Multilevel Analysis of Lifestyle and Household Environment for Toddlers With Symptoms of Acute Respiratory Infection (ARI) in Indonesia in 2007, 2012, and 2017

Investigating neighbourhood environmental risk factors associated with childhood acute respiratory infection symptoms in Ethiopia mixed effect and multilevel logistic regression analysis based on EDHS 2016

Background

Acute respiratory infection is an infectious illness caused by acute viral or bacterial infection. According to a 2018 WHO report, exposures to indoor and ambient air environmental pollution were contributing factors to a higher risk of respiratory problems following 7 million deaths of children under five globally. Housing conditions such as wall material, roof type, kitchen location, sanitation condition, and cooking fuel type are household-level predictors of acute respiratory disease among children under five years of age.

Method

This research used EDHS-2016 secondary data, which are nationally representative. The data collection period was from January 18, 2016, to June 27, 2016. Among the 16,650 total surveys, 10,006 households that had children below 5 years of age. The outcome variable for this study was acute respiratory infection symptoms. Analyses were performed using STATA Version 17.1. The data were weighted before performing analysis to reinstate the representativeness of the sample. In the bivariable analysis, a p value <0.2 was used to screen for multivariable. Multicollinearity was checked using the variance inflation factor. Then, a multilevel multivariable regression model was used in this study for the analysis of acute respiratory infection symptoms and possible predictor variables. Variables with a p value <0.05 in multivariable regression analysis were considered statistically significant predictors.

Results

Most (95.00%) households commonly used solid fuel for cooking, and household main construction materials: 81.44 and 91.03% of floors and walls of households were constructed with unprocessed natural materials, respectively. The prevalence of acute respiratory infection symptoms among children under five years of age was 7.955% (7.397, 8.551%). The findings indicated that acute respiratory infection symptoms among children under five years of age were significantly linked with the age of the children, diarrhea status, residence, region, fuel type, stool disposal, wall material, and floor material.

Conclusion

Interventions should target modifiable factors such as proper stool disposal of the youngest child, informing the health effects of poor housing conditions such as improving wall and floor construction material to reduce acute respiratory infection symptoms among children under five years of age.

In-house environmental factors and childhood acute respiratory infections in under-five children: a hospital-based matched case-control study in Bangladesh

BACKGROUND

Acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under five globally, particularly in regions like South Asia and sub-Saharan Africa. Bangladesh has made substantial progress in reducing child mortality, yet pneumonia remains a significant contributor to under-five deaths. This study aimed to investigate the association between in-house environmental factors and childhood ARI, considering factors such as household crowding, smoking, and sanitation facilities.

METHODS

This case-control study was conducted at a tertiary-level children's hospital in Dhaka, Bangladesh, from March to September 2019. The study included children aged 6-59 months. Cases were children with ARI symptoms, while controls were children without such symptoms. Rigorous matching by age and gender was employed to ensure comparability. Data were collected through structured questionnaires, and bivariate and conditional logistic regression analyses were performed.

RESULTS

Several household environmental factors were significantly associated with childhood ARIs. Children from overcrowded households (AOR = 2.66, 95% CI = 1.52-4.71; p < 0.001), those using unclean cooking fuels (OR = 2.41, 95% CI: 1.56, 3.73; p = < 0.001), those exposed to in-house smoking (AOR = 1.74, 95% CI = 1.01, 3.05; p = 0.04) and those with unimproved sanitation facilities faced higher odds (AOR = 4.35, 95% CI = 2.14-9.26) of ARIs. Additionally, preterm birth and higher birth order were associated with an increased risk of ARI. In contrast, exclusive breastfeeding was a protective factor.

CONCLUSION

In-house environmental factors, including sanitation, crowding and in-house smoking, significantly influence childhood ARIs. Additionally, birth order and preterm birth play a crucial role. Promoting exclusive breastfeeding is associated with a lower ARI risk among under-five children in Bangladesh. These findings can guide interventions to reduce ARIs in low-income regions, particularly in South Asia.

Exploring the association between household access to water, sanitation and hygiene (WASH) services and common childhood diseases using data from the 2017-2018 Demographic and Health Survey in Benin: focus on diarrhoea and acute respiratory infection

OBJECTIVE

The paper aimed to study the association between household access to water, sanitation and hygiene (WASH) services and the occurrence of diarrhoea and acute respiratory infection among children under 5 years in Benin.

DESIGN

We performed secondary analyses using Benin's Fifth Demographic and Health Survey datasets. The dependent variables were diarrhoea and acute respiratory infection (yes=1, no=0). Among the independent variables were the household access to individual WASH services, grouped as follows: 'basic', 'limited', 'unimproved' and 'no service'. Multivariate logistic regression was used to determine the association between household access to WASH services and the occurrence of diarrhoea and acute respiratory infection. Results from the multivariate logistic regression were presented using adjusted Odds Ratios (aORs) with 95% Confidence Intervals (95% CIs).

