Early childhood mortality from community-acquired infections

In this study, the authors identified maternal and child characteristics th at were independent predictors of death from infectious diseases acquired i n the community and determined if these factors could be used to identify g roups of children with excess risk of mortality from infection. A historica l cohort study was conducted of children less than 5 years of age between 1 985 and 1994 (the study period), who were born in Tennessee, and had comple te information on their birth certificates. The primary outcome was death f rom infection identified from death certificates and confirmed through medi cal record review. Among the 1,014,976 children less than 5 years of age, w ho contributed 3,351,568 child-years of follow-up, there were 247 deaths fr om infections (7.4 deaths from infections per 100,000 child-years). Respira tory infections accounted for approximately one half of the deaths. Childre n having three or more older siblings or birth weight of less than 1,500 g had a 3-fold and 10-fold increased risk of death from infection, respective ly, while children with both characteristics had a nearly 20-fold increased risk that persisted beyond the first year of life. Interventions should be focused an prevention of these infections in vulnerable children. At-risk children should be targeted for careful follow-up and early hospitalization when signs of infection develop.