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

Autoři: Rae MacGinty aff001;  Maia Lesosky aff002;  Whitney Barnett aff001;  Polite M. Nduru aff001;  Aneesa Vanker aff001;  Dan J. Stein aff003;  Heather J. Zar aff001
Působiště autorů: 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 aff001;  Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa aff002;  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 aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



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.


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.


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.

Klíčová slova:

Alcohol consumption – Depression – Child health – Infants – Intimate partner violence – Medical risk factors – Psychological and psychosocial issues


1. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2016:

2. Zar HJ, Ferkol TW. The global burden of respiratory disease-impact on child health. Pediatr Pulmonol. 2014;49(5):430–4. Epub 2014/03/13. 24610581.

3. Zar H, Barnett W, Myer L, Stein D, Nicol M. Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study. Thorax. 2015;70(6):592–4. 25228292

4. Dagvadorj A, Ota E, Shahrook S, Baljinnyam Olkhanud P, Takehara K, Hikita N, et al. Hospitalization risk factors for children’s lower respiratory tract infection: A population-based, cross-sectional study in Mongolia. Sci Rep. 2016;6:24615. Epub 2016/04/20. 27090182

5. Reyes M, Perzanowski MS, Whyatt RM, Kelvin EA, Rundle AG, Diaz DM, et al. Relationship between maternal demoralization, wheeze, and immunoglobulin E among inner-city children. Ann Allergy Asthma Immunol. 2011;107(1):42–9 e1. Epub 2011/06/28. 21704884

6. Ramratnam SK, Visness CM, Jaffee KF, Bloomberg GR, Kattan M, Sandel MT, et al. Relationships among Maternal Stress and Depression, Type 2 Responses, and Recurrent Wheezing at Age 3 Years in Low-Income Urban Families. Am J Respir Crit Care Med. 2017;195(5):674–81. Epub 2016/09/23. 27654103

7. Mathilda Chiu YH, Coull BA, Cohen S, Wooley A, Wright RJ. Prenatal and postnatal maternal stress and wheeze in urban children: effect of maternal sensitization. Am J Respir Crit Care Med. 2012;186(2):147–54. Epub 2012/05/15. 22582161

8. Klinnert MD, Nelson HS, Price MR, Adinoff AD, Leung DY, Mrazek DA. Onset and persistence of childhood asthma: predictors from infancy. Pediatrics. 2001;108(4):E69. Epub 2001/10/03. 11581477.

9. Kozyrskyj AL, Letourneau NL, Kang LJ, Salmani M. Associations between postpartum depressive symptoms and childhood asthma diminish with child age. Clin Exp Allergy. 2017;47(3):324–30. Epub 2016/10/23. 27770463.

10. Kozyrskyj AL, Mai XM, McGrath P, Hayglass KT, Becker AB, Macneil B. Continued exposure to maternal distress in early life is associated with an increased risk of childhood asthma. Am J Respir Crit Care Med. 2008;177(2):142–7. Epub 2007/10/13. doi: 10.1164/rccm.200703-381OC 17932381.

11. Lange NE, Bunyavanich S, Silberg JL, Canino G, Rosner BA, Celedon JC. Parental psychosocial stress and asthma morbidity in Puerto Rican twins. J Allergy Clin Immunol. 2011;127(3):734–40 e1-7. Epub 2011/01/05. 21194742

12. Giallo R, Bahreinian S, Brown S, Cooklin A, Kingston D, Kozyrskyj A. Maternal depressive symptoms across early childhood and asthma in school children: findings from a Longitudinal Australian Population Based Study. PLoS One. 2015;10(3):e0121459. Epub 2015/03/27. 25811851

13. Wright RJ. Prenatal maternal stress and early caregiving experiences: implications for childhood asthma risk. Paediatr Perinat Epidemiol. 2007;21 Suppl 3:8–14. Epub 2007/11/21. 17935570.

14. Cheng TS, Chen H, Lee T, Teoh OH, Shek LP, Lee BW, et al. An independent association of prenatal depression with wheezing and anxiety with rhinitis in infancy. Pediatr Allergy Immunol. 2015;26(8):765–71. Epub 2015/08/04. 26235785.

