Moderate Malnutrition, a Risk Factor for Acute Respiratory Illness: Revelation from an Outbreak Investigation in Nakuru County, Kenya, February 2022
- Respiratory Diseases
Background
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.
Methods
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.
Results
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.
Conclusion
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.
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.
Methods
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.
Results
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.
Conclusion
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.