Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in Bangladesh

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.

Multidimensional energy poverty and acute respiratory infection in children under 5 years of age: evidence from 22 low-income and middle-income countries

BACKGROUND

In low-income and middle-income countries (LMICs), energy poverty has predominantly been studied from the unidimensional perspective of indoor air pollution. Acute respiratory infection (ARI) in children under 5 years of age is the most important disease associated with indoor air pollution attributable to solid fuel use in LMICs. This study aimed to extend the existing knowledge on the association between energy poverty and ARI among children under 5 years of age in LMICs, by adopting a multidimensional perspective.

METHODS

Using Demographic and Health Surveys from 22 LMICs, data from 483 088 children were analysed (mean age 2.00 years (SD 1.41); 51.3% male). Energy poverty was measured using the Multidimensional Energy Poverty Index (MEPI) (range 0-1), which comprises five dimensions of essential energy services. Binary logistic regression models were conducted to study the association between MEPI and ARI, adjusting for child, maternal, household and environmental characteristics.

RESULTS

A 0.1 increase in MEPI score was associated with greater odds of ARI (aOR 1.05; 95% CI 1.04 to 1.07). Likewise, MEPI indicators using biomass for cooking (aOR 1.15; 95% CI 1.07 to 1.23) and lack of access to electricity (aOR 1.17; 95% CI 1.10 to 1.26), entertainment/education appliances (aOR 1.07; 95% CI 1.02 to 1.13) and household appliances (aOR 1.12; 95% CI 1.04 to 1.21) were associated with greater odds of ARI.

CONCLUSION

Multidimensional energy poverty was associated with greater odds of ARI in children under 5 years of age living in 22 LMICs. Hence, our findings justify the design and implementation of interventions that address energy poverty from a multidimensional perspective, integrating energy affordability and accessibility.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

Impact of biomass fuel smoke on respiratory health of children under 15 years old in Madagascar

BACKGROUND

Children exposed to biomass used in households are at risk to develop diseases or respiratory symptoms. In Madagascar more than 95% of households use it daily. The main objective is to study the impact of chronic exposure to biomass on respiratory health of children under 15 years old in Madagascar.

METHODS

Descriptive cross-sectional study conducted with questionnaires among urban and rural population of Antananarivo and Mahajanga provinces between 2016 and 2017. Variables were collected: number of hours spent in kitchen per day, respiratory symptoms and spirometric data. Categorized symptoms score and exposure index expressing chronic exposure to biomass were analyzed with multinomial logistic regression models.

RESULTS

Of the 661 children included in the analysis, 27.7% had 1 respiratory symptom and 29.3% had 2 or more respiratory symptoms. Moderate exposure index (aOR=1.57; CI95%=[1.30-1.89]; p<0.001) and high exposure index (aOR=1.76; CI95%=[1.39-2.24]; p<0.001) were significantly associated with 1 respiratory symptom, adjusted with provinces, household members and visitors smoking, perceived discomfort related to air pollution and birthweight. Exposure index was not significantly associated with an increased risk of having 2 or more respiratory symptoms (p = 0.754).

CONCLUSION

Respiratory symptoms were associated with exposure to biomass, living in coastal areas, birthweight, tobacco and perceived discomfort related to air pollution. Recommendations and actions must be implemented in order to improve respiratory health related to biomass among children.

The effects of social determinants on children's health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother's employment, age of household head, and household's garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.

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.

Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study

Background

Acute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce.

Objective

To determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic.

Methods

A multicenter prospective cohort study called the FARA cohort was developed between April 2020 - December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included.

Results

685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-year CI 95%, (37.3-47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72 h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce.

Conclusions

This multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.

Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets

Background

In India, acute respiratory infections (ARIs) are a leading cause of mortality in children under 5 years. Mapping the hotspots of ARIs and the associated risk factors can help understand their association at the district level across India.

Methods

Data on ARIs in children under 5 years and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhea in children, low birth weight, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM_2.5 and PM₁₀ datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. The geographic information system was used for mapping, and ARI hotspots were identified using the Getis-Ord Gi^* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors.

Results

Acute respiratory infections hotspots were predominantly seen in the north Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap among PM_2.5, PM₁₀, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis showed that PM_2.5, illiteracy levels, diarrhea in children, and maternal body mass index were associated with ARI.

Conclusion

To decrease ARI in children, urgent interventions are required to reduce the levels of PM_2.5 and PM₁₀ (major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.

