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 semistructured 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.