Risk Factors for Acute Respiratory Infections in Shai-Osudoku and Ningo-Prampram Districts in the Greater Accra Region of Ghana

Abstract

Background: Acute Respiratory Infections (ARIs) result in a large public health burden worldwide, especially in developing countries. The populations at greatest risk for developing fatal respiratory infections are the very young, the aged, and the immunocompromised. In developing countries, 30% of all patient consultation and 25% of all paediatric admissions are ARIs. In the Shai-Osudoku (SO) and Ningo-Prampram (NP) districts, ARls have continuously ranked second in the top ten causes of morbidity for hospital attendance. Despite the availability of influenza vaccines, Ghana and other West African countries are yet to establish routine immunization policies due to limited information. This study sought to determine the risk factors of ARls by investigating the characteristics of patients with respiratory illness in the two districts. Methods: A health facility-based case-control study was conducted among residents of Shai-Osudoku (SO) and Ningo-Prampram (NP) Districts. Prospective cases were selected from a facility-based surveillance on Acute Respiratory Infections which captured Influenzalike Illness and Severe Acute Respiratory Infection syndromes in residents of SO and NP Districts from April to November 2016. One hundred and forty-seven influenza viruspositive case-patients and 294 influenza virus-negative control-patients were identified to assess the risk factors of influenza among Influenza-like Illness patients. The study also investigated factors for Severe Acute Respiratory Infection (SARI) by identifying 134 SARI patients and 402 out-patients with non-respiratory illness as controls. Crude and adjusted odds ratios were calculated. A purposive selection logistic regression was used for the adjusted modelling. Results: The study identified Influenza A(H3N2) and Influenza B subtypes as the predominant circulating influenza viruses in the two districts from March to November of 2016. Study participants had poor knowledge on the causes and prevention of acute respiratory illness. The Osudoku Health Centre in Shai-Osudoku district reported the highest proportion (29.9%, p = 0.01) of influenza-positive III cases. The crude analysis had the highest odds of an influenza-positive infection in the 5 to <15 years age group (OR:7.80; 95%CI: 2.52 - 24.12). Factors associated with influenza virus infection among Ills were Chills (aOR:4.57; 95%CI: l.51 - 13.76) and a recent travel history in past 2 weeks (aOR:3.05; 95%CI: 1.07 - 8.73). For SARI, Males were more at risk (OR:2.13; 95%CI: 1.40 - 3.23). Just as has been found in some studies, the less than 5-year group formed the majority (42.5%; p<O.OOOI)of SARI case-patients and had an odds ratio of 5.83 (95%CI: 2.89 - 11.86) with ~ 60 years as the reference group. In the adjusted risk factor model for SARI, 8 factors were significantly associated in the presence of other confounders or covariates. They were Sex (Males), (aOR:5.07; 95%CI: 2.28 - 11.25), Diabetes (aOR:4.52; 95%CI:1.17- 17.45), Sore throat (aOR:2.51; 95%CI: 1.20 - 5.24), Diarrhoea (aOR:4.09; 95%CI: 1.38 - 12.08), Chills (aOR: 4.27; 95%CI: 1.74 - 10.49), Perception of cause of SARI as Curse (aOR: 2.44; 95%CI: 1.08 - 5.54) and Onset of SARI occurring in Wet Season (aOR: 2.91; 95%CI: 1.27 - 6.67). The use of LPG (aOR: 0.37; 95%CI: 0.15 - 0.93) as a domestic fuel for cooking on the other hand appeared protective in relation to an outcome of SARI. Conclusion: The study identified factors associated with influenza in patients with influenza-like illness and SARI in Shai-Osudoku and Ningo-Prampram Districts. This important knowledge about associated factors will inform appropriate health interventions to reduce the occurrence of acute respiratory illnesses.