SETTING

Benin.

PARTICIPANTS

Children under 5 years successfully surveyed during Benin's Fifth Demographic and Health Survey.

OUTCOME MEASURES

Diarrhoea and acute respiratory infection.

RESULTS

In the current study, 12 034 children under 5 years met the selection criteria and were included in the analyses. The prevalence of diarrhoea and acute respiratory infection was 10.5% (95% CI=9.8% to 11.3%) and 2.9% (95% CI=2.5% to 3.4%), respectively. Children living in households without sanitation service, that is, practising open defecation (aOR=1.9, 95% CI=1.4 to 2.6), and with unimproved (aOR=1.9, 95% CI=1.3 to 2.7) and limited (aOR=1.5, 95% CI=1.1 to 2.2) services were more likely to have diarrhoea compared with children with basic sanitation services. Household access to WASH services was not associated with acute respiratory infection.

CONCLUSION

We suggest reinforcing household access to basic sanitation services to combat diarrhoea in children under 5 years. Further research is needed on the effects of WASH interventions on diarrhoea and acute respiratory infection in children under 5 years.

Prevalence, potential determinants, and treatment-seeking behavior of acute respiratory infection among children under age five in India: Findings from the National Family Health Survey, 2019-21

BACKGROUND

Acute respiratory infections (ARI) are a major cause of mortality and morbidity among under-five children worldwide, particularly in developing countries. Current evidence using nationally representative data on determinants and care-seeking behavior for ARI is limited in the Indian context. Hence, the present study complements the existing literature by examining the prevalence, determinants, and health-care-seeking behavior regarding ARI among Indian children under age five.

STUDY DESIGN

Cross-sectional study.

METHODS

The data for the present study were drawn from the fifth round of the National Family Health Survey (NFHS-5) conducted in 28 states and 8 union territories of India in 2019-21. A total of 222,233 children age less than five years were selected to estimate the prevalence and determinants of ARI, and 6198 children having ARI were selected to explore the treatment-seeking behavior. Bivariate analysis and multivariable binary logistic regression analysis were employed.

RESULTS

Among children under five years, 2.8% suffered from ARI in the two weeks preceding the survey, and 56.1% sought treatment for ARI. Younger age, a recent episode of diarrhea, maternal asthmatic history, and tobacco smoke exposure in the household increase the risk of having ARI. Further, having a separate room as a kitchen in the household reduces the likelihood of having ARI by 14% (AOR: 0.86; CI: 0.79-0.93). Female children (AOR: 0.88; CI: 0.77-1.00) and children belonging to households having difficulty in accessing transport to health facility (AOR: 0.83; CI: 0.69-0.99) are less likely to seek treatment.

CONCLUSION

The study identified several socio-demographic, maternal, and household characteristics associated with ARI and treatment seeking for ARI. The study also recommends making health centers more accessible to the people in terms of proximity and cost.

Differentials in the Prevalence of Acute Respiratory Infections Among Under-Five Children: An Analysis of 37 Sub-Saharan Countries

Objective

We investigated the prevalence and risk factors of ARI in children under 5 years old in 37 SSA countries.

Methods

Data from Demographic and Health Survey (DHS) of 37 African countries was examined in this analysis. Data from children under the age of 5 years old were examined. Forest plot was used to identify disparities in the occurrence of ARIs across SSA countries.

Results

We observed a higher prevalence of ARI among children under 5 in Uganda, Kenya, Sao Tome and Principe (9% each), Gabon, Chad, Eswatini (8% each), Burundi, Ethiopia, Congo Democratic Republic (7.0% each). The prevalence of ARI among under-five children who sought medical advice/treatment from health facility was higher in South Africa (88%), Sierra Leone (86%), Tanzanian (85%), Guinea (83%) and Uganda (80%). The prevalence rate of ARI among under-five children who received antibiotics was higher in Tanzania (61%), Sao Tome and Principe (60%), Rwanda and Congo (58% each), Angola (56.0%), Mozambique (54.0%), Kenya (53.0%), Namibia (52.0%) and Gabon (50.0%). This study found that the household wealth index, maternal education, and urban residence were significantly associated with ARI (p <0.001). A higher prevalence of ARI was observed among urban residents, low income families, and those with mothers with lower education.

Conclusion

ARI prevalence could be reduced by improving household socioeconomic status, child nutrition and community awareness of indoor and outdoor pollution. Interventions and programs focused on early diagnosis, treatment and prevention of ARIs are crucial in reducing ARIs particularly in developing countries.

