Epidemiology of mortality induced by acute respiratory infections in infants and children under the age of 5 years and its relationship with the Human Development Index in Asia: an updated ecological study

Factors of acute respiratory infection among under-five children across sub-Saharan African countries using machine learning approaches

Symptoms of Acute Respiratory infections (ARIs) among under-five children are a global health challenge. We aimed to train and evaluate ten machine learning (ML) classification approaches in predicting symptoms of ARIs reported by mothers among children younger than 5 years in sub-Saharan African (sSA) countries. We used the most recent (2012-2022) nationally representative Demographic and Health Surveys data of 33 sSA countries. The air pollution covariates such as global annual surface particulate matter (PM 2.5) and the nitrogen dioxide available in the form of raster images were obtained from the National Aeronautics and Space Administration (NASA). The MLA was used for predicting the symptoms of ARIs among under-five children. We randomly split the dataset into two, 80% was used to train the model, and the remaining 20% was used to test the trained model. Model performance was evaluated using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. A total of 327,507 under-five children were included in the study. About 7.10, 4.19, 20.61, and 21.02% of children reported symptoms of ARI, Severe ARI, cough, and fever in the 2 weeks preceding the survey years respectively. The prevalence of ARI was highest in Mozambique (15.3%), Uganda (15.05%), Togo (14.27%), and Namibia (13.65%,), whereas Uganda (40.10%), Burundi (38.18%), Zimbabwe (36.95%), and Namibia (31.2%) had the highest prevalence of cough. The results of the random forest plot revealed that spatial locations (longitude, latitude), particulate matter, land surface temperature, nitrogen dioxide, and the number of cattle in the houses are the most important features in predicting the diagnosis of symptoms of ARIs among under-five children in sSA. The RF algorithm was selected as the best ML model (AUC = 0.77, Accuracy = 0.72) to predict the symptoms of ARIs among children under five. The MLA performed well in predicting the symptoms of ARIs and associated predictors among under-five children across the sSA countries. Random forest MLA was identified as the best classifier to be employed for the prediction of the symptoms of ARI among under-five children.

Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019

BACKGROUND

Tuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relationship with the human development index (HDI).

METHODS

The present study is an ecological study aiming at investigating the incidence and mortality of tuberculosis in Iran during the years 2010 to 2019. The related data were extracted from the Global Burden of Disease (GBD) website. The spatial pattern attributed to tuberculosis in the provinces of Iran was analyzed using ArcGIS software. In this study, the two-variable correlation method was used to analyze the data extracted to study the correlation between Tuberculosis and HDI.

RESULT

Based on the results recorded in GBD, the incidence of tuberculosis in 2010, that is, 14.61 (12.72, 16.74), declined compared to 2019, namely 12.29 (10.71, 14.09). The age-standardized mortality rate which was 1.63 (1.52, 1.73) in 2010, has decreased compared to 2019: 1.17 (1.07, 1.32). The incidence and mortality rates of tuberculosis in Iran in all age groups have decreased in 2019 compared to 2010. The highest incidence and mortality among tuberculosis patients were recorded in Sistan and Baluchistan and Golestan provinces. The results indicated that there was a negative and significant correlation between the mortality rate of tuberculosis and the human development index in 2010 (r = -0.509, P-value = 0.003) and 2019 (r = -0.36, P-value = 0.001); however, this correlation between incidence and human development index was not significant (p > 0.05).

CONCLUSION

Since mortality is mostly observed in areas with low HDI, health system policymakers must pay more attention to these areas in order to improve care and perform screenings to diagnose and treat patients thus reducing the mortality rate of tuberculosis and preventing an increase in its incidence in Iran.

Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa: a multilevel robust Poisson regression modelling

BACKGROUND

Timely and appropriate treatment for childhood illness saves the lives of millions of children. In low-middle-income countries such as sub-Saharan Africa (SSA), poor healthcare-seeking behavior for childhood illnesses is identified as a major contributor to the increased risk of child morbidity and mortality. However, studies are limited on Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.

OBJECTIVE

To examine factors associated with a mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.

METHODS

A secondary data analysis was conducted based on the latest Demographic and Health Survey (DHS) data of 36 sub-Saharan African countries. A total weighted sample of 16,925 mothers who had under-five children with acute respiratory infection symptoms was considered. The Intraclass Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) tests were done to assess the presence of clustering. Model comparison was made based on deviance (-2LLR) value. Variables with a p-value < 0.2 in the bivariable multilevel robust Poisson analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the Adjusted Prevalence Ratio (APR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the association.

