Epidemiology and predictors of infant morbidity in rural Malawi

In rural Malawi, 703 newborns were visited monthly for 1 year to describe t he epidemiology and health-seeking behaviour during acute episodes of diarr hoea, respiratory infections (ARI) and malaria. On average, the infants suf fered from 1.3 annual episodes (11.0 illness days) of diarrhoea, 1.1 episod es (9.4 days) of ARI and 0.7 episodes (4.8 days) of malaria. Multivariate a nalysis with polychotomous logistic regression indicated that the amount of morbidity was associated with the child's area of residence, weight in ear ly life, number of siblings, father's marital status and the source of drin king water. Diarrhoea and malaria were most common at 6-12 months of age an d during the rainy months whereas respiratory infections peaked at 1-3 mont hs of age and in the cold season. Ten per cent of diarrhoea, 9% of ARI and 7% of malaria episodes lasted for more than 14 days. Fifty-eight infants di ed, giving case fatality rates of 1% for diarrhoea, 2% for ARI and 4% for m alaria. One-third (37%) of the illness episodes were managed at home withou t external advice. A traditional healer was consulted in 16% of episodes an d a medical professional in 55% of episodes. If consulted, traditional heal ers were seen earlier than medical professionals (median duration after the onset of symptoms 0.7 vs. 1.8 days, P<0.001). Traditional healers were sig nificantly more commonly used by those families whose infants died than by those whose infants did not die (odds ratio 1.8, 95% CI 1.1, 3.0). Our resu lts emphasise the influence of seasonality, care and living conditions on t he morbidity of infants in rural Malawi. Case fatality for diarrhoea, AXI a nd malaria was high and associated with health-seeking behaviour among the guardians. Future interventions must aim at early and appropriate managemen t of common childhood illnesses during infancy.