Outcome risk factors during respiratory infections in a paediatric ward in Antananarivo, Madagascar 2010-2012.
BACKGROUND
Acute respiratory infections are a leading cause of infectious disease-related morbidity, hospitalisation and mortality among children worldwide, and particularly in developing countries. In these low-income countries, most patients with acute respiratory infection (ARI), whether it is mild or severe, are still treated empirically. The aim of the study was to evaluate the risk factors associated with the evolution and outcome of respiratory illnesses in patients aged under 5 years old.


METHODS
We conducted a prospective study in a paediatric ward in Antananarivo from November 2010 to July 2012 including patients under 5 years old suffering from respiratory infections. We collected demographic, socio-economic, clinical and epidemiological data, and samples for laboratory analysis. Deaths, rapid progression to respiratory distress during hospitalisation, and hospitalisation for more than 10 days were considered as severe outcomes. We used multivariate analysis to study the effects of co-infections.


RESULTS
From November 2010 to July 2012, a total of 290 patients were enrolled. Co-infection was found in 192 patients (70%). Co-infections were more frequent in children under 36 months, with a significant difference for the 19-24 month-old group (OR: 8.0). Sixty-nine percent (230/290) of the patients recovered fully and without any severe outcome during hospitalisation; the outcome was scored as severe for 60 children and nine patients (3%) died. Risk factors significantly associated with worsening evolution during hospitalisation (severe outcome) were admission at age under 6 months (OR = 5.3), comorbidity (OR = 4.6) and low household income (OR = 4.1).


CONCLUSIONS
Co-mordidity, low-income and age under 6 months increase the risk of severe outcome for children infected by numerous respiratory pathogens. These results highlight the need for implementation of targeted public health policy to reduce the contribution of respiratory diseases to childhood morbidity and mortality in low income countries.
Epidemiologic Unit, Institut Pasteur from Madagascar, Antananarivo, Madagascar.
Soatiana
S
Rajatonirina
Norosoa Harline
NH
Razanajatovo
Elisoa Hariniana
EH
Ratsima
Arnaud
A
Orelle
Rila
R
Ratovoson
Zo Zafitsara
ZZ
Andrianirina
Todisoa
T
Andriatahina
Lovasoa
L
Ramparany
Perlinot
P
Herindrainy
Frédérique
F
Randrianirina
Jean-Michel
JM
Heraud
Vincent
V
Richard
D002675:Child, Preschool; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008270:Madagascar; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012307:Risk Factors