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Association of Respiratory Syncytial Virus Infection and Underlying Risk Factors for Death Among Young Infants Who Died at University Teaching Hospital, Lusaka Zambia

  • Forman, Leah S1
  • Macleod, William2
  • Mwananyanda, Lawrence2, 3
  • Kwenda, Geoffrey4
  • Pieciak, Rachel2
  • Mupila, Zachariah3
  • Murphy, Caitriona3
  • Thea, Donald2
  • Chikoti, Chilufya3
  • Yankonde, Baron3
  • Ngoma, Benard3
  • Chimoga, Charles3
  • Gill, Christopher J2
  • 1 Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston, Massachusetts , (United States)
  • 2 Boston University School of Public Health, Department of Global Health, Boston, Massachusetts , (United States)
  • 3 Right to Care—Zambia, Lusaka , (Zambia)
  • 4 School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka , (Zambia)
Published Article
Clinical Infectious Diseases
Oxford University Press
Publication Date
Sep 02, 2021
Suppl 3
DOI: 10.1093/cid/ciab466
PMID: 34472569
PMCID: PMC8411249
PubMed Central
  • AcademicSubjects/MED00290


Background Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections and child mortality. While RSV disease burden is highest in low- and middle-income countries, most knowledge about risk factors for fatal RSV disease comes from high-income settings. Methods Among infants aged 4 days to <6 months who died at University Teaching Hospital in Lusaka, Zambia, we tested nasopharyngeal swabs obtained postmortem for RSV using reverse transcriptase–quantitative polymerase chain reaction. Through a systematic review of death certificates and hospital records, we identified 10 broad categories of underlying medical conditions associated with infant deaths. We used backward-selection models to calculate adjusted and unadjusted risk ratios (RRs) for the association between each underlying condition and RSV status. Results From 720 infant deaths, 6% (44) were RSV-positive, 70% were <4 weeks old, and 54% were male. At least 1 underlying condition was found in 85% of infants, while 63% had ≥2. Prematurity/low birth weight (53% [384]) and complications of labor and delivery (32% [230]) were the most common conditions. Congenital cardiac conditions were significantly associated with an increased risk of RSV infection (4%, 32; adjusted RR: 3.57; 95% CI: 1.71–7.44). No other underlying conditions were significantly associated with RSV. Conclusions Other than congenital cardiac conditions, we found a lack of association between RSV and underlying risk factors. This differs from high-income settings, where RSV mortality is concentrated among high-risk infants. In this population, birth-related outcomes are the highest mortality risk factors. Improved neonatal care remains crucial in the fight against neonatal mortality.

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