Introduction A major priority and challenge in children less than the age of five years old in Africa is the decreasing rate of acute respiratory infection. To have a better understanding of this children in Kibera, a densely populated urban slum in Kenya, are being surveillance for Severe Acute Respiratory Illness (SARI). The research required a surveillance of 5,874 children less than the age of five years old in two neighboring villages in Kibera, these participants had free access to study clinics and utilization were noted during biweekly home visits. The main goal for the researchers in this clinical study was to characterize the major respiratory viral pathogens in children that leads to the cause of SARI.
Background
Severe acute respiratory syndrome (SARS) is caused by a previously unknown coronavirus, now called SARS-associated coronavirus (SARS-CoV). Coronavirus infections are very common and occur worldwide. The incidence of infection is strongly seasonal, with its greatest incidence among children in winter, adult infections are less frequent. Coronaviruses can occasionally cause more severe disease, such as pneumonia, but this is rare. In fact, before SARS was discovered, the human coronavirus previously known were only associated with mild diseases. SARS-related CoV seems to be the first coronavirus that regularly causes potentially fatal illness in humans. The SARS virus is very hardy and can survive in the environment without being inside a host for several hours, majority of viruses have usually short lives when not attached to a living cell. SARS is a communicable disease and a very contagious one that can have fatal consequences. The main transmission of spread of SARS is close person-to-person contact, primarily through the respiratory droplets an infected person produces when he or she coughs or sneezes. Since the 2003 SARS outbreak, virologists and epidemiologists have not been idle. They have unlocked a partial genome of this coronavirus, based on a sequence of the SARS coronavirus replicase gene. The polymerase chain reaction (PCR) technique is a test that can detect viral genetic material; in SARS patients, it can identify the SARS-CoV in tissue samples from patients. Now that doctors know what viral material to look for in possible SARS cases, presence of the virus can be confirmed more rapidly, instead of administering several tests, as was needed when SARS was first discovered.
Materials and Methods There are many different clinical methods the researchers used when trying to identify different pathogens in their patients that either have SARI or are symptomatic to it. The site of study for this research was conducted in Kibera, an impoverished informal settlement in Nairobi, Kenya. Specifically two villages, Gatwikera and Soweto West, were offered enrollment in this study. With the combination of both villages, they accumulated 5,874 children under the age of five years old to be in this trial. As of March 1, 2007, all enrolled participants received free medical care for acute illnesses from the localized clinic. This clinic sees between 90 and 200 out-patients per day and acknowledges all patients that require hospitalization. The clinic based its patients that had SARI by these signs and symptoms: unable to drink/breastfeed, vomits everything, convulsions, lethargic or unconscious, stridor when calm, lower chest wall in drawing, and if oxygen saturation is less that ninety percent. Blood cultures, nasopharyngeal, and oropharyngeal swabs were collected from SARI cases. After the patients complete the clinic surveillance step, they then undergo household surveillance checkups. It involves the participants to answer a standardized questionnaire every two weeks about recent illnesses and to those participants that show symptoms then have to be examined thoroughly by the interviewer. These household symptoms are identified as coughing or difficulty breathing with either chest in drawing or