Brief Reports

Indian Pediatrics 1999;36: 11144-1149

Factor Analysis of Acute Respiratory Infections Among Under Fives in Delhi Slums

From the Institute for Research in Medical Statistics, Indian Council of Medical Research, Ansari Nagar, New Delhi 110 029, India.
Reprint requests: Dr. R.K. Gupta, Assistant Director, Institute for Research in Medical Statistics, Indian Council of Medical Research, Ansari Nagar, New Delhi 110 029, India.
Manuscript received: March 1, 1999;
Initial review completed: March 20, 1999;
Revision accepted: June 7, 1999

Infectious diseases like Acute Respiratory Infections (ARI) and Diarrheal Diseases are major contributors towards the overall morbidity in underfives in India. A report(1) by Directorate General of Health Services, Government of India indicates that ARI contributes towards about one fourth to one third of all under five deaths in India. Various studies(2-7) conducted in the country indicate the incidence of ARI and the factors influencing the same. Factors like environmental conditions, living conditions, nutritional status and socio-economic conditions have been mentioned as associated with ARI, based on the influence observed considering each variable as separate.

No attempt has been made to identify factors considering all variables simultaneously which is an appropriate method. In the present paper an attempt has been made in this direction using Factor Analysis Technique which takes into account the inter-relatioship of manifest (i.e., observed) variables.

Subjects and Methods

A field study was carried out in 10 slum colonies of Delhi to estimate the prevalence of communicable diseases including the respira-tory infections using symptomatic approach. For ensuring representation of slums from all parts of Delhi, it was divided into five zones viz. North, South, East, West and Central. Two slum colonies from each zone were selected. The purposive selection of colonies was guided by the required consideration of including all types of slums, namely, resettlement colonies, notified slum colonies, industrialized colonies and un-authorized colonies in the sample. A list of blocks for each colony was available from the District Census Hand Book for Delhi, 1991. The sample comprised of about 400 contiguous households from each colony with random start of a block. The information was collect-ed by conducting door-to-door survey. The survey resulted in coverage of 2177 under five children.

During the visit, information on each member of the family was collected in a pre-designed schedule about his or her suffering from any symptoms related to ARI and other infectious diseases during the previous one month. The symptoms considered for ARI were cough, difficult breathing, sore throat, running nose, fever and ear pain. Under five group was a part of the whole population and a special care was taken to collect information about the same. The data on demographic characteristics, housing and living conditions and other socio-economic characteristics was recorded. The   period of data collection was from October 1995 to June 1996. Diagnosis of ARI was made on symptoms only as narrated by the respondents and may not reflect the true ARI status in some cases. However, the symptoms studied are very close to ARI.

Data is proper for studying factors associated with the diseases. Factor Analysis Technique was used for identification of factors. Colonies having similar conditions were grouped to form clusters for providing better estimates of ARI as colony wise cases were small in number. The cluster formed were as follows:

(i) RC (Resettlement Colonies) _ Seema Puri, Nand Nagari, Jahangir Puri and Shakur Pur.

(ii) NS (Notified Slums) _ Pahari Dhiraj, Qutab Road and Govind Puri.

(iii) IC (Industrialized Colonies) _ Tri Nagar and Shastri Nagar

(iv) UC (Unauthorized Colony) _ Sangam Vihar

Results

The number of houses, subjects and child-ren covered cluster wise are given in Table I.

Table I^__Sample Covered

Prevalence of ARI

The overall prevalence of ARI among underfives was estimated to be around 4.5 per cent for a period of one month in the colonies under study. The prevalence during a period of one month was 3.9, 3.0, 5.2 and 6.5 per cent for RC, NS, IC and UC clusters, respectively. The highest prevalence of ARI was observed in the Unauthorized Colony cluster, i.e., Sangam Vihar among the four clusters.

Factor Analysis

Factor analysis was carried using SPSS/PC+. Important variables such as Age, Sex, Religion, Caste, Number of Family Members, Occupation, Toilet Facility, Per Capita Income Per Year, Living Area, Number of Rooms, Type of House, Type of Family, Place of Children Excreta Disposal and Drainage System were considered. Principal Component Method was used for extraction of factors and Varimax Rotation for identifying meaningful factors. Five factors were retained correspon-ding to eigen value being greater than or equal to 1. The variation explained by Factors 1, 2, 3, 4 and 5  was 24, 14.6, 10.8, 8.7 and 7.4 per cent, respectively. Overall 65.6 per cent variation was explained by these five factors. Factor matrix obtained is given in Table II.

Table II^__Factor Matrix

In factor matrix, it is evident that Factor 1 has high loadings for variables such as number of family members, living area, number of rooms available for living and type of family. Clearly `Crowding Factor' seems to be common among these variables indicating availability of space for living per family member. Factor 2 has high loadings for Occupation and Per Capita income indicating `economic status'. Toilet facility and place of Children excreta disposal have high associations with Factor 3. This factor may be named as `sanitary conditions'. Factor 4 has high loading for `age'. This could be one of the factors. Factor 5 could indicate `social status' having higher loadings for variables, religion and caste which are considered to be social variables.

Discussion

The study has revealed symptomatic prevalence of ARI in under fives around 4.5% for a period of one month. It may be emphasized that estimates may be read in reference to the period of data collection, i.e., October 1995 to June 1996. Prevalence of ARI with symptom cough accompanied by fast breathing has been reported as 4.8% for Delhi for a period of two weeks by National Family Health Survey(8) conducted during the period from April 1992 to September 1993. The highest prevalence of ARI (6.5%) was observed in Sangam Vihar which is an un-authorized colony deprived of basic civic amenities. The study documented that prevalence of ARI declines with age, higher being among children of lower age group. Factor analysis revealed that crowding, economic status and sanitary conditions are important associates of prevalence of ARI. Occurrence of ARI could be reduced by improving living and sanitary conditions. There is also a need to improve the economic status of people living in these areas. These findings are in agreement with several studies(2-4) reporting similar results based on variables associated with such factors as separate. The importance of the present paper lies in using an advanced and proper statistical technique for identification of factors.

References

1. Acute Respiratory Infections and its Control (in Under Five Children). Directorate General of Health Services, National Institute of Communicable Diseases, Government of India, 22-Sham Nath Marg, Delhi 110 054, March 1991.

2. Singh MP, Nayar S. Magnitude of acute respiratory infections in under five children. J Commun Dis 1996; 28: 273-278.

3. Chhabra P, Garg S, Mittal SK, Chhabra SK. Risk factors for acute respiratory infections in under fives in a rural community. Indian J Matern Child Health, 1997; 8: 13-17.

4. Chhabra P, Garg S, Mittal SK, Satyanarayanan L, Mehra M, Sharma N. Magnitude of acute respiratory infections in under fives. Indian Pediatr 1993; 30: 1315-1319.

5. Combined Surveys on ARI, Diarrhea and EPI. National Institute of Communicable Diseases, Delhi, 1988.

6. Walia BNS, Gambhir SK, Singh S, Seoa SR. Socio-economic and etiologic correlates of acute respiratory infections in pre-school children. Indian Pediatr 1988; 25: 607-612.

7. Reddiah VP, Kapoor SK. Acute respiratory infections in rural under fives. Indian J Pediatr 1988; 35: 424-427.

8. National Family Health Survey (1992-93): International Institute of Population Sciences, Mumbai, 1995.