Prevalence of the Acute Respiratory Infections and Associated Factors in the Rural Areas and Urban Slum Areas of Western Maharashtra, India: A Community-Based Cross-Sectional Study

Determinants of care-seeking for ARI/Pneumonia-like symptoms among under-2 children in urban slums in and around Dhaka City, Bangladesh

Childhood pneumonia affects an estimated 18% of under-five children in Bangladesh. Urban slum-dwellers face challenges in healthcare-seeking. This study examined the factors influencing the healthcare-seeking for childhood pneumonia among under-two children in urban slums in Bangladesh. The study examined influence of children's characteristics (age, sex, number of ARI/pneumonia symptoms, and duration of symptoms), maternal factors (age, education, and working status), and household characteristics (number of household members, wealth quintile, sex of household heads, age of household heads). The outcome variable was receiving care from a qualified medical provider for childhood pneumonia or pneumonia-like symptoms within 14 days before the collection of surveillance data. The research utilized data from the Urban Health and Demographic Surveillance System, which included 155,000 people from five slums in Dhaka and Gazipur City Corporation areas. Overall, 753 out of 4,679 (16%) children under two years of age were included in this study, all of whom had ARI/pneumonia-like symptoms. The mean age of these children was 11.4 months, and 50% were boys. Of them, 350 (46%) sought care from local pharmacies, while 37% sought care from medically trained providers. Logistic regression analyses indicated that children with multiple symptoms (AOR: 2.32, 95% CI: 1.71-3.14) and illness duration over seven days (AOR: 2.61, 95% CI: 1.51-4.51) had higher odds of receiving care from a medically trained provider. Higher maternal education compared to no formal education, having five or more household members compared to four or fewer, household heads aged 40-49 years compared to those under 25 years, a longer duration of living in the slum (more than 10 years compared to less than five years), and belonging to the richest wealth quintile compared to the poorest were protective factors for care-seeking from qualified providers. Further research is required to understand the context for designing appropriate interventions and comprehensive policies for improved child health regarding ARI/pneumonia-like symptoms.

Spatiotemporal clusters of acute respiratory infections associated with socioeconomic, meteorological, and air pollution factors in South Punjab, Pakistan

BACKGROUND

In Pakistan, acute respiratory infections (ARI) continue to be a major public health problem. However, there is still a lack of scholarly work regarding different environmental and socioeconomic influencing factors and how they interact with respiratory infections. Furthermore, we do not know much about geographic variation in this context. Therefore, our study examines the ecological-level spatial and temporal patterns of acute respiratory infection incidence (ARI) and their geographic relationship with selected socio-economic, meteorological, and air pollution factors in Pakistan.

METHODS

We applied the spatiotemporal scan statistics to examine the purely temporal, spatial, and spatiotemporal clusters of ARI in South Punjab, Pakistan for five years (2016-2020). Generalized Linear Model (GLM) and geographically weighted regression (GWR) were also applied to model the linear and non-linear spatial relationships between selected variables and ARI.

RESULTS

Our results indicate that in the central and northern regions of Pakistan, two spatial clusters of ARI were present, accounting for 28.5% of the total cases. A spatiotemporal cluster with a relative risk of 1.57 was discovered in the northeastern area. The results obtained from the season-based GLM highlighted the significance of climatic factors (temperature, fog, dust storms) and air pollutants (NO2) in influencing ARI incidence, while socio-economic variables (rural population, literacy) had limited impact. In addition, GWR revealed that the relationships between predictors and ARI incidence varied across locations, emphasizing the importance of considering local settings. Season-based non-stationary GLM revealed a multifaceted interaction among socio-economic, meteorological, and air pollution factors.

CONCLUSIONS

Our study provides evidence about environmental and socio-economic factors significantly associated with ARI incidence. In addition, this study provides the first baseline of ARI cases in Pakistan to plan for intervention and adaptation strategies and may be replicated in other regions of comparable settings worldwide.

