Risk factors for mortality from acute lower respiratory tract infections in young Gambian children
De Francisco, A.; Morris, J.; Hall, A.J.; Armstrong Schellenberg, J.R.; Greenwood, B.M.
International Journal of Epidemiology 22(6): 1174-1182
1993
ISSN/ISBN: 0300-5771 PMID: 8144302 DOI: 10.1093/ije/22.6.1174Document Number: 331522
Acute lower respiratory tract infections (ALRI) are an important cause of mortality among children under 5 years old in many developing countries. While interventions aim to manage the occurrence of ALRI and the associated mortality through early diagnosis and treatment, efforts must also be taken to prevent the baseline infections. Birthweight, breastfeeding, overcrowding, and exposure to smoke are thought to influence young children's susceptibility to ALRI. The authors present results from a case-control study in a rural area of the Gambia where ALRI was found to be the most significant cause of death among individuals under 2 years old. The study was conducted to evaluate risk factors for mortality from these infections in young children. Post-mortem data on 129 under-2-year-olds thought to have died from ALRI were employed. Data for these cases were matched according to age, sex, ethnic group, and time and place of death with children who had died from other causes as well as with 2 groups of live control children. Results from the comparison between groups suggest that exposure to smoke during cooking, parental smoking, and exclusive, prolonged breast feeding were associated with an increased risk of death from ALRI. Sharing a bed with siblings, use of antenatal and welfare clinics, and immunization had an effect in the opposite direction. No associations were found between ALRI mortality and maternal education and literacy, socioeconomic status, or with mother's age. Comparing data on children who died from causes other than ALRI with the live controls yielded a similar pattern of associations and no significant differences were found in any of the risk factors studied between children whose deaths were attributed to ALRI and those whose death was attributed to another cause. Mortality was most strongly associated with exposure to smoke during cooking. The authors therefore note the need to reduce young children's exposure to such smoke in the interest of reducing the incidence and prevalence of ALRI.