Duration of day-care attendance and acute
respiratory infection
Te mp o d e p e rmanê nc ia na c re c he e infe c ç ão
re sp irató ria ag ud a
1 Dep artam en to d e Med icin a Socia l, Fa cu ld a d e d e M ed icin a , Un iv ersid a d e Fed era l d o Rio Gra n d e d o Su l Ru a Ra m iro Ba rcelos, 2600 sa la 415, Port o Alegre, RS 90035- 003, Bra z il. fa x +55- 51- 330- 1380
Sa n d ra Cost a Fu ch s 1
Rit a d e Cá ssia M a yn a rt 1
Len a ra Ferreira d a Cost a 1
Ad ria n a Ca rd oz o 1
Reja n e Sch ierh olt 1
Abst ract Da y- ca re a t t en d a n ce a ccou n t s for a n in crea sed freq u en cy of a cu t e resp ira t ory in fec-t ion s (ARI), in n u m b ers of b ofec-t h ep isod es a n d h osp ifec-t a liz a fec-t ion s. In a d d ifec-t ion fec-t o d a y- ca re ex p osu re, risk fa ct ors in clu d e a ge, sib lin gs, a n d crow d in g. T h e p u rp ose of t h is st u d y w a s t o in v est iga t e a p ossible a ssocia t ion bet w een d u ra t ion of d a y-ca re ex p osu re a n d ARI. A cross-sect ion a l st u d y w a s ca rri ed o u t t o co m p a red ARI ra t es f o r ch i ld ren ex p o sed t o d a y ca re a n d ch i ld ren ca red f o r a t h om e. Ch ild ren w it h a t lea st on e p a ren t w ork in g in a h osp it a l w ere sa m p led from t h e h osp it a l-ru n d a y- ca re cen t er a n d t h ose ca red for a t h om e. An a cu t e resp ira t ory in fect ion w a s d efin ed a s t h e p resen ce of t w o or m ore sign s or sym p t om s in t h e p rev iou s t w o w eek s. Ch ild ren ex p osed t o t h e d a y- ca re cen t er for 12 t o 50 h ou rs a w eek h a d a t h ree t o fiv e t im es grea t er risk of d ev elop in g ARI t h a n t h ose st a yin g a t h om e. Th is risk w a s a ssessed in d ep en d en t ly, t a k in g socioecon om ic st a-t u s, age, an d n u m ber of siblin gs in a-t o accou n a-t . Risk of resp iraa-t ory illn ess an d d ay-care aa-t a-t en d an ce h a s b een d escrib ed elsew h ere, b u t t h is st u d y p resen t s origin a l fin d in gs rela t ed t o d u ra t ion of ex -p osu re. W it h a v iew t ow ard s red u cin g risk of ARI, im -p rovem en t s sh ou ld be m ad e in in st it u t ion al d a y- ca re cen t ers in Bra z il, w h ere fa m ily d a y ca re is st ill n ot a va ila b le.
Key words Ch ild Hea lt h ; Acu t e resp ira t ory in fect ion ; Da y- ca re cen t ers; Hea lt h Ca re
Resumo A freqü ên cia à crech e associa-se com m aior n ú m ero d e ep isód ios d e in fecção resp irat ória e h osp it aliz ações. Além d a crech e, a id ad e, a p resen ça d e irm ãos e a aglom eração d o am bien -t e sã o ou -t ra s ca ra c-t erít ica s id en -t ifica d a s com o fa -t ores d e risco. N et e et u d o in vet igou - se a a s-sociação en t re in fecção agu d a d o t rat o resp irat ório (IRA) e o n ú m ero d e h oras qu e a crian ça p er-m a n ecia n a crech e. In vest igou -se a p reva lên cia d e IRA en t re cria n ça s freqü en t a d ora s d a crech e e en t re a qu ela s cu id a d a s em ca sa a t ra v és d e u m est u d o t ra n sversa l. Selecion ou -se a a m ost ra en t re filh os d e fu n cion á rios d e u m h osp it a l com d isp on ib ilid a d e d e crech e. In fecçã o resp ira t ória foi d efin id a p ela p resen ça d e p elo m en os d ois sin a is ou sin t om a s ocorrid os n a s d u a s ú lt im a s sem n as. Crian ças ex p ost as à crech e p or 12 a 50 h oras sem an ais ap resen t aram u m risco ap rox im ad am en t e t rês a cin co v ez es am aior d e t er u am a in fecção resp irat ória agu d a. Est e efeit o am ost rou se in d ep en d en t e d o n ív el sócioecon ôm ico d os p ais, d a p resen ça d e irm ãos e d a id ad e d a crian ça. Ou -t ros es-t u d os carac-t eriz aram o risco d ecorren -t e d a ex p osição à crech e, con -t u d o n es-t e d e-t ec-t ou -se o efeit o rela cion a d o a p erm a n ên cia p rolon ga d a . Alt ern a t iv a s com o a s crech es fa m ilia res a m erica -n a s sã o p ou co d ifu -n d id a s em -n osso m eio, p ort a -n t o, d ev e- se b u sca r m eios d e m i-n im iz a r o risco d e IRA n a s in st it u ições t ra d icion a is.