RESULTS

The prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in SSA was 64.9% (95% CI: 64.2%, 65.7%). In the multivariable analysis; mothers who attained primary education (APR = 1.11, 95% CI: 1.08, 1.15), secondary education (APR = 1.13, 95% CI: 1.09, 1.18), and higher education (APR = 1.19, 95% CI: 1.11, 1.27), belonged to the richest household (APR = 1.07: 95% CI: 1.02, 1.12), had media exposure (APR = 1.11, 95% CI: 1.08, 1.15), currently working (APR = 1.08, 95% CI: 1.06, 1.11), had ANC use (APR = 1.25: 95% CI: 1.17, 1.35), health facility delivery (APR = 1.10, 95% CI: 1.07, 1.14), belonged to West Africa (APR = 1.04, 95% CI: 1.01, 1.08) and being in the community with high media exposure (APR = 1.04, 95% CI: 1.02, 1,07) were significantly associated with higher prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. On the other hand, distance to a health facility (APR = 0.87, 95% CI: 0.84, 0.91), and being in central Africa (APR = 0.87, 95% CI: 0.84, 0.91) were significantly associated with a lower prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children.

CONCLUSION

Mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. It was influenced by maternal education, maternal working status, media exposure, household wealth status, distance to the health facility, and maternal health care service use. Any interventions aiming at improving maternal education, maternal healthcare services, and media access are critical in improving mothers' healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children, hence lowering the prevalence of ARI-related death and morbidity.

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.

Correlation between human development index and its components with COVID-19 indices: a global level ecologic study

Background

Given that COVID-19 continues to spread worldwide, attempts to restrain the virus and to prevent the effects that critically ill patients with COVID-19 have on healthcare systems, has become a public health priority. This ecological study aimed to investigate the correlation between the Human Development Index (HDI) and the epidemiological indicators of COVID-19, including the cumulative incidence rate of cases, the cumulative incidence rate of death, performed COVID-19 tests per million, recovery rate, and case fatality rate.

Methods

In this ecological study, a data set was provided, which included the epidemiologic indices of COVID-19, HDI, and its components for each country. Correlation coefficients were used to determine linear correlation. Also, the scatter plots of the HDI for the studied countries based on the epidemiologic indices of COVID-19 were drawn.

Results

This study showed that HDI and its components had positive correlation with a cumulative incidence rate of cases, the cumulative incidence rate of death, and performed COVID-19 tests (p < 0.001). HDI and two of its components, including literacy and Gross National Income (GNI) components had negative correlation with case fatality rate (CFR). Also, HDI and two of its components, including literacy and life expectancy components had negative correlation with recovery rate.

Conclusion

Our study showed that the HDI and its components can affect the epidemiological status of COVID-19. As HDI increased, the cumulative incidence rate of cases, cumulative incidence rate of death, and COVID-19 tests increased as well. As HDI increased, CFR and recovery rate decreased as well. Although the HDI is higher in high-income countries, these countries may have also better reporting and surveillance systems.

Urinary Pesticide Residual Levels and Acute Respiratory Infections in Children Under 5 Years of Age: Findings From the Offinso North Farm Health Study

BACKGROUND

Several environmental factors are associated with the risk of acute lower respiratory infections (ALRIs) and upper respiratory infections (URIs) in children under 5 years of age (YOA). Evidence implicating chemical pesticides remains equivocal. There are also no data on this subject in these children in Ghana. This study investigated the association between urinary pesticide residual levels and the risk for ALRIs/URIs in children under 5 YOA.

METHODS

The participants for this study were from the Offinso North Farm Health Study, a population-based cross-sectional study. Two hundred and fifty four parents/guardians who had answered affirmatively to the question "Has your child ever accompanied you to the farm?" were interviewed on household socio-demographic and environmental factors, being breastfed, child education, age, gender, and respiratory infection. One hundred fifty children were randomly selected to provide the first void urine.

RESULTS

The proportion of children with ALRI was 22.1% and those with URI was 35.8%. We observed a statistically significant exposure-response relation of p,p'-DDE (tertile) with ALRI (1.7-3.2 µg/L urine: prevalence ratio [PR] = 1.22 [1.05-1.70], ⩾3.2 µg/L urine: 1.50 [1.07-3.53] [P-for trend = .0297]). This observation was in children older than two YOA (P-for trend = .0404). Delta-HCH and beta-HCH (2-levels) were significantly associated with ALRI but not URI. The risk of ALRI increased with deltamethrin levels in an exposure-response manner (2.5-9.5 µg/L urine: 2.10 [1.37-3.24], ⩾9.5 µg/L urine: 4.38 [1.87-10.32] [P-for trend = .0011]) and this was also observed in children older than two YOA. Similar observation was noted for URI. Bifenthrin (>0.5 µg/L urine) was positively associated with ALRI and URI whereas permethrin (⩾1.2 µg/L urine) was not associated only with URI.

CONCLUSIONS

The present study supports the hypothesis that exposure to chemical pesticides is associated with respiratory infections in children under 5 YOA.

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.

Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10-33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37-0.74, p < 0.001; OR 0.55; 95%CI: 0.39-0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.