Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh
Karine Vidal1, Shamima Sultana2, Alberto Prieto Patron1
1Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland.
Insights
Seasonal factors, particularly the cool rainy monsoon season, significantly increase acute respiratory infections (ARIs) in young children in Bangladesh. Young maternal age and low birth weight also elevate ARI risk during early infancy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Acute respiratory infections (ARIs) pose a significant health burden in low-income countries, with limited understanding of community-based risk factors.
- The Microbiota and Health study investigated ARI incidence and determinants in young children in a peri-urban setting in Bangladesh.
Purpose of the Study:
- To determine the incidence and identify key risk factors for acute respiratory infections (ARIs) in children under two years of age.
- To explore the influence of socioeconomic, environmental, maternal, and child characteristics on ARI development.
Main Methods:
- Longitudinal study following 267 children from birth to 2 years in Dhaka, Bangladesh, using active ARI surveillance and regular visits.
- Collection of nasopharyngeal samples for pathogen detection and comprehensive data on household, environmental, and maternal/child factors.
- Application of a hierarchical modeling approach to identify proximate determinants of ARIs.
Main Results:
- High ARI incidence observed, with 87.3% of children experiencing at least one episode; peak incidence at 2-4 months of age.
- The cool rainy monsoon season (IRR 2.43) and cool dry winter (IRR 2.10) were major risk factors for ARIs compared to the hot dry summer.
- Young maternal age (<22 years) and low birth weight (<2,500g) were associated with increased ARI incidence in the first six months.
Conclusions:
- Seasonal variations, specifically cooler, wetter weather, emerged as a primary driver of ARIs in peri-urban Bangladesh, overshadowing socioeconomic and hygiene factors.
- Further research into the interplay between seasonal elements (temperature, humidity, crowding, diet) and ARIs is crucial for developing effective prevention strategies.
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.
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