therapy is indicated.keywords The Philippines, malaria, local knowledge, health seeking behaviour, reduce transmission

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