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Patterns of acute respiratory tract infection in children: a longitudinal study in a depressed community in Metro
T E Tupasi1, L E de Leon, S Lupisan
1Tropical Disease Foundation, Makati Medical Center, Manila, Philippines.
Insights
High rates of acute respiratory infections (ARIs) and deaths occur in young children in urban Manila. Malnutrition, crowding, and parental smoking increase ARI risk, highlighting the need for socioeconomic improvements.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute respiratory infections (ARIs) pose a significant health burden on children globally.
- Depressed urban communities often face unique challenges contributing to higher disease incidence.
Purpose of the Study:
- To determine the incidence and mortality rates of ARI and ALRI in children under 5 in urban Manila.
- To identify risk factors and common pathogens associated with these infections.
Main Methods:
- Prospective study in a depressed urban community.
- Surveillance of ARI and ALRI incidence and mortality.
- Identification of viral and bacterial pathogens.
Main Results:
- ARI incidence was 6.1 and ALRI incidence was 0.5 per child-year.
- Peak incidence for ARI and ALRI occurred in children aged 6-23 months and 6-11 months, respectively.
- Risk factors included young age, malnutrition, crowding, and parental smoking. Mortality rates were significant, with RSV, S. pneumoniae, H. influenzae, and S. aureus being key pathogens.
Conclusions:
- High ARI and ALRI morbidity and mortality persist in young children in this urban setting.
- Inadequate housing, poor health access, and malnutrition facilitate pathogen transmission.
- Socioeconomic improvements are crucial to reduce the burden of respiratory infections.
Abstract:
The incidences of acute respiratory tract infection (ARI) and acute lower respiratory infection (ALRI) were 6.1 and 0.5 per child-year, respectively, in children less than 5 years old in a depressed urban community in Manila. The peak age-specific incidence occurred in those children 6-23 months old for ARI and 6-11 months old for ALRI. Age less than 2 years, malnutrition, household crowding, and parental smoking were associated with a statistically significant, though modest, increase in ARI morbidity. The crude mortality rate was 14.3 per 1,000 children 0-4 years old, with a corresponding ARI-specific mortality rate of 8.9 per 1,000. The prevalence of viral infection was 32.8 and that of bacteremic ALRI was 6.7 per 1,000 children with moderate ALRI. Respiratory syncytial virus was the predominant viral pathogen, while Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus were the most frequently isolated bacterial pathogens. Transmission of respiratory pathogens in depressed communities, facilitated by inadequate housing, inaccessible health services, and prevalent malnutrition, will continue unless meaningful socioeconomic improvement is realized.