15. Flanigan C, Sheikh A, DunnGalvin A, Brew BK, Almqvist C, Nwaru BI. Prenatal maternal psychosocial stress and offspring’s asthma and allergic disease: A systematic review and meta-analysis. Clin Exp Allergy. 2018;48(4):403–14. Epub 2018/01/14. 29331049.

16. Andersson NW, Hansen MV, Larsen AD, Hougaard KS, Kolstad HA, Schlunssen V. Prenatal maternal stress and atopic diseases in the child: a systematic review of observational human studies. Allergy. 2016;71(1):15–26. Epub 2015/09/24. 26395995

17. MacGinty RP, Lesosky M, Barnett W, Stein DJ, Zar HJ. Associations between maternal mental health and early child wheezing in a South African birth cohort. Pediatr Pulmonol. 2018;53(6):741–54. Epub 2018/04/11. 29635887

18. Gray D, Willemse L, Visagie A, Czovek D, Nduru P, Vanker A, et al. Determinants of early-life lung function in African infants. Thorax. 2017;72(5):445–50. Epub 2016/11/20. 27856821

19. Ban L, Gibson JE, West J, Tata LJ. Association between perinatal depression in mothers and the risk of childhood infections in offspring: a population-based cohort study. BMC Public Health. 2010;10:799. Epub 2011/01/05. 21194453

20. Asling-Monemi K, Naved RT, Persson LA. Violence against women and increases in the risk of diarrheal disease and respiratory tract infections in infancy: a prospective cohort study in Bangladesh. Arch Pediatr Adolesc Med. 2009;163(10):931–6. Epub 2009/10/07. 19805712.

21. Silverman JG, Decker MR, Gupta J, Kapur N, Raj A, Naved RT. Maternal experiences of intimate partner violence and child morbidity in Bangladesh: evidence from a national Bangladeshi sample. Arch Pediatr Adolesc Med. 2009;163(8):700–5. Epub 2009/08/05. 19652100

22. Ferdousy EZ, Matin MA. Association between intimate partner violence and child morbidity in South Asia. J Health Popul Nutr. 2015;33:16. Epub 2016/01/31. 26825360

23. Zar HJ, Barnett W, Myer L, Nicol MP. Childhood pneumonia—the Drakenstein Child Health Study. S Afr Med J. 2016;106(7):642–3. Epub 2016/07/08. 27384352.

24. Stein D, Koen N, Donald K, Adnams C, Koopowitz S, Lund C, et al. Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study. J Neurosci Methods. 2015;252:27–35. Epub 2015/03/24. 25797842

25. Brittain K, Myer L, Koen N, Koopowitz S, Donald KA, Barnett W, et al. Risk Factors for Antenatal Depression and Associations with Infant Birth Outcomes: Results From a South African Birth Cohort Study. Paediatric and Perinatal Epidemiology. 2015;29(6):505–14. 26236987

26. Barnett W, Brittain K, Sorsdahl K, Zar HJ, Stein DJ. Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants. Philos Ethics Humanit Med. 2016;11(1):3. Epub 2016/07/21. 27435596

27. le Roux DM, Myer L, Nicol MP, Zar HJ. Incidence of childhood pneumonia: facility-based surveillance estimate compared to measured incidence in a South African birth cohort study. BMJ Open. 2015;5(12):e009111. Epub 2015/12/20. 26685027

28. Integrated management of child illness. Distance learning course: chart booklet. In: Organization WH, editor. World Health Organization2014.

29. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6. doi: 10.1192/bjp.150.6.782 3651732

30. Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, le Roux I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8:9. Epub 2011/05/04. 21535876

31. Beusenberg M, Orley J. A user’s guide to the self reporting questionnaire (SRQ). Geneva: World Health Organization. 1994.

