The prevalence and risk factors for acute respiratory infections in children aged 0-59 months in rural Malawi: A cross-sectional study

Predictors of severity and prolonged hospital stay of viral acute respiratory infections (ARI) among children under five years in Burkina Faso, 2016-2019

BACKGROUND

Viruses are the leading etiology of acute respiratory infections (ARI) in children. However, there is limited knowledge on drivers of severe acute respiratory infection (SARI) cases involving viruses. We aimed to identify factors associated with severity and prolonged hospitalization of viral SARI among children < 5 years in Burkina Faso.

METHODS

Data were collected from four SARI sentinel surveillance sites during October 2016 through April 2019. A SARI case was a child < 5 years with an acute respiratory infection with history of fever or measured fever ≥ 38 °C and cough with onset within the last ten days, requiring hospitalization. Very severe ARI cases required intensive care or had at least one danger sign. Oropharyngeal/nasopharyngeal specimens were collected and analyzed by multiplex real-time reverse-transcription polymerase chain reaction (rRT-PCR) using FTD-33 Kit. For this analysis, we included only SARI cases with rRT-PCR positive test results for at least one respiratory virus. We used simple and multilevel logistic regression models to assess factors associated with very severe viral ARI and viral SARI with prolonged hospitalization.

RESULTS

Overall, 1159 viral SARI cases were included in the analysis after excluding exclusively bacterial SARI cases (n = 273)very severe viral ARI cases were common among children living in urban areas (AdjOR = 1.3; 95% CI: 1.1-1.6), those < 3 months old (AdjOR = 1.5; 95% CI: 1.1-2.3), and those coinfected with Klebsiella pneumoniae (AdjOR = 1.9; 95% CI: 1.2-2.2). Malnutrition (AdjOR = 2.2; 95% CI: 1.1-4.2), hospitalization during the rainy season (AdjOR = 1.71; 95% CI: 1.2-2.5), and infection with human CoronavirusOC43 (AdjOR = 3; 95% CI: 1.2-8) were significantly associated with prolonged length of hospital stay (> 7 days).

CONCLUSION

Younger age, malnutrition, codetection of Klebsiella pneumoniae, and illness during the rainy season were associated with very severe cases and prolonged hospitalization of SARI involving viruses in children under five years. These findings emphasize the need for preventive actions targeting these factors in young children.

What is associated with reported acute respiratory infection in children under 5 and PCV vaccination in children aged 1-36 months in Malawi? A secondary data analysis using the Malawi 2014 MICS survey

INTRODUCTION

Acute respiratory illness (ARI) is a leading cause of mortality in children under 5 (CU5) in Malawi and can be prevented with 3-dose pneumococcal conjugate vaccine (PCV). There has been no national study in Malawi that seeks to associate social economic factors leading to PCV vaccine uptake and reported acute respiratory infections (RARI). The objectives of our study were to do this.

METHODS

We conducted a cross-sectional analysis of secondary data from the 2014 UNICEF Malawi Multiple Indicator Cluster Survey to construct mutlivariable logistic regression models for independent associations with PCV 1/2/3 immunisation and RARI.

RESULTS

56% of CU5 in Malawi RARI in the 2 week recall period of the survey. Independent associations with reduced odds of RARI were central region living (OR 0.82, 95%CI (0.71-0.93)) middle (OR 0.84, (0.73-0.97)) fourth (OR 0.79, (0.68-0.92)) and richest wealth quintiles (OR 0.73, (0.60-0.88)). Using straw/shrubs for fuel was associated with increased RARI (OR 3.13, (1.00-9.79)). Among 1-36 month olds, in 2014, 93.3% received PCV1, 86.8% PCV2 and 77.0% PCV3. Between 2011-2014, the average age in months for a child to receive PCV1/2/3 reduced by 26.6 for PCV1, 26.4 for PCV2, and 26.1 for PCV 3. Independent predicators for increased odds of all 3 PCV doses, relative to 0-5 age group, were age group 6-11 (OR 21.8, (18.2-26.1) 12-23 (OR 27.5, (23.5-32.2) 24-36 months (OR 9.09, (7.89-10.5), mothers having a secondary (OR 1.52, (1.25-1.84)) or higher education (OR 2.68, (1.43-5.04) when compared to no education, and children in the middle (OR 1.24, (1.07-1.43)) fourth (OR 1.27, (1.09-1.48)) richest (OR 1.54, (1.27-1.88)) wealth quintiles relative to the lowest. Children living with 4-6 other children was independently associated with reduced odds of receiving all 3 PCV doses (OR 0.56, (0.33-0.96).

CONCLUSION

We report nationally representative social economic associations with RARI and PCV vaccine uptake and coverage estimates. We found reductions in the average age a child receives all 3 PCV vaccine doses between 2011-2014.

