Socio-demographic and environmental determinants of infectious disease morbidity in children under 5 years in Ghana

Prevalence and Determinants of Diarrhea, Fever, and Coexistence of Diarrhea and Fever in Children Under-Five in Bangladesh

Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017-2018 Bangladesh Demography and Health Survey (BDHS) were analyzed using multivariable stepwise logistic regression with backward selection. This study found that 5.0% for diarrhea, 34.0% for fever, and 3.0% for the coexistence of both illnesses. Common factors associated with childhood diarrhea and fever included the child's age (12-23 months), and the mother's education. Diarrhea was associated with households with improved water sources and children in the Barisal division, while fever was linked to underweight children and those from more affluent backgrounds. The coexistence of both was significantly linked to underweight children, higher birth orders, and children from the Rajshahi division. Notably, child illnesses were associated with parental education, higher socio-economic status, and access to improved drinking water sources. Diarrhea affects one in 20 children, fever affects one in three, and the coexistence of both conditions affects one in 35 children in Bangladesh. The findings need further research and policy reviews to develop effective interventions and improve child health in Bangladesh.

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.

Associations between infant and young child feeding (IYCF) practice and attitudes toward intimate partner violence (IPV) in Timor-Leste

BACKGROUND

Both the proportions of malnutrition among children and women's justifying partner's intimate partner violence (IPV) are high in Timor-Leste. However, no study has looked at the associations between acceptable infant and young child feeding (IYCF) and women's attitudes toward IPV, as a women's empowerment index. In light of the lack of evidence described above, the study objective was to examine associations between IYCF practice and attitudes toward IPV in Timor-Leste and other women's characteristics.

METHODS

A secondary analysis of children's records from the Demographic and Health Survey Timor-Leste 2016 was conducted using a cross-sectional design. Univariable and multivariable analyses were performed to investigate associations between acceptable IYCF and women's agreement that men are justified in beating their wives for five specific reasons and socio-economic factors.

RESULTS

The day before the survey, 33.4% of mothers gave their child at least the minimum dietary diversity and 46.4% at least the minimum meal frequency; and 15.0% practiced acceptable IYCF. Among all respondents, 17.5% did not agree that all five specific reasons for beating are justified. The adjusted odds ratio (aOR) of acceptable IYCF for mothers who did not agree was 1.51 (95% confidence interval [CI] 1.09-2.09) compared to those who agreed. The aOR of acceptable IYCF for mothers who worked outside the home was 1.48 (95% CI 1.16-1.96) compared to those who did not. Compared to mothers in the poorest quintile, the aORs of acceptable IYCF among those in the poorer, middle, richer, and richest quintiles were 1.33 (95% CI 0.83-2.21), 1.90 (95% CI 1.15-3.14), 2.01 (95% CI 1.17-3,45), and 2.99 (95% CI 1.63-5.50) respectively. Compared to children aged 6-11 months, the aORs of acceptable IYCF for children aged 12-17 months and 18-23 months were 2.14 (95% CI 1.54-2.97) and 1.63 (95% CI 1.14-2.34), respectively.

CONCLUSIONS

Acceptable IYCF was associated with mothers' attitudes toward wife-beating, wealth quintile, and mother's work. Factors that we found associated with IYCF were all related to women's empowerment. It implies that women's empowerment is a key to improving mothers' childcare. Merely promoting a specific childcare practice may not be enough for better child health.