Introduction
Re sp ira to r y d ise a se s a re o n e o f th e m a in ca u s-e s o f h o sp it a liza t io n in c h ild rs-e n u n d s-e r fivs-e ye a rs o f a ge. Acco rd in g t o Ce sa r (1995), p n e u m o n ia wa s re sp o n sib le fo r 3% o f h o sp it a liza -tion s in ch ild ren u p to on e year of age in th e city of Pelotas, Rio Gran d e d o Su l State. Ch aracteris-tics su ch as age, p resen ce of sib lin gs, a crowd ed e n viro n m e n t , a n d a t t e n d a n ce a t a d a y- ca re cen ter were id en tified by An d erson et al. (1988) a s risk fa cto rs fo r resp ira to r y in fectio n .
Acco rd in g t o a st u d y co n d u ct e d b y Wa ld e t a l. (1991), 13% o f c h ild re n fr o m t wo t o t h re e ye a r s o f a ge a t t e n d in g d a y c a re c e n t e r s p re -se n t e d u n co m p lica t e d e p iso d e s o f re sp ira t o r y in fe c t io n la st in g o ve r 15 d a ys. Co m p a re d t o c h ild re n st a yin g a t h o m e , Wa ld e t a l. (1988) fo u n d th a t ch ild ren a tten d in g d a y-ca re cen ters d e ve lo p e d a t le a st six re sp ira t o r y in fe ct io n s a yea r, rem a in ed sick for over sixty d a ys, a n d p re-se n t e d a t le a st fo u r re-se r io u s e p iso d e s o f t h e ill-n ess. Iill-n two ca se-coill-n trol stu d ies, Foill-n seca et a l. (1993) re p o r t e d t h a t d a y- ca re a t t e n d a n ce wa s a sso cia t e d wit h a five -fo ld in cre a se in t h e risk o f p n e u m o n ia in th e city o f Fo rta leza , a n d Vic-t o ra e Vic-t a l. (1994) re p o rVic-t e d a n in e -fo ld in cre a se in th e city of Porto Alegre.
Ha vin g ch a ra cterized th e im p a ct of resp ira -t o r y in fe c -t io n s o n p re sc h o o l c h ild re n , we so u gh t to a ssess th e a sso cia tio n b etween a cu te re sp ira to r y in fe ctio n a n d th e n u m b e r o f h o u rs sp en t in th e d a y-ca re cen ter.
M aterial and methods
A cro ss-sectio n a l stu d y wa s d esign ed to sim u l-t a n e o u sly in ve sl-t iga l-t e d a y- c a re a l-t l-t e n d a n c e , n u m b e r o f h o u r s p e r we e k t h a t t h e c h ild re -m a in e d in th e d a y-ca re ce n te r, a n d p re va le n ce
o f a cu te resp ira to ry in fectio n . Th e ta rget gro u p con sisted of ch ild ren a ged 1-5 yea rs wh ose p a r-en ts wo rked a t th e Un iversity Ho sp ita l in Po rto Ale gre . Th e c h ild re n we re ra n d o m ly se le c t e d from two grou p s, th ose en rolled in th e d a y-ca re c e n t e r (u sin g t h e c e n t e r’s re gist e r ) a n d t h o se n o t a t t e n d in g t h e ce n t e r (co n t a ct in g h o sp it a l e m p loye e s wh o re p o r t e d h a vin g c h ild re n in th is a ge b ra cket). We o p ted to stu d y ch ild ren o f h o sp it a l e m p loye e s b e ca u se t h e p a re n t s’ e m -p loym e n t st a t u s m a d e t h e ir c h ild re n e ligib le fo r d a y c a re, t h u s re d u c in g o r e lim in a t in g in -terferen ce from econ om ic fa ctors rela ted to a c-cess to ca re.
