Effectiveness of a structured protocol for the prevention of acute respiratory tract infections in daycare centers: A quasi-experimental study

Abstract

BACKGROUND

Acute respiratory tract infections (ARTIs) are a major cause of pediatric morbidity. Daycare centers (DCCs) are high-risk environments where close interpersonal contact facilitates rapid viral transmission. Effective and practical preventive strategies are therefore essential to reduce infection-related burden in these settings.

AIM

To determine the incidence of ARTIs in DCCs following implementation of a structured protocol designed to mitigate respiratory virus transmission.

METHODS

A cluster study was conducted in which two centers were centers to either intervention or control groups via lottery. Although allocation was randomized, the study was not designed as a randomized controlled trial; therefore, potential bias and confounding were considered. Participants were followed for 25 weeks. The primary outcome was physician-diagnosed ARTIs per 100 child-weeks. Incidence rate ratios (IRRs) with 95%CIs were estimated using Poisson regression with a log link and person-time offset, adjusting for covariates under the intention-to-treat principle. Results cautious interpretation Due to limited clusters, results require cautious interpretation. Statistical significance was defined as P < 0.05.

RESULTS

A total of 223 children (149 intervention, 74 control) across 2 clusters were enrolled. By week 25, the cumulative proportion of ARTIs was 18.1% in the intervention group compared with 60.8% in the control group. The incidence rate of ARTIs was lower in the intervention group, with adjusted rates of 1.09 per 100 child-weeks vs 13.00 per 100 child-weeks. The adjusted IRR was 0.14 (95%CI: 0.09-0.22; P < 0.001), suggesting an observed difference in incidence between groups under the study conditions.

CONCLUSION

Protocol implementation was associated with a lower observed incidence of ARTIs under the study conditions. However, interpretation is constrained by the study design, the small number of clusters, and potential sources of bias. Larger, well-designed randomized studies are required to further evaluate this association in daycare settings.

Keywords: Child daycare centers; Common cold; Infectious disease transmission; Prevention; Respiratory tract infection

Core Tip: Acute respiratory tract infections remain a major health concern among children in day care centers. Practical prevention strategies are therefore needed. This study observed an association between the proposed protocol and a reduction in infection incidence under the study conditions. These findings may have implications for informing infection prevention practices in similar day care settings.