Microbial contamination and quantitative microbial risk assessment of high-density polyethylene (HDPE) film sachet drinking water in Ghana

The present research estimated the impact of storage on the microbial quality of high-density polyethylene drinking water. Samples were taken from two popular companies in Greater Accra using a two-sided exact test in SAS JMP to estimate the sample size. The samples were stored across three temperature profiles at 8 °C, 30 °C (average room temperature), and 40 °C (average outdoor temperature) for 28 days. The samples were examined using standard microbiological methods for heterotrophic plate counts (HPCs), faecal coliforms, and Escherichia coli. The data were described and regressed with Microsoft Excel, Argo 4.3.1, and SAS JMP software. The results demonstrated increasing deterioration of the water samples for all microbial indices at all temperatures with increasing storage duration. The highest HPC, faecal coliforms, and E. coli were 1,312; 622; and 252 cfu/100 mL, respectively, all at 40 °C. The daily risk of infection due to E. coli O157:H7 was 5.22 × 10^-5 infections per child per day for children under 5 years, and 1.6 × 10^-4 attacks per adult per day, compared to the upper limit of 1.0 × 10^-6. These results are higher than recommended exposures, and interventions along the sachet drinking water value chain are needed to protect public health.

Negative effects of short birth interval on child mortality in low- and middle-income countries: A systematic review and meta-analysis

Methods

Eight databases, PubMed, CINAHL, Web of Science, Embase, PsycINFO, Cochrane Library, Popline, and Maternity and Infant Care, were searched, covering the period of January 2000 to January 2022. Studies that had examined the association between SBI and any form of child mortality were included. The findings of the included studies were summarized through fixed-effects or random-effects meta-analysis and the model was selected based on the heterogeneity index.

Results

A total of 51 studies were included. Of them, 19 were conducted in Ethiopia, 10 in Nigeria and 7 in Bangladesh. Significant higher likelihoods of stillbirth (odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.32-3.38), early neonatal mortality (OR = 1.58; 95% CI = 1.04-2.41), perinatal mortality (OR = 1.71; 95% CI = 1.32-2.21), neonatal mortality (OR = 1.85; 95% CI = 1.68-2.04), post-neonatal mortality (OR = 3.01; 95% CI = 1.43-6.33), infant mortality (OR = 1.92; 95% CI = 1.77-2.07), child mortality (OR = 1.67; 95% CI = 1.27-2.19) and under-five mortality (OR = 1.95; 95% CI = 1.56-2.44) were found among babies born in short birth intervals than those who born in normal intervals.

Conclusions

SBI significantly increases the risk of child mortality in LMICs. Programmes to reduce pregnancies in short intervals need to be expanded and strengthened. Reproductive health interventions aimed at reducing child mortality should include proper counselling on family planning, distribution of appropriate contraceptives and increased awareness of the adverse effects of SBI on maternal and child health.

Factors associated with comorbidity of diarrhoea and acute respiratory infections among children under five years in Ghana

Introduction

Globally, childhood mortality is an important public health concern. In Ghana, both diarrhoea and acute respiratory infections (ARIs) are among the top five causes of morbidity and mortality among children under five years old (CU5). Yet, there is a paucity of studies on the comorbidity of diarrhoea and ARIs in CU5 in Ghana.

Aim

This study sought to examine factors associated with comorbidity of diarrhoea and ARIs among CU5 in Ghana.

Methods

The Ghana Demographic and Health Survey (GDHS) 2014 was used for this study. A total of 932 CU5 who had at least one morbidity were included in the study. Binary logistic regression was used to predict the factors associated with comorbidity among CU5.

Results

The prevalence of comorbidity of diarrhoea and ARI among CU5 was 11%. Factors including unimproved source of water, unimproved main floor material, age of child, and initiation of breastmilk were significantly associated with comorbidity of diarrhea and ARI. Improved source of water (AOR = 0.42; 95% CI = 0.22–0.78; p = 0.01) reduces the likelihood of having comorbidity than unimproved source of water. Children aged 36–47 months were less likely (AOR = 0.36; 95% CI = 0.14–0.93; p = 0.04) to have comorbidity than those aged 48–59 months. Also, improved floor materials (AOR = 0.45; 95% CI = 0.22–0.95; p = 0.03) reduces the likelihood of having comorbidity than unimproved floor materials. Children breastfed within the first day of birth were more likely (AOR = 1.66; 95% CI = 1.01–0.2.72; p = 0.04) to have comorbidity than those breastfed immediately after birth.

