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Protective and risk factors for acute respiratory infections in hospitalized urban Malaysian children: a case control
B H Azizi1, H I Zulkifli, M S Kasim
1Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Insights
Crowded homes and having a sick sibling increase the risk of acute respiratory infections (ARI) in children. Breastfeeding for at least one month significantly protects against ARI, highlighting environmental and nutritional factors.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Acute respiratory infections (ARI) are a leading cause of childhood hospitalization globally.
- Understanding risk and protective factors is crucial for developing effective prevention strategies.
Purpose of the Study:
- To identify home environmental and host-related risk and protective factors for ARI in hospitalized children.
- To investigate the association between specific factors and the incidence of ARI in a Malaysian pediatric population.
Main Methods:
- A case-control study was conducted with hospitalized children aged one month to five years in Kuala Lumpur.
- Cases included children with pneumonia, acute bronchiolitis, acute laryngotracheobronchitis, and empyema.
- Controls were children hospitalized for non-respiratory causes, with logistic regression used for analysis.
Main Results:
- Independent risk factors for ARI included a coughing sibling (OR=3.76), households with >5 members (OR=1.52), and sleeping with ≥3 others (OR=1.45).
- Host factors like a history of allergy (OR=2.50) and Malay ethnicity (OR=2.07) were significant risk factors.
- Breastfeeding for ≥1 month was a significant protective factor (OR=0.58); domestic air pollution was not found to be an adverse factor.
Conclusions:
- Home environmental factors, especially crowding, are significant risk factors for ARI in hospitalized children.
- Breastfeeding is an important protective factor against ARI.
- Targeting environmental conditions and promoting breastfeeding can aid in ARI prevention.
Abstract:
We performed a case control study to examine protective and risk factors for acute respiratory infections (ARI) in hospitalized children in Kuala Lumpur. Consecutive children between the ages of one month and five years hospitalized for pneumonia (n = 143), acute bronchiolitis (n = 92), acute laryngotracheobronchitis (n = 32) and empyema (n = 4) were included as cases and were compared with 322 children hospitalized during the same 24 hour period for non-respiratory causes. Potential risk and protective factors were initially analysed by univariate analysis. Logistic regression analysis confirmed that several home environmental factors were significantly associated with ARI. The presence of a coughing sibling (OR = 3.76, 95%CI 2.09, 6.77), a household with more than five members (OR = 1.52, 95%CI 1.03, 2.19) and sleeping with three other persons (OR = 1.45, 95%CI 1.00, 2.08) were independent risk factors. Significant host factors were history of allergy (OR = 2.50, 95%CI 1.74, 3.61) and ethnicity (Malay race) (OR = 2.07 95%CI, 1.27, 3.37). Breast feeding for at least one month was confirmed as an independent protective factor (OR = 0.58, 95%CI 0.38, 0.86). However, the study was not able to demonstrate that domestic air pollution had an adverse effect. This study provides further evidence that home environmental factors, particularly those associated with crowding, may predispose to ARI and that breast feeding is an important protective factor.