Understanding the rural-urban disparity in acute respiratory infection symptoms among under-five children in Sub-Saharan Africa: a multivariate decomposition analysis

Background

Acute Respiratory Infections (ARIs) account for more than 6% of the worldwide disease burden in children under the age of five, with the majority occurring in Sub-Saharan Africa. Rural children are more vulnerable to and disproportionately affected by ARIs. As a result, we examined the rural–urban disparity in the prevalence of ARI symptoms and associated factors among children under the age of five in Sub-Saharan Africa.

Methods

We used the most recent Demographic and Health Survey (DHS) data from 36 countries in Sub-Saharan Africa. The study included 199,130 weighted samples in total. To identify variables associated with ARIs symptoms, a multilevel binary logistic regression model was fitted. The Adjusted Odds Ratio (AOR) with a 95% CI was used to determine the statistical significance and strength of the association. To explain the rural–urban disparity in ARI prevalence, a logit-based multivariate decomposition analysis was used.

Results

Being female, ever breastfeeding, belonging to a poorer, better wealth status, and having better maternal educational status were significantly associated with lower odds of ARIs among under-five children. Whereas, small size or large size at birth, not taking vitamin A supplementation, being severely underweight, having diarrhea, didn’t have media exposure, never had the vaccination, being aged 36–47 months, and being aged 48–59 months were significantly associated with higher odds of ARIs among under-five children. The multivariate decomposition analysis revealed that the difference in characteristics (endowment) across residences explained 64.7% of the overall rural–urban difference in the prevalence of ARIs, while the difference in the effect of characteristics (change in coefficient) explained 35.3%.

Conclusion

This study found that rural children were highly affected by ARIs in SSA. To reduce the excess ARIs in rural children, public health interventions aimed at impoverished households, home births, and unvaccinated and malnourished children are crucial.

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries.

METHODS

A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage.

RESULTS

In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets.

CONCLUSIONS

We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries.

TRIAL REGISTRATION NUMBER

CRD42021288971 (PROSPERO).  https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .

Household Air Pollution from Cooking Fuels Increases the Risk of Under-Fives Acute Respiratory Infection: Evidence from Population-Based Cross-Sectional Surveys in Tanzania

Background and Aims:

Increased risk of acute respiratory infection (ARI) in children has been linked with exposure to household air pollution (HAP) from solid biomass fuels. However, information is limited on the trend use of biomass fuels and their association with ARI among children in Tanzania. The current study analysed nationally representative data from the Tanzania Demographic Health Surveys of the years 2004, 2010, and 2015–16 to explore the prevalence of the trend of cooking fuels and ARI as well as ascertain their association among under-fives.

Methods:

A total sample of 20,323 under-fives were included in the current analysis. A mixed-effects multilevel logistic regression was fitted to assess the association between unclean fuels (solid biomass fuels and kerosene) and ARI among under-fives.

Results:

The use of solid biomass fuels has remained persistent high (98.6%) while ARI among under-fives has declined from 16% in 2004 to 9% in 2016; p < 0.001. Furthermore, under-fives exposed to unclean fuel combustion had a significantly higher incidence of ARI (AOR = 3.47; 95% CI, 1.31–9.21).

Conclusion:

Efforts should be made to switch to alternative sources of clean energy such as natural gas and biogas in Tanzania and other countries with similar settings.

Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices

Young children in low- and middle-income countries (LMICs) are vulnerable to adverse effects of household microenvironments. The UN Sustainable Development Goals (SDGs)-specifically SDG 3 through 7-urge for a comprehensive multi-sector approach to achieve the 2030 goals. This study addresses gaps in understanding the health effects of household microenvironments in resource-poor settings. It studies associations of household microenvironment variables with episodes of acute respiratory infection (ARI) and diarrhoea as well as with stunting among under-fives using logistic regression. Comprehensive data from a nationally representative, cross-sectional demographic and health survey (DHS) in Uganda were analysed. We constructed and applied the multidimensional energy poverty index (MEPI) and the three-dimensional women empowerment index in multi-variate regressions. The multidimensional energy poverty was associated with higher risk of ARI (OR = 1.32, 95% CI 1.10 to 1.58). Social independence of women was associated with lower risk of ARI (OR= 0.91, 95% CI 0.84 to 0.98), diarrhoea (OR = 0.93, 95% CI 0.88 to 0.99), and stunting (OR = 0.83, 95% CI 0.75 to 0.92). Women's attitude against domestic violence was also significantly associated with episodes of ARI (OR = 0.88, 95% CI 0.82 to 0.93) and diarrhoea (OR = 0.89, 95% CI 0.84 to 0.93) in children. Access to sanitation facilities was associated with lower risk of ARI (OR = 0.55, 95% CI 0.45 to 0.68), diarrhoea (OR = 0.83, 95% CI 0.71 to 0.96), and stunting (OR = 0.64, 95% CI 0.49 to 0.86). Investments targeting synergies in integrated energy and water, sanitation and hygiene, and women empowerment programmes are likely to contribute to the reduction of the burden from early childhood illnesses. Research and development actions in LMICs should address and include multi-sector synergies.

