The incidence of acute respiratory infection in Indonesian infants and association with vitamin D deficiency

Vicka Oktaria; Margaret Danchin; Rina Triasih; Yati Soenarto; Julie E Bines; Anne-Louise Ponsonby; Michael W Clarke; Stephen M Graham

doi:10.1371/journal.pone.0248722

The incidence of acute respiratory infection in Indonesian infants and association with vitamin D deficiency

PLoS One. 2021 Mar 23;16(3):e0248722. doi: 10.1371/journal.pone.0248722. eCollection 2021.

Authors

Vicka Oktaria^{1

2}, Margaret Danchin¹, Rina Triasih², Yati Soenarto², Julie E Bines¹, Anne-Louise Ponsonby¹, Michael W Clarke³, Stephen M Graham¹

Affiliations

¹ Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.
² Child Health Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
³ Metabolomics Australia, Centre for Microscopy, Characterisation, and Analysis, and School of Biomedical Sciences, Faculty of Health, and Medical Sciences, The University of Western Australia, Perth, WA, Australia.

Abstract

Background: Vitamin D deficiency has been associated with acute respiratory infection (ARI) in early life, but this has not been evaluated in Indonesia. We aimed to determine the incidence of ARI in Indonesian infants, and to evaluate the association with vitamin D deficiency.

Methods: From 23 December 2015 to 31 December 2017, we conducted a community-based prospective cohort study in Yogyakarta province. We enrolled 422 pregnant women and followed their infants from birth until 12 months of age for ARI episodes. Vitamin D status was measured at birth and at age six months. We performed Cox proportional hazard regression analysis to evaluate the association between vitamin D deficiency and pneumonia incidence.

Results: At study completion, 95% (400/422) of infants retained with a total of 412 child years of observation (CYO). The incidence of all ARI and of WHO-defined pneumonia was 3.89 (95% CI 3.70-4.08) and 0.25 (95% CI 0.21-0.30) episodes per CYO respectively. Vitamin D deficiency at birth was common (90%, 308/344) and associated with more frequent episodes of ARI non-pneumonia (adjusted odds ratio 4.48, 95% CI:1.04-19.34). Vitamin D status at birth or six months was not associated with subsequent pneumonia incidence, but greater maternal sun exposure during pregnancy was associated with a trend to less frequent ARI and pneumonia in infants.

Conclusion: ARI, pneumonia, and vitamin D deficiency at birth were common in Indonesian infants. Minimising vitamin D deficiency at birth such as by supplementation of mothers or safe sun exposure during pregnancy has the potential to reduce ARI incidence in infants in this setting.

Publication types

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

MeSH terms

Adult
Cohort Studies
Comorbidity
Female
Humans
Incidence
Indonesia / epidemiology
Infant
Infant, Newborn
Male
Maternal Exposure
Prospective Studies
Respiratory Tract Infections / epidemiology*
Risk Factors
Vitamin D Deficiency / epidemiology*
Young Adult

Grants and funding

This study was supported by Murdoch Children's Research Institute in the form of funding awarded to SMG, Schlumberger foundation faculty for the future in the form of funding awarded to VO, Indonesia Endowment Fund for Education (LPDP) Ministry of Finance in the form of a grant awarded to VO (20130822080370), the David Bickart Clinician Research Fellowship from the University of Melbourne awarded to MD, Australia-Indonesia Centre (AIC) in the form of a grant awarded to MD and YS (01HSP1MELDancUGM003), and infrastructure funding from the Western Australian State Government, in partnership with the Australian Federal Government, through Bioplatforms Australia and the National Collaborative Research Infrastructure Strategy awarded to MWC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.