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Published on: August 30, 2014
Mortality Associated With Acute Respiratory Infections Among Children at Home
Mauricio T Caballero1, Alejandra M Bianchi1, Alejandra Nuño2
1Fundacion INFANT, Argentina.
Insights
Social factors like crowding and lack of water increase home deaths from acute respiratory infections (ARIs) in children under five. High infant mortality from RSV and influenza at home highlights the need for interventions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Home deaths in children under five are common in developing nations.
- Acute respiratory infections (ARIs) are a significant contributor to child mortality.
- Risk factors and specific pathogens associated with fatal home ARI episodes are not well understood.
Purpose of the Study:
- To identify risk factors for home deaths due to ARI in low-income children under five.
- To determine the viral pathogens responsible for fatal home ARI episodes.
- To analyze social vulnerabilities contributing to child mortality from ARI.
Main Methods:
- A case-control study was conducted in Buenos Aires, Argentina.
- The study included 104 deceased children and 174 healthy controls, all under five years old.
- Data collected included home environment, maternal factors, vaccination status, and healthcare utilization during illness.
Main Results:
- Home deaths from ARI disproportionately affected infants under 12 months (87.5%).
- Significant risk factors for home ARI death included crowded housing, adolescent mothers, lack of running water, incomplete vaccinations, NICU admission, and no emergency visit.
- At-home infant mortality rates were 0.26/1000 live births for RSV and 0.07/1000 live births for influenza.
Conclusions:
- Social vulnerabilities are key drivers of at-home mortality from ARIs in young children.
- Infant mortality rates from respiratory syncytial virus (RSV) and influenza at home are substantial and comparable to hospitalized children.
Background:
Numerous deaths in children aged <5 years in the developing world occur at home. Acute respiratory infections (ARIs) are thought to play an important role in these deaths. Risk factors and pathogens linked to fatal episodes remain unclear.
Methods:
A case-control study among low-income children aged <5 years was performed in Buenos Aires, Argentina, to define risk factors and viral pathogens among those who died of ARI at home.
Results:
A total of 278 families of children aged <5 years (of whom 104 died and 174 were healthy controls) participated in the study. A total of 87.5% of ARI-associated deaths occurred among infants aged <12 months. The estimated mortality rate due to ARI among infants was 5.02 deaths/1000 live births. Dying at home from ARI was associated with living in a crowded home (odds ratio [OR], 3.73; 95% confidence interval [CI], 1.41-9.88), having an adolescent mother (OR, 4.89; 95% CI, 1.37-17.38), lacking running water in the home (OR, 4.39; 95% CI, 1.11-17.38), incomplete vaccinations for age (OR, 3.39; 95% CI, 1.20-9.62), admission to a neonatal intensive care unit (OR, 7.17; 95% CI, 2.21-23.27), and no emergency department visit during the ARI episode (OR, 72.32; 95% CI, 4.82-1085.6). The at-home death rate due to respiratory syncytial virus infection among infants was 0.26 deaths/100 live births and that due to influenza was 0.07 deaths/1000 live births.
Conclusions:
Social vulnerabilities underlie at-home mortality due to ARI. Mortality rates due to RSV and influenza virus infection are high among infants at home and are similar to those reported for hospitalized children.
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