Conclusion

Policymakers and health practitioners should consider risk factors such as age of child, initiation of breastfeeding, unimproved floor material, and unimproved water supply in the design of interventions to reduce morbidity and mortality associated with comorbidity of diarrhoea and ARI among CU5.

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.

Viral etiology of acute respiratory infections during 2014–16 in Riyadh, Saudi Arabia

Aim: Viral etiology of respiratory infections is not well understood in Saudi Arabia. This study was conceptualized to understand viral etiology in children with acute respiratory tract infections (ARTI) from Riyadh. Patients and methods: Respiratory viruses were detected by real-time PCR in nasopharyngeal aspirates or swab from 580 children aged ≤5 years. Results: Respiratory viruses were detected in 64% of the samples with 6% mixed viral infections. Respiratory syncytial virus, adenovirus, influenza, parainfluenza and human metapneumovirus infections accounted for 42, 20, 16, 12 and 10%, respectively. Maximum prevalence (37%) was among the lowest age group followed by 30% among the 7- to 12-month age group. Conclusion: The prevalence and determinants of viral etiology are in line with the previous report from the region. No major shift in the viral etiologies was observed in the 2-year study period.

Risk Factors Associated with Diarrheal Episodes in an Agricultural Community in Nam Dinh Province, Vietnam: A Prospective Cohort Study

In Vietnam, data on the risk factors for diarrhea at the community level remain sparse. This study aimed to provide an overview of diarrheal diseases in an agricultural community in Vietnam, targeting all age groups. Specifically, we investigated the incidence of diarrheal disease at the community level and described the potential risk factors associated with diarrheal diseases. In this prospective cohort study, a total of 1508 residents were enrolled during the 54-week study period in northern Vietnam. The observed diarrheal incidence per person-year was 0.51 episodes. For children aged <5 years, the incidence per person-year was 0.81 episodes. Unexpectedly, the frequency of diarrhea was significantly higher among participants who used tap water for drinking than among participants who used rainwater. Participants who used a flush toilet had less frequent diarrhea than those who used a pit latrine. The potential risk factors for diarrhea included the source of water used in daily life, drinking water, and type of toilet. However, the direct reason for the association between potential risk factors and diarrhea was not clear. The infection routes of diarrheal pathogens in the environment remain to be investigated at this study site.

Does Enhancing Paid Maternity Leave Policy Help Promote Gender Equality? Evidence from 31 Low- and Middle-Income Countries

Globally, women continue to have less economic decision-making power and face gender-unequal norms at work. Little is known about the impact of national public policies on norms surrounding equality. We examined the impact of extending paid maternity leave policy on decision making in the household and gender norms in the workplace, specifically whether women have sole or joint decision-making power with respect to large household purchases and whether women are perceived as having an equal right to jobs when jobs are scarce. We used difference-in-differences models to analyze the impact of increasing paid maternity leave on outcomes measured in the Demographic Health Surveys and World Values Surveys collected in 31 low- and middle-income countries. A one-month increase in the legislated duration of paid maternity leave increased the odds that women and their partners/spouses reported that women had more decision-making power by 40% (95% CI 1.14, 1.70) and 66% (95% CI 1.36, 2.03), respectively. A one-month increase in the legislated duration of paid maternity leave was associated with 41.5 percentage-point increase in the prevalence of individuals disagreeing with the statement that "when jobs are scarce, men should have more right to a job than women." More generous maternity leave increases gender equality in economic decision making in the household and improves gender norms related to work. Future studies should examine the impact of paternity leave and non-discrimination policy, as well as other large-scale policies aiming to improve gender equality at work and at home.

