Moderate Malnutrition, a Risk Factor for Acute Respiratory Illness: Revelation from an Outbreak Investigation in Nakuru County, Kenya, February 2022

  • Respiratory Diseases
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Globally, Acute Respiratory Infections (ARI) epidemics result in 3–5 million cases of severe illness, with approximately 290,000 to 650,000 related deaths yearly. East African region has a prevalence of between 11% and 29%. In Kenya, ARI has been associated with 20-30% hospital admissions and 19% of deaths among those under five years old. On February 10, 2022, Nakuru Disease Surveillance Officers reported an increase in flu-like illnesses with no identifiable etiology among children. We sought to investigate the outbreak and identify risk factors to inform control measures.

We conducted active case search in health facilities; a case was any child aged <60 months presenting with cough and hotness of the body, difficulty in breathing from December 1, 2021, through February 28, 2022, in Nakuru County. We rreviewed data from the DHIS 2 from 2016–2022, collected nasopharyngeal and oropharyngeal samples and screened using RT-PCR panels. We conducted an unmatched 1:2 case-control study of randomly selected cases and neighbourhood controls and calculated descriptive and inferential statistics at 95% Confidence level.

We identified 694 cases; median age was 13 months (Range 0.1–60 months), those aged 3–12 months were 50.7% (359/694), males were 60.4% (419/694), Nakuru East contributed 53.5% (371/694) while 7/694 died (case fatality rate: 1%). Most cases 15.1% (105/694) were reported in the week February 9–11, 2022. Adenovirus was detected in 46.7% (36 /77), Respiratory syncytial virus (RSV) in 20.7% (16/77) and Rhinovirus in 22.1% (17/77) of the samples. We enrolled 36 cases and 72 controls. Being aged <1year (OR:1.9, 95% CI: 0.77–3.48), being moderately malnourished (OR: 1.89,95% CI: 0.20–8.13) were risk factors.

Adenovirus was the primary causative agent. Malnutrition was a risk factor. We implemented nutrition strategy to improve nutrition. We sensitized healthcare stakeholders on ARIs and case management especially among those aged <1year.

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