Prevalence and factors associated with acute respiratory infection among under-five children in selected tertiary hospitals of Kathmandu Valley

BACKGROUND

Acute respiratory infection (ARI) is responsible for about 30-50 percent of visits to health facilities and for about 20-30 percent of admissions to hospitals in Nepal for children under 5 years old. Incidence of ARI in children among under-five years of age is 344 per 1000 in Nepal. Hence, the study aims to find out the prevalence and factors associated with acute respiratory infection among under-five children.

METHODS

A cross-sectional study was conducted at Nepal Medical College and Teaching Hospital and International Friendship Children's Hospital (IFCH) in Kathmandu among children of age 2-59 months attending Pediatric OPD. A total of 286 children were selected using the non-probability (convenient) sampling technique. Data were collected using pre-tested semi-structured tool through interview schedule, and descriptive and inferential statistical analyses were used.

RESULTS

Out of 286 children, more than half of children (60.8%) had Acute Respiratory Infection (ARI). Nearly one-fifth of the children had severe or very severe pneumonia. Acute respiratory infection was significantly associated with religion followed by the family (p = 0.009, OR = 4.59 CI = 1.47-14.36), presence of the child in the kitchen while cooking (p = 0.001, OR = 2.03 CI = 1.17-3.51), and presence of respiratory tract infection in family (p = <0.001 OR = 2.83 CI = 1.59-5.05).

CONCLUSION

The study concluded that male children are more susceptible to acute respiratory infection than female children. Parents and family members should be aware of the prevention of acute respiratory infection by addressing and minimizing the factors contributing to ARI.

Prevalence and determinants of fever, ARI and diarrhea among children aged 6–59 months in Bangladesh

Background

Although efforts have been made by the international community to improve childhood health, risk factors linked with the healthiness of preschool-age children in low and middle-income countries (LMICs) are very diverse. Therefore, this paper examines the prevalence and determinants of fever, acute respiratory infection and diarrhea of preschool children in Bangladesh.

Methods

A sample of 8,421 children from the latest country representative BDHS-2017–18 survey was analyzed by utilizing both the bivariate and multivariate techniques.

Results

The results revealed that about 4.7, 33.1, and 35.8% of the children aged under 5 years had suffered from diarrhea, fever and ARI respectively during the 2 weeks preceding the date of the survey. Demographic, socio-economic, and community and health characteristics likely to play an important role in suffering under-five children from diarrhea, fever, and ARI in Bangladesh. The child’s age of 13–24 months, delivery by cesarean section, unsafe drinking water, unhygienic toilet facility, low level of family wealth index and parental education, a higher number of living children in the household, rural residency and regional difference were all found to be most crucial determinants of the occurrences of fever, ARI and diarrhea.

Conclusion

Interventions should focus on improving these significant demographic, socioeconomic, and community and health risk factors. A special attention is necessary to the people who live in rural areas and geospatially disadvantaged regions.

Incidence and predictors of under-five mortality in East Africa using multilevel Weibull regression modeling

BACKGROUND

In 2017, an estimated 5.3 million under-five children died annually in Sub-Saharan African countries, more than half of those deaths occurred in East Africa. Though East African countries share the huge burden of global under-five mortality, there is limited evidence on the incidence and predictors of under-five mortality. Therefore, this study investigated the incidence and predictors of under-five mortality in East Africa.

METHODS

A community-based cross-sectional study was done based on the Demographic and Health Survey (DHS) data of 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years preceding the survey were included for analysis. The Kaplan-Meier curve and Log-rank test were done to assess the children's survival experience across variable categories. The Global Schoenfeld residual test was employed for checking Proportional Hazard (PH) assumptions and it was violated (p-value< 0.05). Considering the hierarchical nature of DHS data, multilevel parametric survival models were fitted. Model comparison was made by AIC, deviance, and shape of the hazard function. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multilevel Weibull regression analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of under-five mortality.

