Original articles

Infant morbidity in an Indian slum birth cohort

B P Gladstone¹, J P Muliyil¹, S Jaffar², J G Wheeler², A Le Fevre², M Iturriza-Gomara³, J J Gray³, A Bose¹, M K Estes⁴, D W Brown³, G Kang⁵

¹ Department of Community Health, Christian Medical College, Vellore, India
² London School of Hygiene and Tropical Medicine, London, UK
³ Enteric Virus Unit, Health Protection Agency, London, UK
⁴ Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
⁵ Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India

Professor Gagandeep Kang, Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, India; gkang{at}cmcvellore.ac.in

Objective: To establish incidence rates, clinic referrals, hospitalisations, mortality rates and baseline determinants of morbidity among infants in an Indian slum.

Design: A community-based birth cohort with twice-weekly surveillance.

Setting: Vellore, South India.

Subjects: 452 newborns recruited over 18 months, followed through infancy.

Main outcome measures: Incidence rates of gastrointestinal illness, respiratory illness, undifferentiated fever, other infections and non-infectious morbidity; rates of community-based diagnoses, clinic visits and hospitalisation; and rate ratios of baseline factors for morbidity.

Results: Infants experienced 12 episodes (95% confidence interval (CI) 11 to 13) of illness, spending about one fifth of their infancy with an illness. Respiratory and gastrointestinal symptoms were most common with incidence rates (95% CI) of 7.4 (6.9 to 7.9) and 3.6 (3.3 to 3.9) episodes per child-year. Factors independently associated with a higher incidence of respiratory and gastrointestinal illness were age (3–5 months), male sex, cold/wet season and household involved in beedi work. The rate (95% CI) of hospitalisation, mainly for respiratory and gastrointestinal illness, was 0.28 (0.22 to 0.35) per child-year.

Conclusions: The morbidity burden due to respiratory and gastrointestinal illness is high in a South Indian urban slum, with children ill for approximately one fifth of infancy, mainly with respiratory and gastrointestinal illnesses. The risk factors identified were younger age, male sex, cold/wet season and household involvement in beedi work.

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