We c o n st r u c t e d a h ie ra rc h ic a l t h e o re t ic a l m o d el (Figu re 1) to d escrib e rela tio n s b etween a t t e n d a n c e a t t h e d a y- c a re c e n t e r a n d a c u t e re sp ira t o r y in fe c t io n (ARI) a n d t o o r ie n t o u r a n a lysis. In t h is m o d e l t h e fa m ily’s so c io e c o -n o m ic st a t u s is t h e d ist a l d e t e r m i-n a -n t o f ARI a n d it s c o m p lic a t io n s, e st a b lish in g h o u sin g c o n d it io n s (a sc o re o f h o u se h o ld go o d s) a n d t h e e n vir o n m e n t (c r owd in g) wh e re t h e c h ild wa s b orn a n d is ra ised , followed by oth er d eterm in a n ts, like co n ta ct with sib lin gs o r with o th -er ch ild ren u p on a tten d in g th e d a y-ca re cen t-er. Th u s, th e in d ep en d en t effect of d a yca re a tten d a n ce sh o u ld b e a n a lyzed co n sid erin g th e o th e r ch a ra ct e r ist ics a s co n fo u n d in g fa ct o rs. De -t a ils o n h ie ra rc h ic a l m o d e lin g a re d e sc r ib e d e lse wh e re, su c h a s Vic t o ra e t a l. (1994) a n d Fu ch s et a l. (1996).
Acu t e re sp ira t o r y in fe ct io n wa s d e fin e d a s t h e p re se n c e o f a t le a st t wo o f t h e fo llo win g sign s o r sym p t o m s in t h e p re vio u s t wo we e ks: a xilla r y t e m p e ra t u re > 38o C, c o u gh , c o r yza , ra les, d ysp n ea , ta ch yp n ea , a n d o titis a s rep o rt-ed by on e of th e p a ren ts.
We in ve st iga t e d t h e a sso c ia t io n b e t we e n a c u t e re sp ira t o r y in fe c t io n a n d t h e fo llo win g ch a ra cteristics:
• sex a n d a ge;
• so cio e co n o m ic st a t u s: sco r e o f h o u se h o ld go o d s, b a se d o n t h e su m o f t h e n u m b e r o f room s in th e h ou se, ca rs, electric a n d electron -ic h o m e a p p lia n ce s (d ish wa sh e r, clo th e s d rie r, re fr ige ra t o r, m icrowa ve ove n , VCR, a ir co n d i-tio n e r, clo th e s wa sh e r, fre eze r, co lo r TV, so u n d syst e m wit h CD, c o m p u t e r, a n d t e le p h o n e ). Th e st u d y a lso in c lu d e d t h e p a re n t s’ le ve l o f sc h o o lin g m e a su re d a s t h e n u m b e r o f ye a r s co m p le t e d (1- 8, 9- 11, a n d > 12) a n d crowd in g o f t h e h o m e e n vir o n m e n t , a s a sse sse d b y t h e n u m b e r o f p e rso n s sle e p in g in t h e sa m e ro o m a s th e ch ild (1, 2, > 3);
• h ist o r y o f d ise a se : h ist o r y o f p n e u m o n ia (yes, n o) a n d otitis (yes, n o);
• cu rren t u se of p a cifier (yes, n o);
Ag e Sib ling s Day-c are c e nte r Cro wd ing So c io e c o no mic
status
ARI Fig ure 1
The o re tic al mo d e l fo r inve stig ating c harac te ristic s asso c iate d with ac ute re sp irato ry
infe c tio n (ARI).