RESULTS

Under-five mortality rate in East Africa was 51.318 (95% CI: 51.311, 51.323) per 1000 live births. Babies born to mothers attained secondary education and above (AHR = 0.83, 95% CI: 0.75, 0.91), being 2nd - 4th birth order (AHR = 0.62, 95% CI: 0.56, 0.67), ≥ 5th birth order (AHR = 0.68, 95% CI: 0.61, 0.76), health facility delivery (AHR = 0.87, 95% CI: 0.82, 0.93), 1-3 ANC visit (AHR = 0.61, 95% CI: 0.54, 0.68), births interval of 24-48 months (AHR = 0.53, 95% CI: 0.50, 0.57), wanted pregnancy (AHR = 0.72, 95% CI: 0.68, 0.76), middle wealth status (AHR = 0.90, 95% CI: 0.83, 0.97), and richest wealth status (AHR = 0.81, 95% CI:0.73, 0.90) were significantly associated with lower hazards of under-five mortality. Whereas, advanced maternal age (≥35 years) (AHR = 1.13, 95% CI: 1.04, 1.24),, babies born to household who did not have media exposure (AHR = 1.13, 95% CI: 1.07, 1.20), twin births (AHR = 3.81, 95% CI: 3.52, 4.12), being male child (AHR = 1.27, 95%CI: 1.21, 1.33), small birth size at birth (AHR = 1.73, 95% CI: 1.63, 1.84), and large size at birth (AHR = 1.11, 95% CI: 1.04, 1.11) were significantly associated with higher hazards of under-five mortality.

CONCLUSION

Under-five mortality is a major public health concern in East African countries. Health facility delivery, ANC visit, higher wealth status, adequate birth spacing, wanted pregnancy, and maternal education were significantly correlated with a lower risk of under-5 mortality. Whereas, higher birth order, small or large size at birth, male birth, twin birth, advanced maternal age and mothers who didn't have media exposure were significantly correlated with a higher risk of under-five mortality. This study highlights that public health programs should enhance health facility delivery, ANC visit, media exposure, maternal education, and adequate birth spacing to decrease the incidence of under-five mortality in East Africa.

Climate Change and Child Health Inequality: A Review of Reviews

There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low-middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.

Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries

BACKGROUND

The World Health Organisation reported that 45% of global acute respiratory infection (ARI) deaths in children under five years are attributable to household air pollution, which has been recognised to be strongly associated with solid biomass fuel usage in domestic settings. The introduction of legislative restrictions for charcoal production or purchase can result in unintended consequences, such as reversion to more polluting biomass fuels such as wood; which may increase health and environmental harms. However, there remains a paucity of evidence concerning the relative health risks between wood and charcoal. This study compares the risk of respiratory symptoms, ARI, and severe ARI among children aged under five years living in wood and charcoal fuel households across 30 low- and middle-income countries.

METHODS

Data from children (N = 475,089) residing in wood or charcoal cooking households were extracted from multiple population-based Demographic and Health Survey databases (DHS) (N = 30 countries). Outcome measures were obtained from a maternal report of respiratory symptoms (cough, shortness of breath and fever) occurring in the two weeks prior to the survey date, generating a composite measure of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever). Multivariable logistic regression analyses were implemented, with adjustment at individual, household, regional and country level for relevant demographic, social, and health-related confounding factors.

RESULTS

Increased odds ratios of fever (AOR: 1.07; 95% CI: 1.02-1.12) were observed among children living in wood cooking households compared to the use of charcoal. However, no association was observed with shortness of breath (AOR: 1.03; 95% CI: 0.96-1.10), cough (AOR: 0.99; 95% CI: 0.95-1.04), ARI (AOR: 1.03; 95% CI: 0.96-1.11) or severe ARI (AOR: 1.07; 95% CI: 0.99-1.17). Within rural areas, only shortness of breath was observed to be associated with wood cooking (AOR: 1.08; 95% CI: 1.01-1.15). However, an increased odds ratio of ARI was observed in Asian (AOR: 1.25; 95% CI: 1.04-1.51) and East African countries (AOR: 1.11; 95% CI: 1.01-1.22) only.

CONCLUSION

Our population-based observational data indicates that in Asia and East Africa there is a greater risk of ARI among children aged under 5 years living in wood compared to charcoal cooking households. These findings have major implications for understanding the existing health impacts of wood-based biomass fuel usage and may be of relevance to settings where charcoal fuel restrictions are under consideration.

