Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala
Abstract Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged <...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12889-019-6824-z |
| _version_ | 1818215619846209536 |
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| author | Sara Tomczyk John P. McCracken Carmen Lucia Contreras Maria Renee Lopez Chris Bernart Juan Carlos Moir Kenneth Escobar Lisette Reyes Wences Arvelo Kim Lindblade Leonard Peruski Joe P. Bryan Jennifer R. Verani |
| author_facet | Sara Tomczyk John P. McCracken Carmen Lucia Contreras Maria Renee Lopez Chris Bernart Juan Carlos Moir Kenneth Escobar Lisette Reyes Wences Arvelo Kim Lindblade Leonard Peruski Joe P. Bryan Jennifer R. Verani |
| author_sort | Sara Tomczyk |
| collection | DOAJ |
| description | Abstract Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. Methods We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician’s discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. Results Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. Conclusions Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality. |
| first_indexed | 2024-12-12T06:38:58Z |
| format | Article |
| id | doaj.art-6ff03cba4cf9419a92c35a66bdf022d2 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-12T06:38:58Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-6ff03cba4cf9419a92c35a66bdf022d22022-12-22T00:34:24ZengBMCBMC Public Health1471-24582019-05-0119111110.1186/s12889-019-6824-zFactors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in GuatemalaSara Tomczyk0John P. McCracken1Carmen Lucia Contreras2Maria Renee Lopez3Chris Bernart4Juan Carlos Moir5Kenneth Escobar6Lisette Reyes7Wences Arvelo8Kim Lindblade9Leonard Peruski10Joe P. Bryan11Jennifer R. Verani12Division of Global Health Protection, Centers for Disease Control and PreventionCenter for Health Studies, Universidad del Valle de GuatemalaCenter for Health Studies, Universidad del Valle de GuatemalaCenter for Health Studies, Universidad del Valle de GuatemalaCenter for Health Studies, Universidad del Valle de GuatemalaQuetzaltenango Health Area, Ministry of Public Health and Social WelfareWestern Regional Hospital San Juan de Dios, Ministry of Public Health and Social WelfareSanta Rosa Health Area, Ministry of Public Health and Social WelfareDivision of Global Health Protection, Centers for Disease Control and PreventionDivision of Global Health Protection, Centers for Disease Control and PreventionDivision of Global Health Protection, Centers for Disease Control and PreventionDivision of Global Health Protection, Centers for Disease Control and PreventionCenters for Disease Control and PreventionAbstract Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. Methods We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician’s discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. Results Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. Conclusions Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.http://link.springer.com/article/10.1186/s12889-019-6824-zAcute respiratory infectionDeathRisk factors |
| spellingShingle | Sara Tomczyk John P. McCracken Carmen Lucia Contreras Maria Renee Lopez Chris Bernart Juan Carlos Moir Kenneth Escobar Lisette Reyes Wences Arvelo Kim Lindblade Leonard Peruski Joe P. Bryan Jennifer R. Verani Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala BMC Public Health Acute respiratory infection Death Risk factors |
| title | Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala |
| title_full | Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala |
| title_fullStr | Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala |
| title_full_unstemmed | Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala |
| title_short | Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala |
| title_sort | factors associated with fatal cases of acute respiratory infection ari among hospitalized patients in guatemala |
| topic | Acute respiratory infection Death Risk factors |
| url | http://link.springer.com/article/10.1186/s12889-019-6824-z |
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