Abstract
Objectives: Risk factors for acute respiratory infections (ARIs) in community settings are not fully understood, especially in low-income countries. We examined the incidence and risk factors associated with ARIs in under-two children from the Microbiota and Health study.Methods: Children from a peri-urban area of Dhaka (Bangladesh) were followed from birth to 2 years of age by both active surveillance of ARIs and regular scheduled visits. Nasopharyngeal samples were collected during scheduled visits for detection of bacterial facultative respiratory pathogens. Information on socioeconomic, environmental, and household conditions, and mother and child characteristics were collected. A hierarchical modeling approach was used to identify proximate determinants of ARIs.Results: Of 267 infants, 87.3% experienced at least one ARI episode during the first 2 years of life. The peak incidence of ARIs was 330 infections per 100 infant-years and occurred between 2 and 4 months of age. Season was the main risk factor (rainy monsoon season, incidence rate ratio [IRR] 2.43 [1.92–3.07]; cool dry winter, IRR 2.10 [1.65–2.67] compared with hot dry summer) in the first 2 years of life. In addition, during the first 6 months of life, young maternal age (<22 years; IRR 1.34 [1.01–1.77]) and low birth weight (<2,500 g; IRR 1.39 [1.03–1.89]) were associated with higher ARI incidence.Conclusions: Reminiscent of industrialized settings, cool rainy season rather than socioeconomic and hygiene conditions was a major risk factor for ARIs in peri-urban Bangladesh. Understanding the causal links between seasonally variable factors such as temperature, humidity, crowding, diet, and ARIs will inform prevention measures.
Highlights
Acute respiratory infections (ARIs) are a primary cause of morbidity worldwide [1] and a major cause of child mortality in the developing world
The goal of the present analysis is to examine a wide range of potential risk factors, including socioeconomic, environmental, WASH, and maternal and perinatal variables, employing an analytical hierarchical approach to identify the most likely causal links to ARI incidence
Around 40% of the ARI episodes were associated with fever (Supplementary Figure 3)
Summary
Acute respiratory infections (ARIs) are a primary cause of morbidity worldwide [1] and a major cause of child mortality in the developing world. Short duration of, breastfeeding is the risk factor considered universally important [6, 7]; the highest impact has been reported for low-resource settings, more severe infections (LRTI), and in youngest children (0–6 months) [8,9,10]. In countries such as Bangladesh that have successfully ameliorated mortality and morbidity due to diarrhea [11], the relative burden of ARIs has been growing [1]. It could be hypothesized that the epidemiology and risk factors for ARIs may be rapidly changing and require reexamination
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