Factors related with the incidence of acute respiratory infections in toddlers in Sleman, Yogyakarta, Indonesia: Evidence from the Sleman Health and Demographic Surveillance System

Various factors associated with Acute Respiratory Infections (ARI) in toddlers have been widely observed, but there are no studies using data from the Sleman Health and Demographic Surveillance System (HDSS). This study aimed to determine the factors associated with ARI in children under five in Sleman, Yogyakarta, Indonesia. This research was an observational analytic study with a cross-sectional design, using secondary data from the Sleman HDSS. Data of 463 children under five who met the inclusion and exclusion criteria were used in this study. Inclusion criteria were toddlers who have complete observed variable data. The variables observed were the characteristics of children under five, the attributes of the mother, the physical condition of the house, the use of mosquito coils, sanitation facilities, and sources of drinking water. The exclusion criteria were toddlers with pulmonary tuberculosis in the past year. Data analysis used chi-squared tests for bivariate analysis and multivariate logistic regression analysis. The results showed that working mothers had a greater risk of ARI under five children with OR 1.46 (95% CI = 1.01-2.11), and groundwater as a water source was a protective factor against the occurrence of ARI in toddlers with OR 0.46 (95% CI = 0.26-0.81). After a logistic regression analysis was performed, only the drinking water source variable had a statistically significant relationship with the incidence of ARI in children under five with OR = 0.47 (95% CI = 0.268-0.827). Research on the relationship between water quality and the incidence of ARI in children under five is needed to follow up on these findings.

Spatial patterns of lower respiratory tract infections and their association with fine particulate matter

This study aimed to identify the spatial patterns of lower respiratory tract infections (LRIs) and their association with fine particulate matter (PM_2.5). The disability-adjusted life year (DALY) database was used to represent the burden each country experiences as a result of LRIs. PM_2.5 data obtained from the Atmosphere Composition Analysis Group was assessed as the source for main exposure. Global Moran's I and Getis-Ord Gi* were applied to identify the spatial patterns and for hotspots analysis of LRIs. A generalized linear mixed model was coupled with a sensitivity test after controlling for covariates to estimate the association between LRIs and PM_2.5. Subgroup analyses were performed to determine whether LRIs and PM_2.5 are correlated for various ages and geographic regions. A significant spatial auto-correlated pattern was identified for global LRIs with Moran's Index 0.79, and the hotspots of LRIs were clustered in 35 African and 4 Eastern Mediterranean countries. A consistent significant positive association between LRIs and PM_2.5 with a coefficient of 0.21 (95% CI 0.06-0.36) was identified. Furthermore, subgroup analysis revealed a significant effect of PM_2.5 on LRI for children (0-14 years) and the elderly (≥ 70 years), and this effect was confirmed to be significant in all regions except for those comprised of Eastern Mediterranean countries.

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.

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.

Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia's demographic and health surveys (1996-2014)

Introduction

acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under the age of five years globally accounting for 16% of deaths. In Zambia, ARI accounts for 30-40% of children's outpatient attendance and 20-30% of hospital admissions. We assessed trends and factors associated with ARI among under-five children in Zambia from 1996 to 2014.

Methods

we analysed the Zambia demographic and health survey data for 1996, 2002, 2007 and 2014 of under five children and their mothers. We extracted data using a data extraction tool from the women's file. We analysed trends using chi square for trends. We conducted a complex survey multivariable logistic regression analysis, reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values.

Results

we included a total of 6,854 and 2,389 (8%) had symptoms consistent with ARI. A 2% upward trend was noted between the 1996 and 2002 surveys but a sharp decline of 10% occurred in 2007. The chi2 trend test was significant p < 0.001. Children whose mothers had secondary or higher education were less likely to have ARI (AOR 0.30 95% CI 0.15-0.58) compared to those with no education. Underweight children had 1.50 times increased odds of having ARI (AOR 1.50 95% CI 1.25 - 1.68) compared with children who were not. Use of biomass fuels such as charcoal (AOR 2.67 95% CI 2.09 - 3.42) and wood (2.79 95% CI 2.45 -3.19) were associated with high odds for ARI compared to electricity.

Conclusion

the prevalence of ARI has declined in Zambia from 1996 to 2014. Factors associated with occurrence of ARI included being a child under one year, underweight, use of biomass fuel such as charcoal and wood. Interventions to reduce the burden of ARI should be targeted at scaling up nutrition programs, as well as promoting use of cleaner fuels.