V
V
V
V
V
• e n viro n m e n t a l fa ct o r s: p re se n ce o f sm o k-e rs in t h k-e h o u sk-e h o ld (m k-e a su rk-e d b y n u m b k-e r o f c iga re t t e s c o n su m e d p e r d a y: 0, 1- 20, 21- 60), a t t e n d a n c e a t t h e d a y- c a re c e n t e r (ye s, n o ), n u m b e r o f h o u r s sp e n t a t t h e d a y- ca re ce n t e r in th e p re vio u s two we e ks, p resen ce a n d n u m -b er o f si-b lin gs resid in g in th e h o u seh o ld .
Th e se va r ia b le s we re o b t a in e d t h ro u gh a n in terview em p loyin g a sta n d a rd ized , p reco d ed , p re vio u sly t e st e d q u e st io n n a ire. As ch a ra ct e r-ist ic s a sso c ia t e d wit h r isk o f d e ve lo p in g ARI, we co n sid ered th o se with a sta tistica lly sign ifc a n t “p” (p <0.05, t wo - t a ile d ), u sin g t h e ifc h isq u a re d o r m u ltiva ria te a n a lysis, with a p re va le n ce ra t io (PR) d iffe re n t fro m o n e fo r t h e la t -t e r. In so m e a n a lyse s we a d o p -t e d -t h e lin e a r t re n d t e st u t ilizin g t h e sa m e st a t ist ica l cr it e ri-on . Th e sa m p le of 106 ch ild ren p rovid ed a p ow-e r o f a p p r o xim a t ow-e ly 80% fo r d ow-e t ow-e c t in g a p re va la n c e ra t io o f 3.0 a s st a t ist ic a lly sign ific a n t a t 5% (t wo t a ile d ), ific o n sid e r in g t h e p r o -p o rtio n o f 2.5 ex-p o sed to 1 n o n -ex-p o sed , a n d a p re va le n c e o f 14% fo r t h e d ise a se a m o n g t h e n o n -exp o sed .
We o b t a in e d c o n se n t fr o m t h e c h ild re n’s p a re n t s a n d t h e d a y-ca re ce n t e r d ire ct o rs a n d gu a ra n t e e d co n fid e n t ia lit y o f t h e in fo rm a t io n o b ta in ed th ro u gh th e in ter views.
We a n a lyze d t h e a sso cia t io n s b e t we e n t h e st u d y ch a ra ct e r ist ics a n d p re va la n ce o f a cu t e re sp ira t o r y in fe c t io n u sin g Pe a r so n’s c h i-sq u a red test, with th e SPSS-PC p ro gra m . In o rd e r t o st u rd y t h e in rd e p e n rd e n t e ffe c t o f a t t e n d a n ce a t th e d a yca re cen ter in rela tio n to co n -fo u n d in g va r ia b le s su c h a s a ge , p re se n c e o f sib lin gs, crowd in g, a n d so cio e co n o m ic st a t u s, we e m p loye d a lo gistic re gre ssio n a n a lysis, u sin g t h e EGRET p r o gra m . Th e o d d s ra t io s o b -t a in e d in -t h e lo git ic re gre ssio n we re -t ra n s-fo r m e d in t o p re va le n c e ra t io s (PR) u sin g t h e fo r m u la d e sc r ib e d b y Mo re ira (1994): PR = OR/ (1 + p re va le n c e o f e ve n t in t h e n o n - e x-p osed X (OR – 1)).
Results
We st u d ie d 106 c h ild re n wit h a m e a n a ge o f 3 ye a r s a n d 4 m o n t h s, wit h a sligh t p re d o m i-n a i-n ce o f fem a les (53%). Ta b le 1 sh ows h ow th e sa m p le in c lu d e d fe we r c h ild re n in t h e 24- 35 m o n t h a ge b ra c ke t , a n d t h a t t h e re wa s a gre a t e r fre q u e n c y o f a c u t e re sp ira t o r y in fe c -tion s in th is grou p.
Th e so c io e c o n o m ic st a t u s o f t h e c h ild re n d id n o t d iffe r gre a t ly fo r t h e ca t e go r ie s ( Ta b le 2), e xce p t fo r th e fa ct th a t 15% h a d a low sco re o f h o u se h o ld go o d s a n d 14% – 17% o f t h e p a
ren ts h a d b egu n o r co n clu d ed a u n iversity ed u -c a t io n . Ch ild re n fro m fa m ilie s wit h lo we r sc o re s o f h o u se h o ld go o d s h a d a h igh e r fre -q u e n c y o f re sp ira t o r y in fe c t io n s (63%), wh ile t h e p a re n t s’ le ve l o f sch o o lin g wa s n o t sign ifica n tly a sso cia te d with th e p re se n ce o f re sp ira -to r y in fectio n .
