Environmental risk factors for acute respiratory infections in hospitalized children under 5 years of age in Ibadan, Nigeria

Exposure-response relationship of residential dampness and mold damage with severe lower respiratory tract infections among under-five children in Nigeria

Previous epidemiological studies demonstrated an increased risk of respiratory health effects in children and adults exposed to dampness or mold. This study investigated associations of quantitative indicators of indoor dampness and mold exposure with severe lower respiratory tract infections (LRTI) among children aged 1-59 months in Ibadan, Nigeria.

Methods

In-home visits were conducted among 178 children hospitalized with LRTI matched by age (±3 months), sex, and geographical location with 180 community-based children without LRTI. Trained study staff evaluated the indoor environment using a standardized home walkthrough checklist and measured visible dampness and mold damage. Damp-moldy Index (DMI) was also estimated to quantify the level of exposure. Exposure-response relationships of dampness and mold exposure with severe LRTI were assessed using multivariable restricted cubic spline regression models adjusting for relevant child, housing, and environmental characteristics.

Results

Severe LRTI cases were more often male than female (61.8%), and the overall mean (SD) age was 7.3 (1.35) months. Children exposed to dampness <0.3 m² (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.05, 4.36), and between 0.3 and 1.0 m² (OR = 2.34; 95% CI = 1.01, 7.32), had a higher odds of severe LRTI compared with children not exposed to dampness. The restricted cubic spline showed a linear exposure-response association between severe LRTI and residential dampness (P < 0.001) but a nonlinear relationship with DMI (P = 0.01).

Conclusions

Residential dampness and DMI were exposure-dependently associated with higher odds of severe LRTI among under-five children. If observed relationships were causal, public health intervention strategies targeted at reducing residential dampness are critically important to mitigate the burden of severe LRTI among under-five children.

Indoor bacterial and fungal aerosols as predictors of lower respiratory tract infections among under-five children in Ibadan, Nigeria

BACKGROUND

This study aimed to investigate the association between exposure to diverse indoor microbial aerosols and lower respiratory tract infections (LRTI) among children aged 1 to 59 months in Ibadan, Nigeria.

METHODS

One hundred and seventy-eight (178) hospital-based LRTI cases among under-five children were matched for age (± 3 months), sex and geographical location with 180 community-based controls (under-five children without LRTI). Following consent from caregivers of eligible participants, a child's health questionnaire, clinical proforma and standardized home-walkthrough checklist were used to collect data. Participant homes were visited and sampled for indoor microbial exposures using active sampling approach by Anderson sampler. Indoor microbial count (IMC), total bacterial count (TBC), and total fungal count (TFC) were estimated and dichotomized into high (> median) and low (≤ median) exposures. Alpha diversity measures including richness (R), Shannon (H) and Simpson (D) indices were also estimated. Conditional logistic regression models were used to test association between exposure to indoor microbial aerosols and LRTI risk among under-five children.

RESULTS

Significantly higher bacterial and fungal diversities were found in homes of cases (R = 3.00; H = 1.04; D = 2.67 and R = 2.56; H = 0.82; D = 2.33) than homes of controls (R = 2.00; H = 0.64; D = 1.80 and R = 1.89; H = 0.55; D = 1.88) p < 0.001, respectively. In the multivariate models, higher categories of exposure to IMC (aOR = 2.67, 95% CI 1.44-4.97), TBC (aOR = 2.51, 95% CI 1.36-4.65), TFC (aOR = 2.75, 95% CI 1.54-4.89), bacterial diversity (aOR = 1.87, 95% CI 1.08-3.24) and fungal diversity (aOR = 3.00, 95% CI 1.55-5.79) were independently associated with LRTI risk among under-five children.

CONCLUSIONS

This study suggests an increased risk of LRTI when children under the age of five years are exposed to high levels of indoor microbial aerosols.

Perception of mothers about Acute Respiratory Infections (ARIs) and risk factors affecting children Under 5 Years (U5Ys) in Fiji

PURPOSE

To explore the perception of mothers about Acute Respiratory Infections (ARIs) and their risk factors affecting children Under 5 Years (U5Ys) in Fiji.

DESIGN

This was a qualitative study done in the Integrated Management of Childhood Illness (IMCI) Clinic in Ba Hospital, Fiji. Mothers who had brought in their children with ARIs were selected through a purposive sampling method. A semi-structured open-ended questionnaire was used to guide in-depth interviews. The interviews were transcribed and the thematic analysis was done to look at the themes and sub-themes that emerged.

