Risk factors and cost of illness for acute respiratory infections in children under five years of age attending selected health facilities in Nakuru County, Kenya

Abstract

Acute Respiratory Infections (ARI) are among of the most common causes of both illness and mortality in children under five years of age. A prevalence of between 11% and 29% has been reported in studies conducted in the East African countries. In Kenya, ARI has been associated with 20-30% admissions and 19% deaths of children under five years of age. Evaluation of risk factors for ARI, assessment of health seeking behaviour that may influence care and management of ARI, knowledge and perceptions regarding ARI transmission and preventive measures as well as cost estimation of ARI episodes that can be used in budgeting and resource allocation is crucial in reducing childhood illnesses attributed to ARI. These factors have not been well investigated in Kenyan populations. This study aimed at identifying the aetiology, risk factors, and cost of illness for acute respiratory illnesses in subjects from selected health facilities in Nakuru County in Kenya. The study also assessed the caretakers’ health care seeking behaviour, knowledge and perception on ARI transmission and prevention. This was a case control study which recruited caretakers (parents or guardians) with children less than 5 years of age who visited the selected health facilities with children suspected to have ARI. A corresponding control was enrolled for each case matching for age and sex. Data was collected using semi-structured questionnaires. A subgroup was sampled to collect specimen for determination of aetiology by laboratory analysis. Demographic data was analysed by descriptive statistics while chi-square and Fisher’s Exact Test were used to analyze categorical data and student’s t-test for continuous data. Logistic regression analysis was used to identify the factors influencing health care seeking behavior and potential risk factors for ARI. The study enrolled a total of 261 participants but 5 of them did not find matching controls and hence data was analysed for 256 participants. Specimens were taken from eighty two (33%) of the children for bacterial culture and detection of viral agents but four were spoilt during transportation and therefore seventy eight were tested for viral and bacteria detection. Bacteria were isolated from 24.4% of sampled patients with Streptococcus pyogenes and Streptococcus viridans, being the most predominant. At least one respiratory virus was detected in 44.9% of the specimen collected from the children. Of the viral agents detected, 20.5% were influenza A, 16.7% were respiratory syncytial virus (RSV) while 10.3% were influenza B viruses. Mixed infections were present in 29.5% of the children. The major risk factors identified were: malnutrition, crowding and smoking. Factors that showed a trend towards protection were immunization, breastfeeding for more than 4 months, parental education above primary school, family income above $176 (kshs 15,000). Knowledge on preventive measures for ARI was generally low. Majority, 231 (92.8%) sought appropriate health care (health facility) but a few sought inappropriate care from traditional doctors, direct purchase of drugs from pharmacies, and others used home remedies. Family size, delivery in a hospital, income and education influenced the health seeking behavior among the respondents. The total mean cost of managing ARI was $17.70 with consultation and cost of prescribed medicine constituting the major cost drivers for management of ARI. The study strongly recommends basic health promotional measures like proper breastfeeding practices, proper nutrition of the child in prevention and control of ARI. Health education can change health care seeking behavior and attitude of caretakers and other family members to take appropriate care of the children with ARI and other childhood illnesses.