Determinants of Acute Respiratory Infection Among Children Under-Five Years in Indonesia

BACKGROUND

Acute respiratory infection (ARI) among children under five years has been identified as a risk factor for child morbidity, leading to child mortality in Indonesia. Many factors may cause ARI; however, determinants associated with ARI remain unclear in Indonesia.

OBJECTIVES

This study sought to analyze the determinants of ARI among children aged under five years in Indonesia.

METHODS

This study was cross-sectional and utilized secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 15,993 children under five years old were selected as respondents. Chi-squared test and binary logistic regression were used to examine the determinants of ARI among children under five years in Indonesia.

RESULTS

Children aged 1 year [Odds Ratio (OR) = 1.43, 95% CI = 1.04-1.97], children aged 2 years [OR = 1.54, 95% CI = 1.12-2.11], mother's occupation [OR = 1.24, 95% CI = 1.01-2.154], poorest wealth index [OR = 1.91, 95% CI = 1.26-2.89], poor [OR = 1.50, 95% CI = 1.01-2.21], region of residence: Western Indonesia [OR = 1.96, 95% CI = 1.28-2.00], Middle of Indonesia [OR = 2.19, 95% CI = 1.44-3.33] were significantly associated with ARI among children under five years in Indonesia.

CONCLUSIONS

This study revealed that the determinants of ARI among children under five years in Indonesia remain related to the socio-demographic aspect. This research highlighted that the family's and the living area's wealth index remains essential in improving children's health outcomes.

PRACTICE IMPLICATIONS

Our findings support increasing awareness of the low-income family through adequate information and health promotion. Advancing the feasibility, accessibility, and affordability of health information and health services across all Indonesian regions should be strengthened.

Effect of in-house crowding on childhood hospital admissions for acute respiratory infection: A matched case-control study in Bangladesh

OBJECTIVE

Despite previous studies conducted to identify potential household factors, no conclusive evidence exists regarding the effect of in-house crowding on hospitalization for acute respiratory infection (ARI) in Bangladesh. Hence, the aim of this study was to detect such an association in children aged 6-59 months.

METHODS

An age and sex-matched case-control study was conducted involving 348 children in Bangladesh. In-house crowding was measured by people-per-bedroom. Conditional logistic regression was performed to identify the association between in-house crowding and hospitalization for ARI.

RESULTS

In-house overcrowding was associated with a 2.9-fold (95% confidence interval 1.80-4.73) greater adjusted odds of hospitalization for ARI compared to children from less crowded houses. In-house overcrowding was common in rural areas and in households with a poor economic status. Suboptimal breastfeeding and household tobacco smoke exposure were found to prevail in overcrowded households.

CONCLUSION

In-house overcrowding is associated with an increased risk of hospitalization for ARI in young children. Eliminating the fraction of the ARI burden due to in-house overcrowding will rely on increasing awareness regarding indoor air pollution and ventilation in the house and making efforts to avoid smoking in dwellings. Along with the management of crowding, child nutrition and exclusive breast-feeding requirements should be continued for a wide range of child health benefits.

Factors associated with diarrhoea and acute respiratory infection in children under-5 years old in Ghana: an analysis of a national cross-sectional survey

BACKGROUND

Diarrhoea and acute respiratory infection (ARI) are major causes of morbidity and mortality in children under-5 years old in Ghana. The aim of the study was to assess factors associated with diarrhoea and ARI in children under-5 years old.

METHODS

We analysed nationally representative data from the 2017-2018 Ghana Multiple Indicator Cluster Survey (MICS) on 8879 children under-5 years old. Multivariable logistic regression was used to assess the factors associated with diarrhoea and ARI. We applied sample weights, stratification and clustering to account for the sampling design of the MICS.

