Article Text

Download PDFPDF
Infant morbidity in an Indian slum birth cohort
  1. B P Gladstone1,
  2. J P Muliyil1,
  3. S Jaffar2,
  4. J G Wheeler2,
  5. A Le Fevre2,
  6. M Iturriza-Gomara3,
  7. J J Gray3,
  8. A Bose1,
  9. M K Estes4,
  10. D W Brown3,
  11. G Kang5
  1. 1
    Department of Community Health, Christian Medical College, Vellore, India
  2. 2
    London School of Hygiene and Tropical Medicine, London, UK
  3. 3
    Enteric Virus Unit, Health Protection Agency, London, UK
  4. 4
    Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
  5. 5
    Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
  1. Professor Gagandeep Kang, Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, India; gkang{at}


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: This work was supported by the Wellcome Trust Trilateral Initiative for Infectious Diseases, grant no. 063144. The researchers were independent and had no research input from the funding agency.

  • Competing interests: None.