Acute respiratory infection and its associated factors among children under-five years attending pediatrics ward at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: institution-based cross-sectional study

BACKGROUND

Acute respiratory infection is manifested by cough accompanied by short rapid breathing which may be associated with death especially when there are other co-morbidities. From an estimated 5.4 million children under -five years that died in 2017-roughly half of those deaths occurred in sub-Saharan Africa and acute respiratory infection contributed to the highest number of deaths. The current study aimed at evaluating the prevalence of, and risk factors associated with, acute respiratory infection hospitalization in under-five years children hospitalized at the University of Gondar Comprehensive Specialized Hospital.

METHOD

An institution-based cross-sectional study was carried out from May 01/2019 to July 10/2019. After the selection of participants using simple random sampling, face to face interview was performed using a semi-structured pre-tested questionnaire. Data were also extracted from medical registration charts. We used EPI Info 7 for data entry and exported into SPSS 21 for analysis. Results were presented by simple frequency, percentage and mean for descriptive variables. Binary logistic regression analysis was used to test the association of covariates and outcome variable. Variables with a p < 0.2 during the bivariable binary logistic regression analysis were included in the multivariable logistic regression analysis. Variables with p < 0.05 were considered as significantly associated with acute respiratory infection. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline.

RESULTS

Four hundred and twenty-two under-five years' children attending the Pediatrics ward were included in this study. The prevalence of acute respiratory infection among under-five years' children in this study was 27.3%. Children aged below 12 months (AOR:3.39, 95% CI: 1.19, 9.65), maternal age of 16 to 27 years (AOR: 1.95, 95% CI: 1.03, 3.70), maternal age of 28 to 33 years (AOR: 2.73, 95% CI: 1.40, 5.34), lack of maternal awareness of handwashing (AOR: 2.79, 95% CI: 1.15, 6.76), rural residence (AOR:2.27, 95% CI: 1.18, 4.39), and lack of meningitis (AOR: 0.22, 95% CI: 0.08, 0.55), were significantly associated with acute respiratory infection.

CONCLUSION

Acute respiratory infection was common among children under-five years. Child and maternal age, residence and maternal hand hygiene information were significant factors identified to be associated with an acute respiratory infection.

Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Does Not Increase Child Morbidity in a Semiurban Setting in Ghana: A Secondary Outcome Noninferiority Analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD Randomized Controlled Trial

BACKGROUND

Adequate knowledge about the safety of consumption of small-quantity lipid-based nutrient supplements (SQ-LNSs) is needed.

OBJECTIVE

We aimed to test the hypothesis that SQ-LNS consumption is noninferior to control with respect to child morbidity.

METHODS

Women (n = 1320) ≤20 wk pregnant were assigned to iron and folic acid until delivery with no supplementation for offspring; or multiple micronutrient supplements until 6 mo postpartum with no supplementation for offspring; or SQ-LNSs until 6 mo postpartum, and SQ-LNSs for offspring (6 mg Fe/d) from 6 to 18 mo of age [the lipid-based nutrient supplement (LNS) group]. We assessed noninferiority (margin ≤20%) between any 2 groups during 0-6 mo of age, and between the non-LNS and LNS groups during 6-18 mo of age for caregiver-reported acute respiratory infection, diarrhea, gastroenteritis, fever/suspected malaria, poor appetite, and "other illnesses."

RESULTS

During 0-6 mo of age, 1197 infants contributed 190,503 infant-days. For all morbidity combined, overall mean incidence (per 100 infant-days) was 3.3 episodes, overall mean prevalence (percentage of infant-days) was 19.3%, and the 95% CIs of the incidence rate ratio (IRR) and longitudinal prevalence rate ratio (LPRR) between any 2 groups were ≤1.20. During 6-18 mo, there were 240,097 infant-days for the non-LNS group and 118,698 for the LNS group. For all morbidity combined, group mean incidences were 4.3 and 4.3, respectively (IRR: 1.0; 95% CI: 1.0, 1.1), and mean prevalences were 28.2% and 29.3%, respectively (LPRR: 1.0; 95% CI: 1.0, 1.1). Noninferiority was inconclusive for diarrhea, fever/suspected malaria, and poor appetite.

