A global analysis of the regional variation in the symptoms of acute respiratory infection during childhood: Epidemics and their association with environmental vulnerability

The burden of acute respiratory infection attributable to fine particulate matter brought by dust storms among children under 5 years of age in low- and middle-income countries

BACKGROUND

Long-term exposure to fine particulate matter brought by dust storms (dust PM2.5) poses a significant risk to children's health, particularly those in low- and middle-income countries (LMICs). To quantify the impact of dust PM2.5 on children, current research focuses on acute respiratory infection (ARI) as a key health outcome, given its significant contribution to child mortality. However, the relationship used to evaluate the disease burden is mainly based on the total PM2.5 concentration, neglecting the specific effect of dust PM2.5 distinct from other PM2.5.This study aimed to develop a dust-specific exposure-response function (ERF) of ARI in children <5 years of age (U5-ARI) for future risk assessments.

METHOD

We combined population data derived from the Demographic and Health Survey covering 53 LMICs, with environmental data, including the gridded concentration of dust PM2.5. ARI in children <5 years of age (U5-ARI) was the outcome of interest, which was defined by a standard questionnaire-based method. The dust PM2.5 exposure was derived from the integration of two well-recognized datasets, and matched to each participant at the community level. We analyzed the linear association between the annual average dust PM2.5 concentration and the odds of U5-ARI with logistic regression and fixed effects after adjusting for multiple covariates. We also used the spline method to develop a dust-specific ERF. Based on the function, we estimated the burden of dust-associated U5-ARI across 100 LMICs and compared it with the results from two well-established functions of total PM2.5 mass.

RESULTS

The analysis of 1,223,118 children showed that a 10 μg/m3 increase in dust PM2.5 was associated with a 7.43% (95% confidence interval [CI]: 4.77-10.15%) increase in the odds of U5-ARI. The spline model indicated that the risk of U5-ARI increased monotonically and linearly with dust PM2.5 concentration with no evident effect threshold. In 2017, based on the dust-specific ERF, across the 100 LMICs, the number of dust-associated U5-ARI was estimated to be 159,000 (95% CI: 153,000-165,000), which was consistently higher than the estimates from ERFs based on total PM2.5 mass (142,000 [95% CI: 97,000-181,000] or 114,000 [95% CI: 80,000-153,000]). The long-term dust PM2.5 exposure contributed to 12-13% of all the children affected by U5-ARI between 2000 and 2017. The geographic hotspots were the arid and populous areas of South Asia and Africa.

CONCLUSION

This study provides critical insight into the association between long-term exposure to dust PM2.5 and the health of children in LMICs, highlighting the need for specific ERFs to distinguish the adverse effects of different PM2.5 components. Personal protection during sand dust storms can be an effective intervention to safeguard the respiratory health of children.

Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review

OBJECTIVES

To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries.

DESIGN AND SETTING

Scoping review using Arksey and O'Malley's framework and a Delphi survey for consensus building.

PARTICIPANTS

Mothers, new-borns, and children living in low- and middle-income countries were selected as participants.

OUTCOMES

Vulnerability as defined by the authors was deduced from the studies.

RESULTS

A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH.

CONCLUSION

Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs.

SCOPING REVIEW REGISTRATION

The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr).

Association between the Use of Biomass as Fuel for Cooking and Acute Respiratory Infections in Children under 5 Years of Age in Peru: An Analysis of a Population-Based Survey, 2019

Background

Acute respiratory infections (ARIs) are the most frequent respiratory diseases associated with the use of biomass as fuel within the home. ARIs are the main cause of mortality in children under 5 years of age. We aimed to evaluate the association between the use of biomass as cooking fuel and ARI in children under 5 years of age in Peru in 2019.

Methods

A secondary data analysis of the 2019 Peru Demographic and Family Health Survey (ENDES) has been performed. The outcome variable was a history of ARI. The exposure variable was the use of biomass as fuel for cooking food. To evaluate the association of interest, generalized linear models from the Poisson family with logarithmic link function considering complex sampling to estimate crude prevalence ratio (cPR) and adjusted prevalence ratio (aPR) with their respective 95% confidence intervals have been performed. P values <0.05 were considered statistically significant.

