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

Table 1 Structured multimodal protocol for preventing respiratory tract infections in childcare centers

Time	Activity	Responsible personnel
07:00 a.m.-08:00 a.m.	Teachers conduct health screening for children aged 2-6 years, including temperature measurement and assessment for skin lesions, rashes, and oral abnormalities (e.g., erythematous throat, tonsillar swelling, oral ulcers), to identify potential respiratory infections. Children with suspected infection are referred to a designated healthcare facility. Those without signs of infection are instructed to wear a surgical face mask, perform hand hygiene using alcohol-based hand sanitizer, and attend classes as usual	Duty teacher
08:00 a.m.-11:00 a.m.	During class, teachers assess surgical face masks for contamination and replace them if soiled. Ensure that children wear surgical face masks at all times, except during meals and sleep. Require hand hygiene using alcohol-based hand sanitizer after activity changes or class periods. After restroom use, require handwashing with soap and water and followed by hand drying	Classroom teacher
11:00 a.m.-01:00 p.m.	Remove surgical face masks before meals and perform hand hygiene before and after eating. Surgical face masks are not required during sleep. After restroom use, require handwashing with soap and water followed by hand drying	Classroom teacher
01:00 p.m.-03:00 p.m.	During class, teachers assess surgical face masks for contamination and replace them if necessary. Ensure continuous surgical face masks use except during meals and sleep. Require hand hygiene after activity transitions and after restroom use	Classroom teacher
03:00 p.m.-04:00 p.m.	Clean and disinfect high-touch surfaces (e.g., doorknobs, shared toys) using disinfectants, dishwashing liquid, or soapy water	Housekeeping staff
After 04:00 p.m.	Indoor areas: Classroom floors and walls, and shared toys are cleaned once daily using cleaning agents or disinfectants; Outdoor areas: Cafeteria, playgrounds equipment, shared play equipment, and restrooms are cleaned once daily using cleaning agents or disinfectants	Housekeeping staff

Table 2 Comparative analysis of baseline demographic, n (%)/mean ± SD

Characteristics	Missing	Total (n = 233)	Intervention group (n = 149)	Control group (n = 74)	P value
Sex (male)		112 (50.2)	74 (49.7)	38 (51.4)	0.887
Age (years)		3.3 ± 0.1	3.5 ± 1.1	2.9 ± 0.5	< 0.001
BMI (kg/m2)		16.5 ± 3.0	16.4 ± 3.0	16.7 ± 3.0	0.410
Pre-existing conditions		16 (7.2)	13 (8.7)	3 (4.1)	0.275
Primary caregiver					0.788
Parents		195 (87.4)	131 (87.9)	64 (86.5)
Grandparents		20 (9.0)	12 (8.1)	8 (10.8)
Others		8 (3.6)	6 (4.0)	2 (2.7)
Parent’s occupation	5 (2.2)				0.042
Unemployed		5 (2.3)	4 (2.8)	1 (1.4)
Labor		90 (41.3)	57 (39.3)	33 (45.2)
Agriculture		6 (2.8)	5 (3.5)	1 (1.4)
Business		54 (24.8)	41 (28.3)	13 (17.8)
Government		46 (21.1)	23 (15.9)	23 (31.5)
Private sector		15 (6.9)	13 (9.0)	2 (2.7)
Others		2 (0.9)	2 (1.4)	0
Paternal education	9 (4.0)				< 0.001
Primary school		33 (15.4)	23 (16.2)	10 (13.9)
Secondary school		94 (43.9)	77 (54.2)	17 (23.6)
Higher education		87 (40.7)	42 (29.6)	45(62.5)
Maternal education	7 (3.1)				0.021
Primary school		23 (10.7)	15 (10.5)	8 (11.0)
Secondary school		83 (38.4)	66 (46.2)	17 (23.3)
Higher education		110 (51.0)	62 (43.4)	48 (65.8)
Income sufficiency	3 (1.4)				0.571
Sufficient		183 (83.2)	123 (84.3)	60 (81.1)
Insufficient		37 (16.8)	23 (15.8)	14 (18.9)

BMI: Body mass index.

Table 3 Incidence rate of respiratory tract infections and incidence rate ratios during follow-up, median (interquartile range)

Group	Children (n)	Child-weeks with ARTI (n)	Episodes per child	Observed child-weeks	Incidence rate (per 100 child-weeks)	Crude IRR (95%CI)	P value	Adjusted IRR (95%CI)1	P value
Control	74	132	1 (0-2)	1842	7.17	Reference		Reference
Intervention	149	139	0 (0-0)	3697	3.76	0.52 (0.31-0.88)	0.015	0.14 (0.09-0.22)	< 0.001

¹Adjusted for age, sex, primary caregiver, father’s education, mother’s education, and income sufficiency.

IRR: Incidence rate ratios; ARTI: Acute respiratory tract infections.