Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

Rae MacGinty; Maia Lesosky; Whitney Barnett; Polite M Nduru; Aneesa Vanker; Dan J Stein; Heather J Zar

doi:10.1371/journal.pone.0226144

Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

PLoS One. 2019 Dec 30;14(12):e0226144. doi: 10.1371/journal.pone.0226144. eCollection 2019.

Authors

Rae MacGinty¹, Maia Lesosky², Whitney Barnett¹, Polite M Nduru¹, Aneesa Vanker¹, Dan J Stein³, Heather J Zar¹

Affiliations

¹ Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
² Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
³ Department of Psychiatry and Mental Health, South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.

Abstract

Objective: To investigate the association between maternal antenatal and/or postnatal psychosocial risk factors (including depression, psychological distress, alcohol abuse and intimate partner violence (IPV) and infant lower respiratory tract infection (LRTI) in a low- and middle-income-country (LMIC).

Study design: Pregnant women (n = 1137) enrolled in a South African birth cohort study, the Drakenstein Child Health Study (DCHS) were longitudinally assessed for psychosocial risk factors including depression, psychological distress, alcohol abuse and/or intimate partner violence (IPV). Infants were followed from birth until one year of age for the development of LRTI by active surveillance. Two outcomes were evaluated: any LRTI, and severe and/or hospitalised LRTI. Logistic regression was used to identify associations between individual maternal psychosocial risk factors and LRTI outcomes. Analyses stratified by age were also performed to determine which age groups related to infant LRTI were linked with maternal psychosocial risk factors.

Results: There were 606 LRTI episodes in 369 infants in the first year (crude incidence rate = 0.53 episodes per person-year, 95%CI: 0.50; 0.56); 31% (n = 186) of episodes were severe or hospitalised events. Maternal psychosocial risk factors were associated with LRTI and severe LRTI, particularly postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal IPV. Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months of age, and postnatal maternal IPV was associated with early LRTI and severe forms of LRTI.

Conclusion: The associations between maternal psychosocial risk factors and infant LRTI highlight the potential value of screening for maternal psychosocial risk factors in clinical settings and developing targeted interventions. Such interventions may not only improve maternal well-being, but also help reduce the burden of infant LRTI in LMIC settings.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alcohol Drinking / epidemiology*
Alcohol Drinking / psychology
Cohort Studies
Depression, Postpartum / epidemiology*
Depression, Postpartum / psychology
Developing Countries
Female
Humans
Infant
Logistic Models
Longitudinal Studies
Male
Maternal Age
Pregnancy
Pregnancy Complications / epidemiology
Pregnancy Complications / psychology*
Respiratory Tract Infections / epidemiology*
South Africa
Young Adult

Grants and funding

Funding for the Drakenstein Child Health Study (DCHS) was provided by the Bill & Melinda Gates Foundation (OPP1017641). Additional support was received from the National Research Foundation (105865), South Africa and support for DJS and HJZ was received from the South African Medical Research Council (SAMRC). WB is supported by the SAMRC National Health Scholars program. The study sponsors were not involved in study design, analysis or interpretation of data nor the writing of this manuscript.