Contribution of Peak Expiratory Flow as a Complementary Respiratory Assessment Tool in Children Aged 5 to 14 Years in the Kamina Health Zone: A Resource-Limited Setting

Introduction: Acute respiratory infections (ARIs) remain a significant cause of childhood morbidity in resource-limited settings. In the Kamina Health Zone of the Democratic Republic of the Congo, where a large proportion of the population lives in poverty and has limited access to specialized diagnostic services, the early identification of ARIs is a major challenge. Peak expiratory flow (PEF), a simple, rapid, and inexpensive tool, could be a useful complement to clinical assessment. This study evaluated the contribution of PEF to the identification of ARIs in children aged 5 to 14 years. An Acute Respiratory Infection (ARI) is defined by the presence of at least two of the following symptoms occurring within the 14 days prior to the investigation: cough, rhinorrhea, difficulty breathing, odynophagia or reported/measured fever. Une acute upper respiratory infection is an infection limited to the upper airways (rhinorrhea, nasal congestion, sore throat, earache, without signs of distress or pulmonary rales), while lower respiratory infection is an infection of the lower airways characterized by the presence of polypnea (respiratory rate > 25 to 30 cycles/min depending on age), intercostal retractions, abnormal lung auscultation (crackles, wheezes) or deep productive cough. Methods: A cross-sectional study was conducted with 283 children aged 5 to 14 years. Sociodemographic, clinical, and anthropometric data were collected, as well as peak expiratory flow (PEF) measurements obtained using a peak flow meter. A descriptive analysis was performed, followed by multivariate logistic regression to identify factors associated with the occurrence of acute respiratory infections (ARIs). Results are expressed as adjusted odds ratios (aORs) with their 95% confidence intervals. Results: The children were predominantly aged 9 to 14 years (65.4%) and male (53.7%). A recent acute respiratory infection was reported in 91.5% of participants, with a predominance of upper ARIs (76.7%). PEF was mainly between 100 and 200 L/min (84.1%). The test proved feasible, with 98.9% of measurements obtained on the first attempt. Multivariate analysis showed no significant association between PEF and the occurrence of ARI (ORa = 1.38; 95% CI: 0.55 - 3.45; p = 0.490). Similarly, sex, age, and anthropometric parameters were not significantly associated with the occurrence of ARI (p > 0.05). In contrast, PEF was significantly associated with growth variables, including age, weight, and height. Conclusion: Peak expiratory flow (PEF) is a feasible and well-accepted tool in children, but it is not a diagnostic marker for acute respiratory infections (ARIs). Its variations are primarily influenced by growth parameters. In resource-limited settings, it represents a useful complementary tool for respiratory function assessment, but it has no independent diagnostic value for ARIs.