RESULTS

A total of 30 mothers were interviewed. There were five themes that were derived from the interviews including the mothers' perception of ARIs; treatment methods; perceived barriers; services provided by IMCI clinic; and recommendations and suggestions. The mothers were familiar with the causes, risk factors and able to recognize severity of ARIs based on the local context. They mostly relied on traditional and home remedies for ARIs. Most mothers preferred injections for treatment for their child. There were many perceived barriers of ARIs prevention such as traditional norms and poor social support. Most mothers stayed in rural areas which caused poor accessibility to health care services. Few mothers had issues with poor attitude and skills of health care workers.

CONCLUSIONS

There are multiple factors that are barriers in reducing the risks of ARIs. There needs to be policies implemented to support the health of children in the communities as well as social support structures.

PRACTICE IMPLICATIONS

This study provides a clear picture of the perception of the mothers regarding ARIs in children under five years old. With this information at hand, it is easier to answer the question regarding the perceptions of the mothers of ARIs and the risk factors and design tailored interventions to prevent ARIs among children.

Acute respiratory infections among under-five children from households using biomass fuel in Ethiopia: systematic review and meta-analysis

Acute respiratory infections are a serious public health concern across the globe, they are, however, prominently present in Sub-Saharan Africa. In Ethiopia, different primary studies were conducted in regard to the link between household biomass fuel use and acute respiratory infections among under-five children. However, there is no national study on the association between household biomass fuel use and acute respiratory is infections among under-five children. Thus, the aim of this systematic review and meta-analysis to estimate the pooled prevalence of acute respiratory infections and their predictors among under-five children in Ethiopia.

The systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the databases: PubMed/Medline, Cochrane library, Google Scholar, Web of Science, and Scopus were searched to access potentially relevant articles conducted in Ethiopia about acute respiratory infections among under five children. Stata/SE 14.00 statistical software was used for analysis and the pooled prevalence with 95% confidence interval (CI) were presented using tables and forest plots. To assess the heterogeneity among studies, I square (I2) tests were used. Publication bias was checked by Begg’s and Egger’s regression test. The random effects meta-analysis model was employed to estimate the pooled prevalence and predictors of under-five acute respiratory infections A total of 7 studies with 8, 529 study participants were included in this meta-analysis. The pooled prevalence of acute respiratory infection among under five children was 17.75% (95% CI: 16.95, 18.55). Child holding during cooking (OR: 2.84, 95% CI: 1.48, 5.47) and using unclean sources of energy for cooking (OR: 0.38, 95% CI: 0.21, 0.70) were identified predictors of under-five children acute respiratory infection.

In the current study, the pooled prevalence of acute respiratory infection among under-five children was relatively high. Child holding during cooking and using unclean sources of energy for cooking were significantly associated with under-five acute respiratory infections. Therefore, the policies and regulations enacted should address the barriers that impede the development of clean and efficient energy sources.

Environmental Risks Associated with Symptoms of Acute Respiratory Infection among Preschool Children in North-Western and South-Southern Nigeria Communities

The exposure-disease-stress model places young children in their physical and social contexts and considers the extent and intensity of associational links to symptoms of acute respiratory infection (ARI), taking in to account a range of biological, social, and environment components. This study uses the 2013 Nigeria Demographic and Health Survey to assess the individual and environmental risks present in the North-Western and South-Southern Nigerian communities and examines their associations with ARI symptoms. The descriptive findings show that the prevalence of ARI symptoms is significantly higher among preschool children in the North-Western province (5.7%) than in the South-Southern province (1.4%) (p < 0.001). In addition to regional differences, multilevel logistic models further indicate that the increased likelihood of a child suffering from ARI symptoms is significantly associated with the dry season (aOR 1.42; 95% CI: 1.02–1.97) and household poverty (aOR 1.42; 95% CI: 1.01–1.99), even after adjusting for the cooking fuel used and various other characteristics of the children, households, and communities. These findings underscore the importance of taking into account environmental risks when addressing specific regional variations in ARI symptoms, because these determinants differ between communities in Nigeria. As it is imperative to achieve minimum levels of child health, in order to improve economic development across regions, future health policies aiming to promote child health will benefit from taking a region-specific perspective into consideration.