32. Rumble S, Swartz L, Parry C, Zwarenstein M. Prevalence of psychiatric morbidity in the adult population of a rural South African village. Psychol Med. 1996;26:997–1007. 8878332

33. Harpham T, Reichenheim M, Oser R, Thomas E, Hamid N, Jaswal S, et al. Measuring mental health in a cost-effective manner. Health Policy Plan. 2003;18(3):344–9. 12917276

34. Ventevogel P, De Vries G, Scholte W, Shinwari N, Faiz H, Nassery R, et al. Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan. Soc Psychiatry Psychiatr Epidemiol. 2007;42 (4):328–35. 17370049

35. Jewkes R. Intimate partner violence: causes and prevention. The Lancet. 2002;359(9315):1423–9.

36. Shamu S, Abrahams N, Temmerman M, Musekiwa A, Zarowsky C. A systematic review of African studies on intimate partner violence against pregnant women: prevalence and risk factors. PloS one. 2011;6(3):e17591. 21408120

37. WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. 2002 [cited 97 9]. 1183–94].

38. Vanker A, Barnett W, Workman L, Nduru PM, Sly PD, Gie RP, et al. Early-life exposure to indoor air pollution or tobacco smoke and lower respiratory tract illness and wheezing in African infants: a longitudinal birth cohort study. The Lancet Planetary Health. 2017;1(8):e328–e36. 29167839

39. Government Gazette. Republic of South Africa Department of Environmental Affairs. National Ambient Air Quality Standards. 2009.

40. Budree S, Stein DJ, Brittain K, Goddard E, Koen N, Barnett W, et al. Maternal and infant factors had a significant impact on birthweight and longitudinal growth in a South African birth cohort. Acta Paediatr. 2017;106(11):1793–801. Epub 2017/08/11. doi: 10.1111/apa.14015 28796908

41. Fenton T, Kim J. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. 23601190

42. Myer L, Stein D, Grimsrud A, Seedat S, Williams D. Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med. 2008;66:1828–40. 18299167

43. le Roux DM, Nicol MP, Myer L, Vanker A, Stadler JAM, von Delft E, et al. Lower Respiratory Tract Infections in Children in a Well-vaccinated South African Birth Cohort: Spectrum of Disease and Risk Factors. Clin Infect Dis. 2019. Epub 2019/03/30. doi: 10.1093/cid/ciz017 30925191.

44. Wright RJ, Cohen S, Carey V, Weiss ST, Gold DR. Parental stress as a predictor of wheezing in infancy: a prospective birth-cohort study. Am J Respir Crit Care Med. 2002;165(3):358–65. Epub 2002/01/31. doi: 10.1164/ajrccm.165.3.2102016 11818321.

45. McLean DE, Hatfield-Timajchy K, Wingo PA, Floyd RL. Psychosocial Measurement: Implications for the Study of Preterm Delivery in Black Women. American Journal of Preventive Medicine. 1993;9(6):39–81. doi: 10.1016/s0749-3797(18)30665-2

46. Wright RJ. Epidemiology of stress and asthma: from constricting communities and fragile families to epigenetics. Immunol Allergy Clin North Am. 2011;31(1):19–39. Epub 2010/11/26. 21094921

47. Suglia SF, Enlow MB, Kullowatz A, Wright RJ. Maternal intimate partner violence and increased asthma incidence in children: buffering effects of supportive caregiving. Arch Pediatr Adolesc Med. 2009;163(3):244–50. Epub 2009/03/04. doi: 10.1001/archpediatrics.2008.555 19255392

48. Bair-Merritt MH, Voegtline K, Ghazarian SR, Granger DA, Blair C, Family Life Project I, et al. Maternal intimate partner violence exposure, child cortisol reactivity and child asthma. Child Abuse Negl. 2015;48:50–7. Epub 2014/12/02. 25435104

49. Hassan BK, Werneck GL, Hasselmann MH. Maternal mental health and nutritional status of six-month-old infants. Rev Saude Publica. 2016;50:7. Epub 2016/03/24. 27007683

50. Nwabuzor Ogbonnaya I, Keeney AJ, Villodas MT. The role of co-occurring intimate partner violence, alcohol use, drug use, and depressive symptoms on disciplinary practices of mothers involved with child welfare. Child Abuse Negl. 2019;90:76–87. Epub 2019/02/16. doi: 10.1016/j.chiabu.2019.02.002 30769190.

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden