Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh

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.

The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

“…Previous studies have investigated the associations between SDoH and health outcomes (i.e. diarrhoea, fever, cough and ARI) among U5y in Bangladesh [7,8,14,15,[24][25][26][27][28][29]. They have found that child's age [7,8,14,28,29], child's gender [7,14,15], mother's employment [28], father's occupation [24], housing conditions [28], and low birth weight [29] are associated with ARI among U5y in the country.…”

“…diarrhoea, fever, cough and ARI) among U5y in Bangladesh [7,8,14,15,[24][25][26][27][28][29]. They have found that child's age [7,8,14,28,29], child's gender [7,14,15], mother's employment [28], father's occupation [24], housing conditions [28], and low birth weight [29] are associated with ARI among U5y in the country. Similarly, low socio-economic status measured by the household wealth index [8,14,15,24,25,27,28], parental education [8,14,24,27], rural residency and regional differences [8] are associated with fever, ARI, diarrhoea, and cough in U5y.…”

“…Similarly, low socio-economic status measured by the household wealth index [8,14,15,24,25,27,28], parental education [8,14,24,27], rural residency and regional differences [8] are associated with fever, ARI, diarrhoea, and cough in U5y. In addition, the mother's nutritional status [24], mother's age [8,14,29], and child malnutrition [14,24] are associated with diarrhoea and ARI in U5y. Finally, maternal depression [15], the household's access to improved water and sanitation [15,27,28], and the household's garbage disposal system [10,15] are associated with ARI and cough in U5y.…”

Epidemiology of Acute Lower Respiratory Tract Infections in Children

“…Maternal food and nutritional health play a significant outcome in early infancy (0-6 months) by influencing breast milk quality and output and restricting milk antibody transmission. Thereafter, the kid gets more exposed to the external world, and it is believed that water, sanitation and hygiene (WASH) and other environmental elements exert a greater influence 4 .…”

Physical Home Sanitation as a Risk Factor for Acute Respiratory Infection in Children under 5 at Labuan Regency, Central Sulawesi

“…Based on Riskesda 2013, the prevalence of ARI in children aged 1-4 years reached 25.8%. Environmental factors have a very large influence on the incidence of ARI, excessive dust content [6], [7], [8], [9], [10], air ventilation [11], [12], [13], [14], [15], lighting [16], and humidity [17], [18], [19], [20], [21] believed to be the cause of ARI, including ventilation which functions as an inlet and outlet of the air in the room. Natural or artificial lighting can directly or indirectly illuminate the entire room with an intensity of at least 60 Lux provided it creates glare.…”