Childhood pneumonia – the Drakenstein Child Health Study

Zar, Heather J.; Barnett, Whitney; Myer, Landon; Nicol, Mark P.

doi:10.7196/samj.2016.v106i7.11108

Cited by 17 publications

(18 citation statements)

References 26 publications

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“…The introduction of vaccination programmes like pneumococcal conjugate vaccines (PCV) and Haemophilus influenzae type B immunization decreased the incidence and severity of childhood pneumonia [11][12][13][14]. However, even with high coverage for PCV13 (a PCV that protects against 13 serotypes of pneumococcus) the incidence of pneumonia remains high, particularly in the first six months of life (0.55 episodes per child year in the DCHS birth cohort [3,14]).…”

Section: Pneumonia Backgroundmentioning

confidence: 99%

Flexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling

Ramjith

Roes

Zar

et al. 2021

BMC Med Res Methodol

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Introduction Recurrent episodes of pneumonia are frequently modeled using extensions of the Cox proportional hazards model with the underlying assumption of time-constant relative risks measured by the hazard ratio. We aim to relax this assumption in a study on the effect of factors on the evolution of pneumonia incidence over time based on data from a South African birth cohort study, the Drakenstein child health study. Methods We describe and apply two models: a time-constant and a time-varying relative effects model in a piece-wise exponential additive mixed model’s framework for recurrent events. A more complex model that fits in the same framework is applied to study the continuously measured seasonal effects. Results We find that several risk factors (male sex, preterm birth, low birthweight, lower socioeconomic status, lower maternal education and maternal cigarette smoking) have strong relative effects that are persistent across time. When time-varying effects are allowed in the model, HIV exposure status (HIV exposed & uninfected versus HIV unexposed) shows a strong relative effect for younger children, but this effect weakens as children grow older, with a null effect reached from about 15 months. Weight-for-length at birth shows a time increasing relative effect. We also find that children born in the summer have a much higher risk of pneumonia in the 3-to-8-month age period compared with children born in winter. Conclusion This work highlights the usefulness of flexible modelling tools in recurrent events models. It avoids stringent assumptions and allows estimation and visualization of absolute and relative risks over time of key factors associated with incidence of pneumonia in young children, providing new perspectives on the role of risk factors such HIV exposure.

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Section: Pneumonia Backgroundmentioning

confidence: 99%

Flexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling

Ramjith

Roes

Zar

et al. 2021

BMC Med Res Methodol

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“…Two sets of multiple regression models were run for each of the maternal psychosocial risk factors: the first set included the minimum set of confounder variables identified by the DAGs, and the second set included the confounding variables as well as additional variables (including mediators) based on prior literature: smoke exposure (maternal & infant urine cotinine results), indoor air pollution (assessed by PM10), weight for age z-score at birth, duration of exclusive breastfeeding and season of birth. [2, 23]. Season of birth was included to adjust for seasonality, as winter and autumn months are more commonly linked with LRTI episodes [27].…”

Section: Methodsmentioning

confidence: 99%

“…A high prevalence of maternal psychosocial risk factors including maternal depression, psychological distress, IPV and trauma have been reported in the cohort [17, 24, 25]. In addition, a high incidence of LRTI in infancy has also been reported in this cohort, despite high immunisation coverage, adequate access to primary health care, and a low prevalence of infant HIV [3, 23].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there is a paucity of research that has comprehensively evaluated the association of antenatal and postnatal maternal psychosocial risk factors with infant LRTI. There are very sparse data from Sub-Saharan Africa despite the high prevalence of both maternal psychosocial risk factors and childhood LRTI in this context [3, 23, 24].…”

Section: Introductionmentioning

confidence: 99%

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Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

et al. 2019

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ObjectiveTo investigate the association between maternal antenatal and/or postnatal psychosocial risk factors (including depression, psychological distress, alcohol abuse and intimate partner violence (IPV) and infant lower respiratory tract infection (LRTI) in a low- and middle-income-country (LMIC).Study designPregnant women (n = 1137) enrolled in a South African birth cohort study, the Drakenstein Child Health Study (DCHS) were longitudinally assessed for psychosocial risk factors including depression, psychological distress, alcohol abuse and/or intimate partner violence (IPV). Infants were followed from birth until one year of age for the development of LRTI by active surveillance. Two outcomes were evaluated: any LRTI, and severe and/or hospitalised LRTI. Logistic regression was used to identify associations between individual maternal psychosocial risk factors and LRTI outcomes. Analyses stratified by age were also performed to determine which age groups related to infant LRTI were linked with maternal psychosocial risk factors.ResultsThere were 606 LRTI episodes in 369 infants in the first year (crude incidence rate = 0.53 episodes per person-year, 95%CI: 0.50; 0.56); 31% (n = 186) of episodes were severe or hospitalised events. Maternal psychosocial risk factors were associated with LRTI and severe LRTI, particularly postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal IPV. Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months of age, and postnatal maternal IPV was associated with early LRTI and severe forms of LRTI.ConclusionThe associations between maternal psychosocial risk factors and infant LRTI highlight the potential value of screening for maternal psychosocial risk factors in clinical settings and developing targeted interventions. Such interventions may not only improve maternal well-being, but also help reduce the burden of infant LRTI in LMIC settings.

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“…Despite sustained efforts to decrease this, including better access to vaccination and strengthening of primary healthcare services, childhood LRTIs continue to impact significantly on child health. [1,2] SA, a middle-income country, has undergone much social and political change in the past two decades, resulting in urban migration and the mushrooming of peri-urban communities with subsequent health, education and environmental challenges. [3] Despite an increase in electrification, many households continue to rely on alternative fuel sources for cooking and heating.…”

Section: Guest Editorialmentioning

confidence: 99%

Early-life exposures to environmental tobacco smoke and indoor air pollution in the Drakenstein Child Health Study: Impact on child health

2018

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Childhood pneumonia – the Drakenstein Child Health Study

Cited by 17 publications

References 26 publications

Flexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling

Flexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling

Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

Early-life exposures to environmental tobacco smoke and indoor air pollution in the Drakenstein Child Health Study: Impact on child health

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