CONCLUSIONS

SQ-LNS consumption does not increase reported overall child morbidity in this population compared with the 2 other treatments.This trial was registered at clinicaltrials.gov as NCT00970866.

Factors associated with diarrhea and acute respiratory infection in children under two years of age in rural Bangladesh

Background

Diarrhea and acute respiratory infection (ARI) are major causes of child mortality. We aimed to identify risk factors associated with diarrhea and ARI among children under 2 years of age in rural northern Bangladesh.

Method

We collected information on diarrhea and ARI in the previous 14 days and the previous 6 months at 6, 12, 18 and 24 months of age as part of a longitudinal, cluster randomized effectiveness trial, the Rang-Din Nutrition Study which enrolled 4011 pregnant women at ≤20 gestational weeks. Women and their children were followed up until 2 years postpartum. Information on household socioeconomic status, type of toilet, garbage disposal system, food insecurity, number of under-five children in the household, type of family, maternal characteristics and child characteristics was collected at baseline and/or at 6, 12, 18 and 24 months postpartum. Data on newborn health and feeding behaviors were collected within 72 h of delivery. Associations between potential risk factors and morbidity prevalence outcomes were assessed using logistic regression controlling for potential confounders.

Results

Out of 3664 live born children, we collected information from ~ 3350 children at 6, 12, 18 and 24 months of age. Diarrhea in the previous 14 days, and in the previous 6 months, was associated with maternal depression score and food insecurity; diarrhea in the previous 6 months was also associated with family type (nuclear vs. joint). ARI in the previous 14 days was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity and sex. Cough or nasal discharge in the past 6 months was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity, sex and perceived overall physical condition of the infant after birth.

Conclusion

Maternal depression and food insecurity appear to be important risk factors for diarrhea and respiratory infection among children under 2 years of age in this setting. These findings suggest that policies and programs that include strategies to address maternal mental health and household food insecurity may contribute to improved child health.

Trial registration

The trial was registered with the US National Institutes of Health at ClinicalTrials.gov, # NCT01715038, with registration completed October 26, 2012. 

Prevalence and determinants of Acute Lower Respiratory Infections among children under-five years in sub-Saharan Africa: Evidence from demographic and health surveys

Acute Lower Respiratory Infections (ALRIs) account for 5.8 million deaths globally and 50% of these deaths occur in sub-Saharan Africa. In this paper, we examined the prevalence and determinants of ALRIs among children under-five years in 28 sub–Saharan African countries. We used data from the most recent (2011–2016) Demographic and Health Surveys of the 28 countries. Women aged 15–49 (N = 13,495) with children under-five years participated in the study. Data were extracted and analysed using STATA version 14.2. Bivariate and multivariate analyses were done to establish associations between the outcome and explanatory variables. The prevalence of ALRI for all the countries was 25.3%. Congo (39.8%), Gabon (38.1%), Lesotho (35.2%), and Tanzania (35.2%) were the countries with the highest prevalence of ALRIs. The results from the multivariate analyses showed that children aged 24–59 months (AOR = 1.15; 95% CI = 1.04–1.28), and children who received intestinal parasite in the 6 months preceding the survey (AOR = 1.11; 95% CI = 1.02–1.22) had higher odds of developing ALRIs. However, children whose mothers were employed (AOR = 0.77; 95% CI = 0.64–0.94) and those whose households used improved toilet facilities (AOR = 0.72; 95% CI = 0.64–0.97) had lower odds of contracting ALRIs. Our findings underscore the need for stakeholders in health in the various sub-Saharan African countries, especially those worst affected by ALRIs to implement programmes and develop policies at different levels aimed at reducing infections among children under-five years. Such strategies should specifically focus on improving the administration of medications for intestinal worms, health education to mothers with children under five on ALRIs and improving the sanitation situations of households through the provision of improved toilet facilities.