Results

A total of 16,043 children were included in the analysis. Of the total, biomass was used as fuel to cook food in the homes of 3,479 (20.0%) children. Likewise, 2,185 (14.3%) of the children had a history of ARI. In the adjusted model, it was found that children living in homes in which biomass was used as cooking fuel had a greater probability of presenting ARI (aPR = 1.13; 95% CI: 1.01–1.28).

Conclusions

It has been found that biomass was used to cook food in two of every 10 households. Likewise, almost one-seventh of children under 5 years old presented an ARI. The use of biomass as a source of energy for cooking in the home was associated with a higher probability of presenting ARIs.

Ambient air pollution and acute respiratory infection in children aged under 5 years living in 35 developing countries

BACKGROUND

Evidence from developed countries suggests that fine particulate matter (≤2.5 µm [PM_2.5]) contributes to childhood respiratory morbidity and mortality. However, few analyses have focused on resource-limited settings, where much of this burden occurs. We aimed to investigate the cross-sectional associations between annual average exposure to ambient PM_2.5 and acute respiratory infection (ARI) in children aged <5 years living in low- and middle-income countries (LMICs).

METHODS

We combined Demographic and Health Survey (DHS) data from 35 countries with gridded global estimates of annual PM_2.5 mass concentrations. We analysed the association between PM_2.5 and maternal-reported ARI in the two weeks preceding the survey among children aged <5 years living in 35 LMICs. We used multivariable logistic regression models that adjusted for child, maternal, household and cluster-level factors. We also fitted multi-pollutant models (adjusted for nitrogen dioxide [NO₂] and surface-level ozone [O₃]), among other sensitivity analyses. We assessed whether the associations between PM_2.5 and ARI were modified by sex, age and place of residence.

RESULTS

The analysis comprised 573,950 children, among whom the prevalence of ARI was 22,506 (3.92%). The mean (±SD) estimated annual concentration of PM_2.5 to which children were exposed was 48.2 (±31.0) µg/m³. The 5th and 95th percentiles of PM_2.5 were 9.8 µg/m³ and 110.9 µg/m³, respectively. A 10 µg/m³ increase in PM_2.5 was associated with greater odds of having an ARI (OR: 1.06; 95% CI: 1.05-1.07). The association between PM_2.5 and ARI was robust to adjustment for NO₂ and O₃. We observed evidence of effect modification by sex, age and place of residence, suggesting greater effects of PM_2.5 on ARI in boys, in younger children, and in children living in rural areas.

CONCLUSIONS

Annual average ambient PM_2.5, as an indicator for long-term exposure, was associated with greater odds of maternal-reported ARI in children aged <5 years living in 35 LMICs. Longitudinal studies in LMICs are required to corroborate our cross-sectional findings, to further elucidate the extent to which lowering PM_2.5 may have a role in the global challenge of reducing ARI-related morbidity and mortality in children.

A multilevel analysis of the social determinants associated with symptoms of acute respiratory infection among preschool age children in Pakistan: A population-based survey

BACKGROUND

As advocated by WHO in "Closing the Health Gap in a Generation", dramatic differences in child health are closely linked to degrees of social disadvantage, both within and between communities. Nevertheless, research has not examined whether child health inequalities include, but are not confined to, worse acute respiratory infection (ARI) symptoms among the socioeconomic disadvantaged in Pakistan. In addition to such disadvantages as the child's gender, maternal education, and household poverty, the present study also examined the linkages between the community environment and ARI symptoms among Pakistan children under five. Furthermore, we have assessed gender contingencies related to the aforementioned associations.

METHODS

Using data from the nationally representative 2017-2018 Pakistan Demographic and Health Survey, a total of 11,908 surviving preschool age children (0-59 months old) living in 561 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between ARI symptoms and individual-level and community-level social factors.

RESULTS

The social factors at individual and community levels were found to be significantly associated with an increased risk of the child suffering from ARI symptoms. A particularly higher risk was observed among girls who resided in urban areas (AOR = 1.42; p<0.01) and who had a birth order of three or greater.

DISCUSSIONS

Our results underscore the need for socioeconomic interventions in Pakistan that are targeted at densely populated households and communities within urban areas, with a particular emphasis on out-migration, in order to improve unequal economic underdevelopment. This could be done by targeting improvements in socio-economic structures, including maternal education.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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