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High Prevalence of Acute Respiratory Tract Infections Among Warao Amerindian Children in Venezuela in Relation to Low Immunization Coverage and Chronic Malnutrition

Verhagen, Lilly M. MD*,†; Warris, Adilia MD, PhD†,‡; Hermans, Peter W. M. PhD†,‡; del Nogal, Berenice MD§; de Groot, Ronald MD, PhD†,‡; de Waard, Jacobus H. PhD*

The Pediatric Infectious Disease Journal: March 2012 - Volume 31 - Issue 3 - p 255–262
doi: 10.1097/INF.0b013e31823eed8e
Original Studies

Background: Higher prevalence rates of acute respiratory tract infections (ARTIs) have been described in Australian and Canadian indigenous populations than in nonindigenous age-matched counterparts. Few studies on ARTIs in South American indigenous populations have been published. We performed a cross-sectional survey to describe the prevalence of upper respiratory tract infections and acute lower respiratory tract infections (ALRTIs) and associations with malnutrition and immunization status.

Methods: From December 1, 2009 to May 31, 2010, 487 Warao Amerindian children 0 to 59 months of age living in the Delta Amacuro in Venezuela were included in a cross-sectional survey. Data were obtained through parent questionnaires, vaccination cards, and physical examinations including anthropometric measurements.

Results: Of the 487 children, 47% presented with an ARTI. Of these, 60% had upper respiratory tract infections and 40% were ALRTI. Immunization coverage was low, with only 27% of all children presenting a vaccination card being fully immunized. The prevalence of malnutrition was high (52%), with stunting (height-for-age <−2 standard deviations) being the most frequent presentation affecting 45% of children. ARTI and ALRTI prevalence diminished with increasing age (odds ratio for ALRTI in children 25–59 months of age vs. children younger than 12 months, 0.49; 95% confidence interval, 0.26–0.93). Furthermore, significant differences in ARTI prevalence were seen between villages. No significant associations between immunization status or malnutrition and ARTI or ALRTI prevalence were identified.

Conclusions: A high prevalence of ARTIs and chronic malnutrition in combination with a low immunization status highlights the need for an integrated approach to improve the health status of indigenous Venezuelan children.

From the *Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela; †Division of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; ‡Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and §Departamento de Pediatría, Hospital de Niños “J.M. de los Rios,” Caracas, Venezuela.

Accepted for publication October 25, 2011.

Supported by LOCTI research grant from Total Venezuela SA. The authors have no other funding or conflicts of interest to disclose.

Address for Correspondence: Lilly M. Verhagen, MD, Laboratory of Pediatric Infectious Diseases, Radboud University Nijmegen Medical Centre, PO Box 9101 (internal post 224), 6500 HB Nijmegen, The Netherlands. E-mail:

© 2012 by Lippincott Williams & Wilkins, Inc.