Prevalence of and factors associated with childhood diarrhoeal disease and acute respiratory infection in Bangladesh: an analysis of a nationwide cross-sectional survey

OBJECTIVES

This study aimed to estimate the prevalence of childhood diarrhoeal diseases (CDDs) and acute respiratory infections (ARIs) and also to determine the factors associated with these conditions at the population level in Bangladesh.

SETTING

The study entailed an analysis of nationally representative cross-sectional secondary data from the most recent Bangladesh Demographic and Health Survey conducted in 2017-2018.

PARTICIPANTS

A total of 7222 children aged below 5 years for CDDs and 7215 children aged below 5 years for ARIs during the survey from mothers aged between 15 and 49 years were the participants of this study. In the bivariate and multivariable analyses, we used Pearson χ2 test and binary logistic regression, respectively, for both outcomes.

RESULTS

The overall prevalence of CDD and ARI among children aged below 5 years was found to be 4.91% and 3.03%, respectively. Younger children were more likely to develop both CDDs and ARIs compared with their older counterparts. Children belonging to households classified as poorest and with unimproved floor materials had a higher prevalence of diarrhoea than those from households identified as richest and with improved floor material, respectively. Stunted children had 40.8% higher odds of diarrhoea than normal children. Being male and having mothers aged below 20 years were 48.9% and two times more likely to develop ARI than female counterparts and children of mothers aged 20-34 years, respectively. Children whose mothers had no formal education or had primary and secondary education had higher odds of ARI compared with children of mothers having higher education.

CONCLUSION

This study found that children aged below 24 months were at higher risk of having CDDs and ARIs. Thus, programmes targeting these groups should be designed and emphasis should be given to those from poorest wealth quintile to reduce CDDs and ARIs.

Predicting environmental risk factors in relation to health outcomes among school children from Romania using random forest model - An analysis of data from the SINPHONIE project

BACKGROUND

Few studies have simultaneously assessed the health impact of school and home environmental factors on children, since handling multiple highly correlated environmental variables is challenging. In this study, we examined indoor home and school environments in relation to health outcomes using machine learning methods and logistic regression.

METHODS

We used the data collected by the SINPHONIE (Schools Indoor Pollution and Health: Observatory Network in Europe) project in Romania, a multicenter European research study that collected comprehensive information on school and home environments, health symptoms in children, smoking, and school policies. The health outcomes were categorized as: any health symptoms, asthma, allergy and flu-like symptoms. Both logistic regression and random forest (RF) methods were used to predict the four categories of health outcomes, and the methods prediction performance was compared.

RESULTS

The RF method we employed for analysis showed that common risk factors for the investigated categories of health outcomes, included: environmental tobacco smoke (ETS), dampness in the indoor school environment, male gender, air freshener use, residence located in proximity of traffic (<200 m), stressful schoolwork, and classroom noise (contributions ranged from 7.91% to 23.12%). Specificity, accuracy and area under the curve (AUC) values for most outcomes were higher when using RF compared to logistic regression, while sensitivity was similar in both methods.

CONCLUSION

This study suggests that ETS, dampness in the indoor school environment, use of air fresheners, living in proximity to traffic (<200 m) and noise are common environmental risk factors for the investigated health outcomes. RF pointed out better predictive values, sensitivity and accuracy compared to logistic regression.

Family Health Behavior: Preventive Measures against Acute Respiratory Infections in Under-5 Children

BACKGROUND

The under-5 mortality rate in Indonesia is 32 per 1,000 live births, still higher than the SDG target. Acute respiratory infections (ARIs), as one of the leading causes of death, must be prevented. Arguments emerge concerning the association of home crowding, health behavior, and the incidence of ARI.

METHODS

A cross-section analysis with the Indonesia Demographic and Health Survey (IDHS) 2017 dataset is performed. Samples are restricted to 16,555 children aged 0-59 months who lived with their mother (eligible women interviewed) during the survey. For each of the variables observed during this study, missing data must be omitted as exclusion criteria. A 100 per cent answer rate was achieved. Logistic regression was used to determine ARI-associated factors, by examining the effect of each explanatory factor (independent variables) on the odds ratio of ARI (one dependent binary variable).

RESULTS

The prevalence of ARI was more common among children living in the poorest households (AOR 1.66; 95% CI, 1.20 - 2.28) and those exposed to indoor tobacco smoke pollution (AOR 1.27; 95% CI, 1.04-1.56). On the other hand, those aged 0-5 months (AOR 0.59; 95% CI, 0.43-0.82), living at home with improved sanitation (AOR 0.74; 95% CI, 0.61-0.89), and exclusively breastfed (AOR 0.85; 95% CI, 0.73-0.99) were less likely to have ARI.