Wh e n a sse ssin g h o u se h o ld e xp o su re, we fou n d th a t a la rger n u m b er of p erson s sleep in g
Tab le 2
Asso c iatio n b e twe e n so c io e c o no mic c harac te ristic s and ac ute re sp irato ry infe c tio n.
Variables n ARI
Sc o re o f ho use ho ld g o o d s
≤8 16 63%
9 – 11 36 44%
12 – 14 28 41%
≥15 26 28%
Line ar tre nd te st p 0.03
Fathe r’s sc ho o ling (yrs.)
1 – 8 39 51%
9 – 11 45 36%
≥12 15 33%
p 0.4
Mo the r’s sc ho o ling (yrs.)
1 – 8 32 39%
9 – 11 55 46%
≥12 18 33%
p 0.6
Cro wd ing *
1 27 31%
2 51 43%
≥3 29 52%
Line ar tre nd te st p 0.12
* Numb e r o f p e rso ns sle e p ing in same ro o m with the c hild . Tab le 1
Asso c iatio n b e twe e n d e mo g rap hic c harac te ristic s and ac ute re sp irato ry infe c tio n.
Variables n ARI
Ag e (mo nths)
12 – 23 26 42%
24 – 35 13 62%
36 – 47 24 33%
48 – 59 25 48%
60 – 71 18 33%
p 0.5
Se x
Male 50 38%
Fe male 56 46%
in th e ch ild’s b e d ro o m d id n o t sign ifica n tly in -crea se p reva len ce o f ARI.
Wh e n we in ve st iga t e d t h e fre q u e n c y wit h wh ic h t h e c h ild re n h a d p re se n t e d in fe c t io u s resp ira to r y d isea ses p rio r to th e given ep iso d e, n eith er th e u se of a p acifier n or exp osu re to p a r-en ts or rela tives wh o sm oked sh owed a sta tisti-ca lly sign ifitisti-ca n t a sso cia tio n with ARI ( Ta b le 3). Ove ra ll p re va le n ce o f a cu t e re sp ira t o r y in -fection wa s 42%, with 14% for ch ild ren wh o d id n o t a tte n d th e d a y-ca re ce n te r a s co m p a re d to 53% fo r t h o se wh o d id . Th e ch ild re n wh o h a d a t t e n d e d t h e c e n t e r h a d st a ye d t h e re fo r a m e a n o f 68 h o u r s in t h e p re vio u s t wo we e ks (ra n ge wa s 24 t o 100 h o u rs). We fo u n d t h a t a t -t e n d in g -t h e d a y- c a re c e n -t e r wa s a sso c ia -t e d wit h a p p r o xim a t e ly t wic e t h e p re va le n c e o f a cu t e re sp ira t o r y in fe ct io n ; a ft e r a d ju st in g fo r sco re o f h o u se h o ld go o d s, crowd in g, p re se n ce o f sib lin gs, a n d a ge , t h is a sso c ia t io n wa s a p -p roxim a tely fo u r-fo ld .
Atten d a n ce a t th e d a y-ca re cen ter p roved to b e a sso cia t e d wit h p re va le n ce o f ARI a n d wa s t h re e t o five t im e s gre a t e r a s t h e n u m b e r o f h ou rs sp en t th ere in th e p reviou s two weeks in -c re a se d , re ga rd le ss o f t h e s-c o re o f h o u se h o ld go o d s, c rowd in g in t h e h o u se h o ld e n viro n -m en t, th e ch ild ’s a ge, a n d p resen ce of sib lin gs.
H a vin g m o re sib lin gs livin g in t h e sa m e h o u se h o ld wa s n o t sign ific a n t ly a sso c ia t e d with p reva len ce o f ARI.
