International Journal of Epidemiology, Vol 28, 157-162, Copyright © 1999 by International Epidemiological Association
MW Weber, P Milligan, S Hilton, G Lahai, H Whittle, EK Mulholland and BM Greenwood
BACKGROUND: Acute lower respiratory tract infections (ALRI) are the major
cause of mortality and morbidity in young children worldwide. Respiratory
syncytial virus (RSV) infection is the most important viral cause of severe
ALRI but only a small proportion of children infected with this virus
develop severe disease. To identify possible risk factors for severe RSV
infection leading to hospital admission we have carried out a case-control
study of Gambian children with RSV infection admitted to hospital. METHODS:
In all, 277 children admitted to three hospitals in the Western Region of
The Gambia with lower respiratory tract infection due to RSV were compared
with 364 control children matched for age and location of residence who had
not been admitted to hospital with an ALRI during the RSV season. A
detailed questionnaire covering a wide range of potential social,
environmental and nutritional risk factors was administered to the child's
guardian. RESULTS: Cases came from larger or more crowded compounds than
controls; increased risk was particularly associated with greater numbers
of children in the age group 3-5 years living in the compound (odds ratio
[OR] for > or =2 children in the age group 3-5 years = 9.1, 95% CI:
3.7-28). Cases were more likely to have a sibling who had died (OR = 3.4,
95% CI: 1.7-7). Controls were more likely to have been exposed to smoke
from cooking fires (OR for the mother of cases cooking at least once daily
= 0.31, 95% CI: 0.14-0.7). Other protective factors were father's
nationality and some professions. Vegetables were included in the diet of
controls more frequently than in that of cases (OR = 0.16, 95% CI:
0.06-0.46). Mothers of cases complained of asthma more frequently than
mothers of controls, but the number of asthmatic mothers was small (4.2
versus 0.5%, P = 0.05). CONCLUSIONS: Risk factors for severe RSV infection
identified in this study are not amenable to public health interventions.
Prevention of severe infection is likely to require the development of an
effective vaccine.
ARTICLES
Risk factors for severe respiratory syncytial virus infection leading to hospital admission in children in the Western Region of The Gambia
Medical Research Council Laboratories, Fajara, The Gambia.
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