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

Predictors of severity and prolonged hospital stay of viral acute respiratory infections (ARI) among children under five years in Burkina Faso, 2016-2019

BACKGROUND

Viruses are the leading etiology of acute respiratory infections (ARI) in children. However, there is limited knowledge on drivers of severe acute respiratory infection (SARI) cases involving viruses. We aimed to identify factors associated with severity and prolonged hospitalization of viral SARI among children < 5 years in Burkina Faso.

METHODS

Data were collected from four SARI sentinel surveillance sites during October 2016 through April 2019. A SARI case was a child < 5 years with an acute respiratory infection with history of fever or measured fever ≥ 38 °C and cough with onset within the last ten days, requiring hospitalization. Very severe ARI cases required intensive care or had at least one danger sign. Oropharyngeal/nasopharyngeal specimens were collected and analyzed by multiplex real-time reverse-transcription polymerase chain reaction (rRT-PCR) using FTD-33 Kit. For this analysis, we included only SARI cases with rRT-PCR positive test results for at least one respiratory virus. We used simple and multilevel logistic regression models to assess factors associated with very severe viral ARI and viral SARI with prolonged hospitalization.

RESULTS

Overall, 1159 viral SARI cases were included in the analysis after excluding exclusively bacterial SARI cases (n = 273)very severe viral ARI cases were common among children living in urban areas (AdjOR = 1.3; 95% CI: 1.1-1.6), those < 3 months old (AdjOR = 1.5; 95% CI: 1.1-2.3), and those coinfected with Klebsiella pneumoniae (AdjOR = 1.9; 95% CI: 1.2-2.2). Malnutrition (AdjOR = 2.2; 95% CI: 1.1-4.2), hospitalization during the rainy season (AdjOR = 1.71; 95% CI: 1.2-2.5), and infection with human CoronavirusOC43 (AdjOR = 3; 95% CI: 1.2-8) were significantly associated with prolonged length of hospital stay (> 7 days).

CONCLUSION

Younger age, malnutrition, codetection of Klebsiella pneumoniae, and illness during the rainy season were associated with very severe cases and prolonged hospitalization of SARI involving viruses in children under five years. These findings emphasize the need for preventive actions targeting these factors in young children.

Prediction of Toddlers Acute Respiratory Infection (ARI) to Become Pneumonia in Martapura Catchment Area, Banjar District, Indonesia

Introduction. The pneumonia pattern in young children may vary across different catchment areas. Therefore, this study aims to analyze the predictive factors for toddlers with an Acute Respiratory Infection (ARI) developing into pneumonia in the catchment area of Banjar Regency, Indonesia. Methods. A case-control design, with 300 respondents, consisting of 106 cases and 194 controls. A questionnaire of interviews with mothers/caregivers of toddlers. Forty-one indicators data were analyzed using multiple logistic regression with backward stepwise regression to arrive at the final model. Results. The predictive factors for toddlers with pneumonia were the child's age (P-value .070), child development (P-value .007), breastfeeding (P-value .051), family income (P-value .026), and location of houses along the river (P-value .025). Conclusion. A prediction index for toddler pneumonia has been compiled, which can be applied to improve the health of lower middle-class toddlers requiring more government attention.

Application of a count regression model to identify the risk factors of under-five child morbidity in Bangladesh

BACKGROUND

Bangladesh has seen a significant decline in child mortality in recent decades, but morbidity among children <5 y of age remains high. The aim of this analysis was to examine trends and identify risk factors related to child morbidity in Bangladesh.

METHODS

This analysis is based on data from four successive cross-sectional Bangladesh Demographic and Health Surveys for the years 2007, 2011, 2014 and 2017-18. Several count regression models were fitted and the best model was used to identify risk factors associated with morbidity in children <5 y of age.

RESULTS

According to the results of the trend analysis, the prevalence of non-symptomatic children increased and the prevalence of fever, diarrhoea and acute respiratory infections (ARIs) decreased over the years. The Vuong's non-nested test indicated that Poisson regression could be used as the best model. From the results of the Poisson regression model, child age, sex, underweight, wasted, stunting, maternal education, wealth status, religion and region were the important determinants associated with the risk of child morbidity. The risk was considerably higher among women with a primary education compared with women with a secondary or greater education in Bangladesh.

CONCLUSIONS

This analysis concluded that child morbidity is still a major public health problem for Bangladesh. Thus it is important to take the necessary measures to reduce child morbidity (particularly fever, diarrhoea and ARI) by improving significant influencing factors.