Discussion
Th is stu d y co n firm s re su lts p u b lish e d b y De n -n y e t a l. (1986), Wa ld e t a l. (1988), Pe t e rsso -n & H a ka n sso n (1990), a n d H u r wit z e t a l. (1991) ch a ra cterizin g grea ter freq u en cy o f resp ira to r y in fe c t io n in c h ild re n a t t e n d in g d a y c a re c e n t e r s. In a d d it io n , it d e m o n st ra t e s t h a t p re va -le n ce o f a cu t e re sp ira t o r y in fe ct io n in cre a se d p ro gre ssive ly fo r p re sc h o o l c h ild re n a s t h e y sp en t m o re tim e in a d a y-ca re cen ter.
Th e c h ild re n wh o h a d st a ye d 24 h o u r s in th e p re vio u s two we e ks h a d b e e n in th e ce n te r fo r six h o u rs o n two d ifferen t d a ys o f th e week, a n d t h o se wh o h a d sp e n t t h e m o st t im e h a d b e e n t h e re fo r 10 h o u r s a d a y. Hu r wit z e t a l. (1991) h a d ch a ra ct e r ize d a we e kly m e a n o f 34 h o u rs in ch ild re n fro m 18 t o 59 m o n t h s o f a ge wh o a tten d ed a d a y-ca re cen ter in Atla n ta . Still, t h is At la n t a st u d y fa ile d t o fin d a gre a t e r fre -q u e n c y o f ARI a m o n g c h ild re n wh o st a ye d a t th e d a y-ca re cen ter fo r over 40 h o u rs a week a s co m p a red to th o se wh o o n ly sta yed d u rin g th e n orm a l sh ift.
In o u r st u d y, we fo u n d t h a t t im e sp e n t a t th e d a y-ca re cen ter a n d p reva la n ce of ARI were in d e p e n d e n t o f o th e r e xp o su res, in clu d in g th e sco re o f h o u se h o ld go o d s, n u m b e r o f p e rso n s s le e p in g in t h e c h ild ’s r o o m , c h ild ’s a ge , a n d p re s e n c e o f s ib lin gs. In t h e s t u d y b y H u r w it z e t a l. (1991), t h e r is k o f re s p ir a t o r y in fe c t io n va r ie d fro m 1.3 (36- 59 m o n t h s) t o 1.6 (6- 17 m o n th s) fo r ch ild ren a tten d in g a n in stitu tio n a l d a y- ca re ce n t e r a s o p p o se d t o t h o se in fa m ily d a y ca re. In a d d itio n , Fo n se ca e t a l. (1993) a n d Victora et a l. (1994) fou n d th a t r isk of p n eu m o -n ia a s d ia g-n o se d ra d io lo gic a lly wa s a p p r o xi-m a te ly 5 to 9 tixi-m e s gre a te r a xi-m o n g ch ild re n a t-t e n d in g d a y- c a re c e n t-t e r s. Howe ve r, in t-t h e se t wo st u d ie s t h e ch ild re n we re u n d e r t wo ye a rs o f a ge, a n d t h e a u t h o rs d id n o t in ve st iga t e a s-so c ia t io n wit h t h e n u m b e r o f h o u r s sp e n t a t th e cen ters.
H u r wit z e t a l. (1991) fo u n d t h a t t h e p r e s -e n c -e o f a gr-e a t -e r n u m b -e r o f s ib lin gs livin g in t h e sa m e h o u se re d u ce d t h e in cid e n ce o f ARI, p a rticu la rly fo r ch ild ren a ged 36 to 59 m o n th s. In o u r st u d y we d e t e c t e d a t re n d fo r c h ild re n livin g with sib lin gs to b e p rotected a ga in st ARI, a s co m p a red to th o se with n o sib lin gs a t h o m e. Wit h re ga rd t o o t h e r co n fo u n d in g fa ct o r s, we fo u n d t h a t c h ild re n wit h lowe r sc o re s fo r h o u se h o ld go o d s h a d a h igh e r p re va le n c e o f ARI. A lo we r sc o re fo r h o u se h o ld go o d s a p -p ea rs to a t lea st -p a r tia lly reflect a lon ger sta y in t h e d a y- c a re c e n t e r, wh ic h is m o re fre q u e n t a m o n g ch ild re n fro m fa m ilie s o f lowe r so cio e -co n o m ic sta tu s.
Tab le 3
Dise ase and b e havio ral histo ry asso c iate d with ac ute re sp irato ry infe c tio n.
