Danish Medical Bulletin - No. 3. September 2004. Vol. 51 Page 308.

ABSTRACT OF PhD DISSERTATION

Community study of acute respiratory infections in children less than one year of age

Soweto, South Africa

Ines Ackerl Kristensen

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This PhD dissertation was accepted by the Faculty of Health Science of the University of Aarhus and will be defended on June 18, 2004.

Official opponents: Jesper Reinholdt, Beth Maina Ahlberg, Sweden, and Niels Henrik Valerius.

Tutors: Professor Jørn Olsen, professor Jens Chr. Jensenius and Steffen Thiel.

Correspondence: e-mail: inesa@telkomsa.net or ines@dadlnet.dk

Dan Med Bull 2004;51:308.

ABSTRACT

The PhD dissertation is based on two studies, a cohort study and a case-control study, conducted in Soweto, a black township with 1.2 million inhabitants outside of Johannesburg in South Africa.

The overall aim was to determine the incidence and seasonality of acute respiratory infections in the area with emphasis on respiratory syncytial virus (RSV) in a birth cohort during a follow-up time of 12 months, and to identify risk factors for the disease in order to suggest preventive arrangements.

We followed 572 children in three areas of Soweto by direct observation and found a much lower incidence of acute respiratory infections (ARI) than expected of only 1.54 per child year.

Information on the determinants under study, such as birth weight, breastfeeding, gender, crowding, passive smoking, indoor pollution and sanitary facilities was obtained through interview based questionnaires.

We found that crowding and socio-economic factors such as the father's education are important determinants for ARI. The lack of association with well described risk factors, such as maternal education, gender and passive smoking could partly be due to lack of statistical power in this rather uniform population.

Breastfeeding showed a protective effect against more severe cases of ARI.

A matched case-control study, in which cases and controls were matched for age and sex, was conducted in the same area. The cases were identified through surveillance for lower respiratory infections due to RSV at Chris Hani Baragwanath Hospital, and the controls were sampled from four immunization clinics in the area.

We examined the impact of deficiency of mannan-binding lectin (MBL), which is frequent on the African continent, and we did not find any association between this deficiency and hospitalisation for lower respiratory tract infection caused by RSV (RSV-LRTI).

We found breastfeeding to be protective against hospitalisation for RSV-LRTI. It is not known, how breastfeeding confers protection against severe infection, but it could be a combination of nutritional, immunological, social, and psychological factors.
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