Acute respiratory illnesses in the first 18 months of life

Abstract

To help assess the causes and frequency of acute respiratory illnesses (ARI) during the first 18 months of life in Chile, a cohort of 437 children born in good health between May 1991 and April 1992 was followed at an urban health clinic in northern Santiago. Information was obtained from medical checkups performed at the clinic, from emergency health care services, from private physicians, and from interviews with each child's mother when the child was enrolled in the study and when it was 6, 12, and 18 months old. Followup was completed for 379 (87%) of the children. ARI accounted for 67% of all 3762 episodes of illness recorded for these children in the 18-month study period, 1384 (55%) of the ARI episodes affecting the upper respiratory tract and the remaining 1144 (45%) affecting the lower. The overall rate of ARI observed was 33 episodes per 100 child-months of observation. The incidences of upper, lower, and total ARI episodes decreased significantly in the third six months of life. A statistically significant association was found between upper ARI (≥2 episodes) and maternal smoking (≥5 cigarettes per day), but no significant associations were found with any of the other risk factors studied. However, lower ARI (≥2 episodes) was significantly associated with maternal schooling (<8 years), a family history of atopic allergy, and substandard housing conditions; and lower ARI (≥4 episodes) was significantly associated with these factors and also with the existence of one or more siblings, birth in a cold season, limited breast-feeding (<4 months), and low socioeconomic status. Significant associations were found between obstructive bronchitis episodes and most of the risk factors studied (gender, siblings, season of birth, duration of breast-feeding, maternal schooling, smoking, use of polluting fuels in the home, and a family history of atopic allergy); similarly, significant associations were found between the occurrence of pneumonia and many risk factors (including siblings, season of birth, duration of breast-feeding, maternal schooling, smoking, and socioeconomic level). Overall, 42 of the study children were hospitalized during the study period for lower tract ARI, and two children died of pneumonia at home during their first 6 months of life. The rate of hospitalization fell significantly with increasing age.

Effect of passive smoking on growth and infection rates of breast‐fed and non‐breast‐fed infants

“…Rylander et al found a significant relationship between tobacco smoke exposure and wheezing among infants up to 18 months of age 17 . Tobacco smoke exposure is considered among the risk factors of pneumonia 18–20 …”

Choice of Alternative Energy Sources of Farm Households for Cooking in Rural Areas of Peshawar

“…In several studies finding no association, relatively small proportions of the samples were exposed. Thus, in urban Brazil only 6% of children were exposed to indoor smoke (Victora et al, 1994) and in another south American study 97% of homes used gas for cooking, although 81% used polluting fuels (kerosene, wood, coal) for heating (Lopez-Bravo et al, 1997). This study also excluded neonates with birth weight <2,500 gms -the group most vulnerable to ALRI.…”

“…Five studies reported no significant association between ALRI incidence and exposure (Johnson & Aderele, 1992;Victora et al, 1994;Shah et al, 1994;Wesley & Loening, 1996, Lopez-Bravo et al, 1997, but the remainder reported significantly elevated ORs (for incidence or deaths) in the range 2-8. Not all however, have dealt adequately with confounding factors (Pandey te al., 1989;Kossove, 1982;Cerquiero et al, 1990;Collings et al, 1990;Johnson & Aderele, 1992), although accounting for confounding in studies of this exposure may in any case be problematic (Armstrong & Campbell, 1991;Bruce et al, 1998).…”

“…Acute lower respiratory infections (ALRI) remain the single most important cause of death globally in children under 5 years and account for around 2 million deaths annually in this age group. There are some sixteen studies in LDCs which have reported on the association between IAP exposure and ARLI (Kossove, 1982;Pandey et al, 1989;Campbell et al, 1989;Cerquiero et al, 1990;Collings et al, 1990;Armstrong & Campbell, 1991, Mtango et al, 1992, Johnson & Aderele, 1992de Francisco et al, 1993;Shah et al, 1994;Victora et al, 1994;Depmsey et al, 1996, Wesley & Loening, 1996, Lopez-Bravo et al, 1997, Ezzati and Kammen 2001a and two further studies among Navajo Indians in the US (Morris et al, 1990;. Comment will be restricted to the studies listed as these have all used definitions of ALRI which conform reasonably closely to current WHO criteria (or other definitions that were accepted at the time the study was carried out) and/or include radiographic evidence.…”

“…Of the sixteeen LDC studies, 10 are case-control designs (two mortality studies), 5 cohort studies (all morbidity), and one a case-fatality study. In contrast to the relatively robust definitions of ALRI, the measurement of exposure has relied in almost all studies on proxies, including the type of fuel and stove (Cerqueiro et al, 1990;Collings et al, 1990;Johnson & Aderele, 1992;Mtango et al, 1992;Victora et al, 1994;Shah et al, 1994;O'Dempsey et al, 1996, Wesley & Loening, 1996Lopez-Bravo et al, 1997), whether the child stays in the smoke during cooking (Kossove, 1982, Mtango et al, 1992, Victora et al, 1994, reported hours spent near stove (Kossove, 1982;Pandey et al, 1989), and whether the child is carried on the mother's back during cooking (Campbell et al, 1989;Armstrong & Campbell, 1991;de Francisco et al, 1993). Apart from Ezzati's study (see below), only one previous study made direct measurements of pollution (particulates) and exposure (COHb) in a subsample (Collings et al, 1990).…”