Variables n ARI
Pre vio us p ne umo nia
No 81 40%
Ye s 25 29%
p 0.3
Pre vio us o titis
No 41 37%
Ye s 65 46%
p 0.3
Use s p ac ifie r
No 39 39%
Ye s 67 45%
p 0.5
No . o f c ig are tte s smo ke d b y family
0 63 43%
1 – 20 33 39%
21 – 60 10 50%
Pa re n t s o f p re sch o o l ch ild re n in o u r st u d y h a d a h igh e r m e a n le ve l o f sch o o lin g t h a n d e -sc r ib e d fo r p a re n t s o f c h ild re n a t t e n d in g t h e d a y-ca re cen ters in Rio Gra n d e d o Su l th a t were stu d ied u n d er th e PIMES p ro ject (1993). In th e la tte r, 58% o f th e p a re n ts h a d n o t fin ish e d p r im a ry sch ool, a n d on ly 13% h a d fin ish ed p r iim a -r y sch o o l, wh ile in o u -r stu d y 42% o f th e fa th e-rs a n d 52% of th e m oth ers h a d b egu n or con clu d -ed seco n d a ry sch o o l. Th is d ifferen ce in sch o o l-in g m a y b e d u e t o t h e fa c t t h a t a t le a st o n e o f t h e t wo p a re n t s wa s a u n ive rsit y h o sp it a l e m -p loyee.
A gre a t e r n u m b e r o f p e r so n s livin g in t h e h o u se h o ld (p a r t ic u la r ly t h o se sle e p in g in t h e sa m e room with th e ch ild ) p rod u ces grea ter ex-p o su re to resex-p ira to r y in fectio n s. A rela tio n sh iex-p b e twe e n m o re p e rso n s livin g in th e h o u se h o ld a n d in c re a se d in c id e n c e o f lo we r re sp ira t o r y tra ct illn ess h a s b een sh own b y An d erso n et a l. (1988) a n d Vict o ra e t a l. (1989), t h e la t t e r h a vin g fo u n d a n vin cre a se vin d e a t h fro m p n e u m o -n ia . Ou r st u d y sh ows a t re -n d fo r a sso c ia t io -n b etween th e n u m b er of p erson s sleep in g in th e ch ild ’s b ed ro o m a n d p reva len ce o f ARI.
We we re n o t a b le t o d e t e c t a st a t ist ic a lly sign ifica n t a sso ca t io n b e t we e n re sp ira t o r y in -fe ctio n a n d p re se n ce o f sm o ke rs in th e h o u se-h o ld . Vict o ra e t a l. (1994) a lso fa ile d t o fin d a n a sso cia tio n b etween sm o kin g in th e h o u seh o ld a n d p n e u m o n ia . H o lb e rg e t a l. (1993) fo u n d th a t sm o kin g b y d a yca re a tten d a n ts wa s a sso
-Tab le 4
Enviro nme ntal c harac te ristic s asso c iate d with risk o f ac ute re sp irato ry infe c tio n.
Variables n N on-adjusted PR Adjusted
(CI= 95% ) PR*
Day-c are c e nte r
No 29 1.0 1.0
Ye s 77 1.8 (1.4 – 2.4) 4.2
p < 0.001 < 0.001
Ho urs sp e nt in d ay-c are c e nte r in last 14 d ays
0 29 1.0 1.0
24 – 48 12 1.5 (0.9 – 2.4) 3.3
49 – 60 23 2.0 (1.2 – 3.2) 5.3
61 – 100 42 1.9 (1.3 – 2.7) 4.9
p 0.003 < 0.001
Line ar tre nd te st p < 0.001 < 0.001
Numb e r o f sib ling s at ho me
0 57 1.0 1.0
1 32 0.9 (0.5 – 1.4) 0.7
2 – 9 17 0.6 (0.3 – 1.4) 0.5
Line ar tre nd te st p 0.18 0.09
*Pre vale nc e ratio ad juste d fo r sc o re o f ho use ho ld g o o d s, c ro wd ing , c hild ’s ag e , sib ling s, and d ay-c are c e nte r, using lo g istic re g re ssio n
c ia t e d wit h gre a t e r r isk o f ra le s a m o n g t h re e -yea r o ld ch ild ren a tten d in g th e cen ter.
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