RESULTS

The prevalence of diarrhoea was 17.0% (95% CI: 15.70, 18.24%). Children aged 6-11 months [Adjusted prevalence odds ratio (aPOR): 2.06, 95% CI: 1.45, 2.92], and 12-23 months (aPOR: 2.37, 95% CI: 1.67, 3.35), had higher prevalence of diarrhoea compared to children aged 0-5 months. Children whose mothers had a college or higher education (aPOR: 0.41, 95% CI: 0.22, 0.78), and a secondary education (aPOR: 0.66, 95% CI: 0.51, 0.86), had 59% and 34% lower odds of diarrhoea respectively, compared to children whose mothers had no formal education. Children from the richest households (aPOR: 0.58, 95% CI: 0.39, 0.86), had 42% lower odds of diarrhoea compared to children from the poorest households. Children resident in rural areas had 22% lower odds of diarrhoea compared to their peers in urban areas (aPOR: 0.78, 95% CI: 0.63, 0.98). The prevalence of ARI was 33.3% (95% CI: 31.72, 34.82%). Children aged 6-11 months (aPOR: 1.43, 95% CI: 1.06, 1.93), and 12-23 months (aPOR: 1.41, 95% CI: 1.10, 1.82), had higher prevalence of ARI compared to children aged 0-5 months.

CONCLUSIONS

This study suggests that the prevalence of diarrhoea and ARI among children aged 6-11 and 12-23 months was higher compared to children aged 0-5 months. Children under-5 years old whose mothers had a secondary or higher education had a lower prevalence of diarrhoea compared to children whose mothers had no formal education.

Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh

Objectives: Risk factors for acute respiratory infections (ARIs) in community settings are not fully understood, especially in low-income countries. We examined the incidence and risk factors associated with ARIs in under-two children from the Microbiota and Health study. Methods: Children from a peri-urban area of Dhaka (Bangladesh) were followed from birth to 2 years of age by both active surveillance of ARIs and regular scheduled visits. Nasopharyngeal samples were collected during scheduled visits for detection of bacterial facultative respiratory pathogens. Information on socioeconomic, environmental, and household conditions, and mother and child characteristics were collected. A hierarchical modeling approach was used to identify proximate determinants of ARIs. Results: Of 267 infants, 87.3% experienced at least one ARI episode during the first 2 years of life. The peak incidence of ARIs was 330 infections per 100 infant-years and occurred between 2 and 4 months of age. Season was the main risk factor (rainy monsoon season, incidence rate ratio [IRR] 2.43 [1.92-3.07]; cool dry winter, IRR 2.10 [1.65-2.67] compared with hot dry summer) in the first 2 years of life. In addition, during the first 6 months of life, young maternal age (<22 years; IRR 1.34 [1.01-1.77]) and low birth weight (<2,500 g; IRR 1.39 [1.03-1.89]) were associated with higher ARI incidence. Conclusions: Reminiscent of industrialized settings, cool rainy season rather than socioeconomic and hygiene conditions was a major risk factor for ARIs in peri-urban Bangladesh. Understanding the causal links between seasonally variable factors such as temperature, humidity, crowding, diet, and ARIs will inform prevention measures.

Investigating the Association between Wood and Charcoal Domestic Cooking, Respiratory Symptoms and Acute Respiratory Infections among Children Aged Under 5 Years in Uganda: A Cross-Sectional Analysis of the 2016 Demographic and Health Survey

Background: Household air pollution associated with biomass (wood, dung, charcoal, and crop residue) burning for cooking is estimated to contribute to approximately 4 million deaths each year worldwide, with the greatest burden seen in low and middle-income countries. We investigated the relationship between solid fuel type and respiratory symptoms in Uganda, where 96% of households use biomass as the primary domestic fuel. Materials and Methods: Cross-sectional study of 15,405 pre-school aged children living in charcoal or wood-burning households in Uganda, using data from the 2016 Demographic and Health Survey. Multivariable logistic regression analysis was used to identify the associations between occurrence of a cough, shortness of breath, fever, acute respiratory infection (ARI) and severe ARI with cooking fuel type (wood, charcoal); with additional sub-analyses by contextual status (urban, rural). Results: After adjustment for household and individual level confounding factors, wood fuel use was associated with increased risk of shortness of breath (AOR: 1.33 [1.10-1.60]), fever (AOR: 1.26 [1.08-1.48]), cough (AOR: 1.15 [1.00-1.33]), ARI (AOR: 1.36 [1.11-1.66] and severe ARI (AOR: 1.41 [1.09-1.85]), compared to charcoal fuel. In urban areas, Shortness of breath (AOR: 1.84 [1.20-2.83]), ARI (AOR: 1.77 [1.10-2.79]) and in rural areas ARI (AOR: 1.23 [1.03-1.47]) and risk of fever (AOR: 1.23 [1.03-1.47]) were associated with wood fuel usage. Conclusions: Risk of respiratory symptoms was higher among children living in wood compared to charcoal fuel-burning households, with policy implications for mitigation of associated harmful health impacts.