CONCLUSIONS

Home crowding is not associated with ARI. Efforts should be focused on preserving family health behavior. The family functioned as a health-support system for their under-5 children by establishing an indoor tobacco smoking-free zone, practicing exclusive breastfeeding, and enhancing hygiene facilities.

Association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases in sub-Saharan Africa: a systematic review and meta-analysis

In previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird's random-effect model at 95% confidence intervals (CIs). The I² statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results' stability. The Mixed Methods Appraisal Tool (MMAT) - Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I² = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.

Study of the Etiology of Acute Respiratory Infections in Children Under 5 Years at the Dr. Agostinho Neto Hospital, Praia, Santiago Island, Cabo Verde

Background: Acute respiratory infections are one of the major causes of morbidity and mortality in children under 5 years in developing countries and are a challenge for the health system of these countries. In Cabo Verde, despite the lack of recent studies, data indicate that it affects thousands of children, being the fourth leading cause of infant mortality in 2013. The aim of this study was to identify and describe the etiological agents associated with acute respiratory tract infections in children under 5 years old, and their associated risk factors, such as clinical symptoms or socio-demographic characteristics. Methods: Naso-pharyngeal samples were collected from children under 5 years attending at Dr. Agostinho Neto Hospital (Praia, Santiago Island, Cabo Verde) with suspected ARI at different time-points during 2019. Samples were analyzed using FilmArray® Respiratory Panel v. 2.0 Plus to identify etiological agents of ARI. A questionnaire with socio-demographic information was also collected for each participant. Data analyses were carried out using the IBM SPSS version 25 (IBM Corporation, Armonk, NY) and R 3.5.1 statistical software. Results: A total of 129 naso-pharyngeal samples were included in the study. Seventeen different etiologic agents of respiratory infections were identified. HRV/EV was the most frequent agent detected, followed by FluA H3 and RSV. Coinfection with two or more pathogens was detected in up to 20% of positive samples. The results were analyzed in terms of age-group, sex, period of the year and other social and demographic factors. Conclusion: Viruses are the main causative agents of ARI in children <5 years attending at the pediatrics service at the Dr. Agostinho Neto Hospital in Praia city, Santiago Island, Cabo Verde. Some factors are described in this study as statistically associated with the presence of an infectious agent, such as having one or more children sharing the bedroom with an adult and the presence of some clinical symptoms. The data addresses the need for studies on respiratory tract infections in Cabo Verde.

A Qualitative Study on Family Role in the Care and Prevention of Acute Respiratory Infection Among Children in Primary Health Care

Background. Acute Respiratory Infection (ARI) is a common reason that parents seek help to primary health care. In 2016, almost 65% (64.4%) pneumonia and less than 36% (35.6%) non-pneumonia cases were found among the children in Malang. Members of families have important roles to play in individual's health, especially the children. The aim of this study was to explore the roles of family members in the care and prevention of children with ARI. Method. This was a qualitative study, with a phenomenological approach involving 12 informants. An in-depth interview was conducted on each informant having children with recurrent ARI during a space of 3 months in the primary health care. Information collected from the interviews were transcribed and analyzed into different themes. Results. The 4 themes identified include ARI in children, parent roles, influences of family members, and family problems. Different styles of parenting were established between the fathers and mothers also between the mothers and grandmothers on preventing ARI. The behavior of other family members impact both on the risk and prevention of ARI. Some of the identified problems capable of affecting children's health include inability to control the children, unstable income and the stressed condition of most mothers. Conclusion. Behavior of family members impacts on the prevention of ARI among the children. Problems within the family could affect the mothers' or caregivers' psychology, which might in turn impact on the care given to the children infected with ARI or in preventing it.

The prevalence and risk factors for acute respiratory infections in children aged 0-59 months in rural Malawi: A cross-sectional study

Background

Acute Respiratory Infections (ARI) are a leading cause of childhood mortality and morbidity. Malawi has high childhood mortality but limited data on the prevalence of disease in the community.

Methods

A cross‐sectional study of children aged 0‐59 months. Health passports were examined for ARI diagnoses in the preceding 12 months. Children were physically examined for malnutrition or current ARI.

Results

828 children participated. The annual prevalence of ARI was 32.6% (95% CI 29.3‐36.0%). Having a sibling with ARI (OR 1.44, P = .01), increasing household density (OR 2.17, P = .02) and acute malnutrition (OR 1.69, P = .01) were predictors of infection in the last year. The point prevalence of ARI was 8.3% (95% CI 6.8‐10.4%). Risk factors for current ARI were acute‐on‐chronic malnutrition (OR 3.06, P = .02), increasing household density (OR1.19, P = .05) and having a sibling with ARI (OR 2.30, P = .02).

Conclusion

This study provides novel data on the high prevalence of ARI in Malawi. This baseline data can be used in the monitoring and planning of future interventions in this population.