A sample of 153 children was drawn from a teaching hospital in Säo Paulo, Brazil. It comprised 51 pneumonia cases and equal number of non-respiratory and healthy controls matched by age and sex. Age ranged from 1 month to 7 years. They were all submitted to a standard protocol to investigate clinical symptoms and signs, and diagnosis of pneumonia was supported by X-ray images. Univariate data analysis contrasting pneumonia and non-pneumonia subjects suggested that the best pneumonia indicators would be chest auscultation, history of breathlessness, history of cough, chest in-drawing and fast respiratory rate, in descending order. A multivariate approach including also data from X-ray investigation was then tried with the application of multiple discriminant analysis to study the separation of pneumonia cases, non-respiratory patients and healthy children. It revealed that when many items of information are considered the performance of individual symptoms and signs change. The best predictors of pneumonia were then identified as chest in-drawing, chest auscultation, X-ray, history of breathlessness and toxaemia. Clinical symptoms taken all together contribute more than signs and equal X-ray in importance. Accordingly, it is concluded that any attention to X-ray should be secondary to clinical investigation, and it is suggested that the WHO's guidelines could profit with the inclusion of at least one clinical symptom, namely history of breathlessness which was found more useful than the WHO recommended breath count.

VOLUME 33 NÚMERO 4 AGOSTO 1999© Copyright Faculdade de Saúde Pública da USP. Proibida a reprodução mesmo que parcial sem a devida autorização do Editor Científico. Proibida a utilização de matérias para fins comerciais. All rights reserved. Morbidity information is easily available from medical records but its scope is limited to the population attended by the health services. Information on the prevalence of diseases requires community surveys, which are not always feasible. These two sources of information represent two alternative assessments of disease occurrence, namely demand morbidity and perceived morbidity. The present study was conceived so as to elicit a potential relationship between them so that the former could be used in the absence of the latter. Methods A community of 13,365 families on the outskirts of S. Paulo, Brazil, was studied during the period from 15/Nov/1994 to 15/Jan/1995. Data regarding children less than 5 years old were collected from a household survey and from the 2 basic health units in the area. Prevalence of diseases was ascertained from perceived morbidity and compared to estimates computed from demand morbidity. Revista de Saúde Pública ResultsData analysis distinguished 2 age groups, infants less than 1 year old and children 1 to less than 5. The most important groups of diseases were respiratory diseases, diarrhoea, skin problems and infectious & parasitical diseases. Basic health units presented a better coverage for infants. Though disease frequencies were not different within or outside these units, a better coverage was found for diarrhoea and infectious & parasitical diseases in the infant group, and for diarrhoea in the older age group. Equivalence between the two types of morbidity was found to be limited to the infant group and concerned only the best covered diseases. The odds of a disease being seen at the health service should be of at least 4:10 to ensure this equivalence. ConclusionIt was concluded that, provided that health service coverage is good, demand morbidity can be taken as a reliable estimate of community morbidity.

OBJECTIVE: A case-control study of patients with pneumonia was conducted to investigate whether wheezing diseases could be a risk factor. METHODS: A random sample was taken from a general university hospital in S. Paulo City between March and August 1994 comprising 51 cases of pneumonia paired by age and sex to 51 non-respiratory controls and 51 healthy controls. Data collection was carried out by two senior paediatricians. Diagnoses of pneumonia and presence of wheezing disease were independently established by each paediatrician for both cases and controls. Pneumonia was radiologically confirmed and repeatability of information on wheezing diseases was measured. Logistic regression analysis was used to identify risk factors. RESULTS: Wheezing diseases, interpreted as proxies of asthma, were found to be an important risk factor for pneumonia with an odds ratio of 7.07 (95%CI= 2.34-21.36), when the effects of bedroom crowding (odds ratio = 1.49 per person, 95%CI= 0.95-2.32) and of low family income (odds ratio = 5.59 against high family income, 95%CI= 1.38-22.63) were controlled. The risk of pneumonia attributable to wheezing diseases is tentatively calculated at 51.42%. CONCLUSION: It is concluded that at practice level asthmatics should deserve proper surveillance for infection and that at public health level pneumonia incidence could be reduced if current World Health Organisation's guidelines were reviewed as to include comprehensive care for this illness.