Geospatial modelling of ambient air pollutants and chronic obstructive pulmonary diseases at regional scale in Pakistan

Pakistan is among the South Asian countries mostly vulnerable to the negative health impacts of air pollution. In this context, the study aimed to analyze the spatiotemporal patterns of chronic obstructive pulmonary disease (COPD) incidence and its relationship with air pollutants including aerosol absorbing index (AAI), carbon monoxide, sulfur dioxide (SO2), and nitrogen dioxide. Spatial scan statistics were employed to identify temporal, spatial, and spatiotemporal clusters of COPD. Generalized linear regression (GLR) and random forest (RF) models were utilized to evaluate the linear and non-linear relationships between COPD and air pollutants for the years 2019 and 2020. The findings revealed three spatial clusters of COPD in the eastern and central regions, with a high-risk spatiotemporal cluster in the east. The GLR identified a weak linear relationship between the COPD and air pollutants with R2 = 0.1 and weak autocorrelation with Moran's index = -0.09. The spatial outcome of RF model provided more accurate COPD predictions with improved R2 of 0.8 and 0.9 in the respective years and a very low Moran's I = -0.02 showing a random residual distribution. The RF findings also suggested AAI and SO2 to be the most contributing predictors for the year 2019 and 2020. Hence, the strong association of COPD clusters with some air pollutants highlight the urgency of comprehensive measures to combat air pollution in the region to avoid future health risks.

Effect of educational intervention based on protection motivation theory on preventive behaviors of respiratory infections among hospital staff

Background

Hospital staff represent a vulnerable population for respiratory diseases. Consequently, the implementation of training programs becomes imperative as a preventive measure against such infections in these populations. The current study was conducted to examine the impact of an educational intervention based on the Protection Motivation Theory (PMT) on preventive behaviors for respiratory infections among a group of hospital staff.

Methods

This experimental study involves a sample of 150 hospital staff from Gachsaran City, Iran, in 2021-2022. The sampling technique involved the utilization of a random assignment approach to allocate individuals into two distinct groups: the experimental group, consisting of 75 participants, and the control group, also including 75 individuals. The data collection instrument was a questionnaire designed in accordance with the PMT. This questionnaire was administered to both the experimental and control groups prior to the intervention as well as two months following the intervention. The intervention program consisted of a total of five sessions, each lasting for 60 min, for the experimental group. These sessions were conducted on a weekly basis over a period of two and a half months. Specifically, there were two sessions held every month and one session held every two weeks. Following the completion of the program, the data was entered into SPSS-24 statistical software for analysis using paired t-tests, independent t-tests, and chi-square tests.

Results

The results indicated that prior to the intervention, there was no significant difference between the two groups in terms of perceived vulnerability constructs (p = 0.25), perceived severity (p = 0.63), perceived response (p = 0.32), and perceived reward (p = 0.11). Besides, there was no considerable distinction in perceived self-efficacy (p = 0.84), perceived response cost (p = 0.33), fear (p = 0.45), behavior motivation (p = 0.51), knowledge (p = 92), or vaccination behavior (p = 0.12) before the educational intervention. However, a significant change was noticed in each of the mentioned variables between the two groups after the intervention (p < 0.05).

Conclusion

The results of this study indicated that the implementation of an educational intervention grounded in the PMT yields positive outcomes in enhancing preventative behaviors pertaining to respiratory infections. Hence, it is recommended to utilize an intervention grounded in this theory among hospital staff as a viable approach to mitigating the occurrence of respiratory infections.

Differentials in the Prevalence of Acute Respiratory Infections Among Under-Five Children: An Analysis of 37 Sub-Saharan Countries

Objective

We investigated the prevalence and risk factors of ARI in children under 5 years old in 37 SSA countries.

Methods

Data from Demographic and Health Survey (DHS) of 37 African countries was examined in this analysis. Data from children under the age of 5 years old were examined. Forest plot was used to identify disparities in the occurrence of ARIs across SSA countries.

Results

We observed a higher prevalence of ARI among children under 5 in Uganda, Kenya, Sao Tome and Principe (9% each), Gabon, Chad, Eswatini (8% each), Burundi, Ethiopia, Congo Democratic Republic (7.0% each). The prevalence of ARI among under-five children who sought medical advice/treatment from health facility was higher in South Africa (88%), Sierra Leone (86%), Tanzanian (85%), Guinea (83%) and Uganda (80%). The prevalence rate of ARI among under-five children who received antibiotics was higher in Tanzania (61%), Sao Tome and Principe (60%), Rwanda and Congo (58% each), Angola (56.0%), Mozambique (54.0%), Kenya (53.0%), Namibia (52.0%) and Gabon (50.0%). This study found that the household wealth index, maternal education, and urban residence were significantly associated with ARI (p <0.001). A higher prevalence of ARI was observed among urban residents, low income families, and those with mothers with lower education.

Conclusion

ARI prevalence could be reduced by improving household socioeconomic status, child nutrition and community awareness of indoor and outdoor pollution. Interventions and programs focused on early diagnosis, treatment and prevention of ARIs are crucial in reducing ARIs particularly in developing countries.