Send to

Choose Destination
Pneumonia (Nathan). 2018 Dec 25;10:14. doi: 10.1186/s41479-018-0058-1. eCollection 2018.

Risk factors associated with nasopharyngeal carriage and density of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children living in Indonesia.

Author information

1Department of Child Health, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java Indonesia.
2Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC Australia.
3Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia.
4Department of Biomedical Sciences, Division of Microbiology, Universitas Padjadjaran, Bandung, West Java Indonesia.
5Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC Australia.
District Health Office of Central Lombok, Praya, West Nusa Tenggara Indonesia.
West Nusa Tenggara Province General Hospital, Mataram, West Nusa Tenggara Indonesia.
8Department of Child Health, Universitas Andalas, Padang, West Sumatra Indonesia.
9London School of Hygiene and Tropical Medicine, London, UK.



Potentially pathogenic bacteria Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus are commonly carried in the nasopharynx of young children. Host and environmental factors have been linked with pathogen carriage, and in many studies rural children have higher carriage rates than their urban counterparts. There are few published data on what factors contribute to increased pathogen density. The objectives of this study were to identify risk factors for nasopharyngeal carriage and density of S. pneumoniae, H. influenzae, M. catarrhalis, and S. aureus in young children in Indonesia.


Risk factor analysis was done using data on bacterial carriage and participant characteristics from a cross-sectional study that enrolled 302 children aged 12-24 months living in urban or semi-rural areas of Indonesia. Associations between host factors and odds of pathogen carriage were explored using logistic regression. Characteristics identified to be independent predictors of carriage by univariable analysis, as well as those that differed between urban and semi-rural participants, were included in multivariable models. Risk factors for increased pathogen density were identified using linear regression analysis.


No differences in carriage prevalence between urban and semi-rural children were observed. Multiple children under the age of 5 years in the household (< 5y) and upper respiratory tract infection (URTI) symptoms were associated with S. pneumoniae carriage, with adjusted odds ratios (aOR) of 2.17 (95% CI 1.13, 4.12) and 2.28 (95% CI 1.15, 4.50), respectively. There was some evidence that URTI symptoms (aOR 1.94 [95% CI 1.00, 3.75]) were associated with carriage of M. catarrhalis. Children with URTI symptoms (p = 0.002), and low parental income (p = 0.011) had higher S. pneumoniae density, whereas older age was associated with lower S. pneumoniae density (p = 0.009). URTI symptoms were also associated with higher M. catarrahlis density (p = 0.035). Low maternal education (p = 0.039) and multiple children < 5y (p = 0.021) were positively associated with H. influenzae density, and semi-rural residence was associated with higher S. aureus density (p < 0.001).


This study provides a detailed assessment of risk factors associated with carriage of clinically-relevant bacteria in Indonesian children, and new data on host factors associated with pathogen density.


Carriage; Density; Haemophilus influenzae; Moraxella catarrhalis; Nasopharynx; Pneumococcus; Risk factors; Streptococcus pneumoniae; Stunting; and Staphylococcus aureus

Conflict of interest statement

Study procedures were approved by the Health Research Ethics Committee, Universitas Padjadaran Faculty of Medicine, Indonesia and the Royal Children’s Hospital Human Research Ethics Committee, Australia (reference number 35258). Written informed consent was obtained from parents/guardians of study participants.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center