Trends and determinants of acute respiratory infection symptoms among under-five children in Cambodia: Analysis of 2000 to 2014 Cambodia demographic and health surveys

Acute Respiratory Infections (ARIs) are the leading cause of mortality and morbidity among children under 5 years old and about 1.3 million annually worldwide. Account for 33% of deaths among children under 5 years that occurred in developing countries. In Cambodia, ARIs prevalence in children under 5 years old was 20% in 2000, and 6% in 2014. Hence, the aimed to describe the trends of ARI symptoms among children aged 0-59 months over time using the 2000, 2005, 2010, and 2014 Cambodia Demographic and Health Survey (CDHS) and determined the relationships between socio-demographic, behavioral, and environmental factors with ARI symptoms. We analyzed existing children's data from 2000, 2005, 2010 and 2014 of Cambodia Demographic and Health Survey (CDHS) that used a two-stage stratified cluster sampling design. We limited our analysis to children born in the last five years prior to the surveys, alive and living in households during interview time. Data were pooled across the four survey years for 29,171 children aged 0-59 months. All statistics were carried out using STATA V16, and survey weights were taken into account for the survey design of the CDHS. We used multiple logistic regression to determine the main predictors of ARI symptoms among children under 5 years. ARI symptoms in the previous two weeks in children aged 0-59 months in Cambodia were 19.9% in 2000 to 8.6% in 2005 to 6.4% in 2010, and 5.5% in 2014. Factors independently associated with increased odds of ARI symptoms were children ages 6-11 months with adjusted odds ratio [AOR = 1.91; 95% CI: 1.53-2.38], 12-23 months [AOR = 1.79; 95% CI: 1.46-2.20], and 24-35 months [AOR = 1.41; 95% CI: 1.13-1.76], smoking mother [AOR = 1.61; 95% CI: 1.27-2.05], and using non-improved toilets in households [AOR = 1.20; 95% CI: 0.99-1.46]. However, the following factors were found to be associated with decreased odds of having ARI symptoms: Mothers with higher education [AOR = 0.45; 95% CI: 0.21-0.94], breastfeeding children [AOR = 0.87; 95% CI: 0.77-0.98], and children born into richest wealth quantile [AOR = 0.73; 95% CI: 0.56-0.95], respectively. Survey 2005 [AOR = 0.36; 95% CI: 0.31-0.42], 2010 [AOR = 0.27; 95% CI: 0.22-0.33], 2014 [AOR = 0.24; 95% CI: 0.19-0.30]. The trends of ARI symptoms among children under five in Cambodia significantly decreased from 2000-2014. Smoking mothers, young children ages (0-35 months), and using non-improved toilet in household are factors that independently increased the likelihood that children would develop ARI symptoms. Inversely, factors were found to be associated with decreased odds of having ARI symptoms: Mothers with higher education, breastfeeding children, and children born into the richest wealth quantile and Survey years. Therefore, government and child family programs must promote maternal education, particularly infant breastfeeding. The government ought to support maternal education and infant breastfeeding in the interest of early childhood care.

Gendered Impact of Age, Toilet Facilities, and Cooking Fuels on the Occurrence of Acute Respiratory Infections in Toddlers in Indonesia and the Philippines

INTRODUCTION

The purpose of the study was to analyze the risk factors of acute respiratory infections (ARI) in children under five in Indonesia and the Philippines and to implement a primary review of the characteristics of toddlers and their households in both countries.

METHODS

Data were obtained from the 2017 Demographic and Health Survey (DHS) of Indonesia and the Philippines. The characteristics of children, mothers, and households were analyzed using bivariate and multivariate logistic regression to examine the significant correlations between variables.

RESULTS

The percentage of children under five with ARI symptoms in 2017 was 1.51% in the Philippines and 4.22% in Indonesia. In Indonesia, males aged under one year had significantly lower occurrences of ARI symptoms (OR 0.54, 95% CI 0.36-0.82). In the Philippines, dirty cooking fuels had a significant effect on increasing the likelihood of ARI in female toddlers (OR 4.01, 95% CI 1.02-15.83). In the Philippines, the unavailability of toilet facilities had a significant effect on increasing the likelihood of ARI in male toddlers (OR 2.67, 95% CI 1.15-6.16).

CONCLUSION

The comparison of risk factors between male and female toddlers revealed different results in some variables, as follows: children aged under one year, dirty cooking fuels, and unavailable toilet facilities. The role of parents is fundamental in taking care of female toddlers, since they are more exposed to ARI at the age of under one year and are more prone to indoor air pollution from solid cooking fuels.