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We examined the prevalence and determinants of Acute Lower Respiratory Infections (ALRIs) among children under-five years in sub–Sahara Africa.

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ALRIs account for 5.8 million deaths globally.

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The prevalence of ALRI is 25.3% in sub-Sahara Africa.

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Children aged 24–59 months had higher odds of developing ALRIs.

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Employed mothers and improved toilet facility are protective factors against ALRIs.

Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis

INTRODUCTION

Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever.

MATERIALS AND METHODS

A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity.

RESULTS

The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage.

CONCLUSIONS

High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.

Risk factors for acute childhood diarrhea: A cross-sectional study comparing refugee camps and host communities in Gambella Region, Ethiopia

BACKGROUND

Diarrhea is one of the most common causes of child morbidity and mortality in refugee camps, aggravated by inadequate water, sanitation and hygiene services, and malnutrition, particularly in developing countries.

METHODOLOGY

A comparative cross-sectional study was conducted to assess acute diarrhea and associated risk factors among under-five children in refugee and host communities in Gambella Region, Ethiopia. Descriptive statistics were used, and bivariate and multivariate logistic regressions were performed to identify variables associated with diarrhea.

RESULTS

A total of 1667 under-five children was included in this study, and prevalence of diarrhea differed between the refugee (38%) and host (33%) communities [OR = 1.37, 95% CI 1.04, 1.8]. Refugee camp households using uncovered water containers, consuming low quantities of water, and lacking hand washing setups were more likely to report children with diarrhea. Within host communities, households were more likely to report acute childhood diarrhea if they consumed surface water or did not have a latrine.

CONCLUSION

The two-week prevalence of diarrhea was significantly higher among children in the refugee camps than those in the host communities. Therefore, further collaboration between government and non-government organizations is required to identify persisting factors of diarrhea transmission in various communities in the region.

Determinants of childhood diarrhea in Medebay Zana District, Northwest Tigray, Ethiopia: a community based unmatched case-control study

Background

Globally, childhood diarrhea is amongst the most prevalent health problems and accounts for 9% of all deaths in children under-five. In Ethiopia, childhood diarrhea is a major public health problem in which the prevalence ranges from 13.5 to 30.5% and experienced by multiple factors. Although health extension program has been implementing for couples of years; diarrheal disease remains the second cause of morbidity and continues an important public health problem in the study district. Thus, this study assessed determinants of diarrheal disease among under-five children in the Medebay Zana district, northwest Tigray, Ethiopia, 2015.

Method

A community based case-control study was used. A multistage sampling procedure was employed to enroll the study participants. Data were collected using face to face administered questionnaire. The collected data were entered into Epi Info version 3.5.4 and exported to SPSS Version 21 for analysis. Frequencies with percentages were computed using univariate analysis. Finally, logistic regression model was fitted to identify factors associated with childhood diarrhea where P-values of less than 0.05 were considered statistically significant.

Results

Socio-demographic factors such as low maternal educational level [AOR = 2.88, 95% CI (1.70, 4.88)], being index child of older age, households with ≥3 number of children under-five [AOR = 4.05, 95% CI (1.91, 8.60)] and maternal history of diarrhea [AOR = 2.10, 95% CI (1.09, 4.05)] were statistically associated with childhood diarrhea. This study also revealed that child feeding practice; not exclusively breastfed [AOR = 4.84, 95% CI (2.21, 10.60)] and initiation of complementary feeding above 6 months [AOR = 1.78, 95% CI (1.09, 2.92)] were statistically associated with outcome variable. Environmental and behavioral practices such as unavailability toilet facility [AOR = 2.10, 95% CI (1.34, 3.30)], improper solid waste disposal [AOR = 2.29, 95% CI (1.53, 3.44)] and unprotected drinking water [AOR = 1.83, 95% CI (1.12, 2.98)] were also found significant factors of childhood diarrhea.

Conclusion

Maternal educational status, age of index child, number of < 5 children, child feeding practices, maternal history of diarrhea, toilet facility, solid waste disposal and household drinking water were found determinants of childhood diarrhea. These findings have policy implications and insight the strengthening for health intervention programs.

Spatial and temporal patterns of diarrhoea in Bhutan 2003-2013

Background

To describe spatiotemporal patterns of diarrhoea in Bhutan, and quantify the association between climatic factors and the distribution and dynamics of the disease.

Methods

Nationwide data on diarrhoea were obtained for 2003 to 2013 from the Health Information and Management System (HIMS), Ministry of Health, Bhutan. Climatic variables were obtained from the Department of Hydro Met Services, Ministry of Economic Affairs, Bhutan. Seasonal trend decomposition was used to examine secular trends and seasonal patterns of diarrhoea. A Bayesian conditional autoregressive (CAR) model was used to quantify the relationship between monthly diarrhoea, maximum temperature, rainfall, age and gender.

Results

The monthly average diarrhoea incidence was highly seasonal. Diarrhoea incidence increased by 0.6% (95% CrI: 0.5–0.6%) for every degree increase in maximum temperature; and 5% (95 Cr I: 4.9–5.1%) for a 1 mm increase in rainfall. Children aged <5 years were found to be 74.2% (95% CrI: 74.1–74.4) more likely to experience diarrhoea than children and adults aged ≥5 years and females were 4.9% (95% CrI: 4.4–5.3%) less likely to suffer from diarrhoea as compared to males. Significant residual spatial clustering was found after accounting for climate and demographic variables.

Conclusions

Diarrhoea incidence was highly seasonal, with positive associations with maximum temperature and rainfall and negative associations with age and being female. This calls for public health actions to reduce future risks of climate change with great consideration of local climatic conditions. In addition, protection of <5 years children should be prioritize through provision of rotavirus vaccination, safe and clean drinking water, and proper latrines.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-017-2611-6) contains supplementary material, which is available to authorized users.

Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda

Background

In low and middle-income countries, acute lower respiratory illness is responsible for roughly 1 in every 5 child deaths. Rwanda has made major health system improvements including its community health worker systems, and it is one of the few countries in Africa to meet the 2015 Millennium Development Goals, although prevalence of acute lower respiratory infections (4 %) is similar to other countries in sub-Saharan Africa. This study aims to assess social, economic, and environmental factors associated with acute lower respiratory infections among children under five to inform potential further improvements in the health system.

Methods

This is a cross-sectional study using data collected from women interviewed in the 2010 DHS about 8,484 surviving children under five. Based on a literature review, we defined 19 health, social, economic, and environmental potential risk factors, tested bivariate associations with acute lower respiratory infections, and advanced variables significant at the 0.1 confidence level to logistic regression modelling. We used manual backward stepwise regression to arrive at a final model. All analyses were performed in Stata v13 and adjusted for complex sample design.

Results

The following factors were independently associated with acute lower respiratory infections: child’s age, anemia level, and receipt of Vitamin A; household toilet type and residence, and season of interview. In multivariate regression, being in the bottom ten percent of households (OR: 1.27, 95 % CI: 0.85-1.87) or being interviewed during the rainy season (OR: 1.61, 95 % CI: 1.24-2.09) was positively associated with acute lower respiratory infections, while urban residence (OR: 0.58, 95 % CI: 0.38-0.88) and being age 24–59 months versus 0–11 months (OR: 0.53, 95 % CI: 0.40-0.69) was negatively associated with acute lower respiratory infections.

Conclusion

Potential areas for intervention including community campaigns about acute lower respiratory infections symptoms and treatment, and continued poverty reduction through rural electrification and modern stove distribution which may reduce use of dirty cooking fuel, improve living conditions, and reduce barriers to health care.