Multidimensional energy poverty and acute respiratory infection in children under 5 years of age: evidence from 22 low-income and middle-income countries

BACKGROUND

In low-income and middle-income countries (LMICs), energy poverty has predominantly been studied from the unidimensional perspective of indoor air pollution. Acute respiratory infection (ARI) in children under 5 years of age is the most important disease associated with indoor air pollution attributable to solid fuel use in LMICs. This study aimed to extend the existing knowledge on the association between energy poverty and ARI among children under 5 years of age in LMICs, by adopting a multidimensional perspective.

METHODS

Using Demographic and Health Surveys from 22 LMICs, data from 483 088 children were analysed (mean age 2.00 years (SD 1.41); 51.3% male). Energy poverty was measured using the Multidimensional Energy Poverty Index (MEPI) (range 0-1), which comprises five dimensions of essential energy services. Binary logistic regression models were conducted to study the association between MEPI and ARI, adjusting for child, maternal, household and environmental characteristics.

RESULTS

A 0.1 increase in MEPI score was associated with greater odds of ARI (aOR 1.05; 95% CI 1.04 to 1.07). Likewise, MEPI indicators using biomass for cooking (aOR 1.15; 95% CI 1.07 to 1.23) and lack of access to electricity (aOR 1.17; 95% CI 1.10 to 1.26), entertainment/education appliances (aOR 1.07; 95% CI 1.02 to 1.13) and household appliances (aOR 1.12; 95% CI 1.04 to 1.21) were associated with greater odds of ARI.

CONCLUSION

Multidimensional energy poverty was associated with greater odds of ARI in children under 5 years of age living in 22 LMICs. Hence, our findings justify the design and implementation of interventions that address energy poverty from a multidimensional perspective, integrating energy affordability and accessibility.

Prevalence and predictors of acute respiratory infection among children under-five years in Tigray regional state, northern Ethiopia: a cross sectional study

BACKGROUND

Acute respiratory infection is still one of the leading causes of child morbidity and mortality worldwide. Developing countries, especially in Sub-Saharan Africa including Ethiopia continue to share an overburden of this infection. Studies showed that different predictor factors were associated with the occurrence of childhood acute respiratory infection. Therefore, the main aim of this study was to assess the prevalence and associated predictor factors of acute respiratory infection among children under-five years in the Tigray Regional State, northern Ethiopia.

METHODS

A retrospective cross-sectional study design was done from January 18, 2016, to June 27, 2016. A total of 986 children under-five years were selected for this study. The logistic regression model analysis was employed to examine the predictor factors of childhood acute respiratory infection. Both bi-variable and multivariable data analysis was performed using STATA version 14.0.

RESULTS

Overall, the study showed that the two weeks prevalence of acute respiratory infection among children under-five years was 16.10% [95%CI: 13.80-18.40]. According to the multivariable logistic regression model analysis, children aged (24-60) months (AOR: 0.59, 95%CI: 0.352-0.98), rich wealth index of households (AOR: 0.60, 95%CI: 0.378-0.959), diarrhea status of children (AOR: 3, 95%CI: 1.97-4.73), and mothers smoking cigarettes (AOR: 4, 95%CI: 1.15-16.50), were significant predictors of acute respiratory infection.

CONCLUSION

The prevalence of ARI displays that Tigray regional state was experiencing a higher ARI rate than the national level. The current study identified the low wealth index of households, children aged (24-60 months), mothers smoking cigarettes, and diarrhea status of the children as crucial predictor factors for ARI. Interventions should be improved to these modifiable major predictor factors that significantly decrease the ARI problem among under-five children.

Associations Between Indoor Air Pollutants and Risk Factors for Acute Respiratory Infection Symptoms in Children Under 5: An Analysis of Data From the Indonesia Demographic Health Survey

OBJECTIVES

The study investigated the association between indoor air pollution (IAP) and risk factors for acute respiratory infection (ARI) symptoms in children under 5 years of age.

METHODS

A cross-sectional study was conducted using data derived from Indonesia Demographic and Health Survey in 2017. Binary logistic regression modeling was employed to examine each predictor variable associated with ARI among children under 5 years of age in Indonesia.

RESULTS

The study included a total of 4936 households with children. Among children under 5 years old, 7.2% reported ARI symptoms. The presence of ARI symptoms was significantly associated with the type of residence, wealth index, and father's smoking frequency, which were considered the sample's socio-demographic characteristics. In the final model, living in rural areas, having a high wealth index, the father's smoking frequency, and a low education level were all linked to ARI symptoms.

CONCLUSIONS

The results revealed that households in rural areas had a substantially higher level of reported ARI symptoms among children under 5 years old. Furthermore, the father's smoking frequency and low education level were associated with ARI symptoms.

Multilevel Analysis of Lifestyle and Household Environment for Toddlers With Symptoms of Acute Respiratory Infection (ARI) in Indonesia in 2007, 2012, and 2017

Introduction. The morbidity and mortality rate of Acute Respiratory Tract Infection (ARI) in children under 5 is relatively high in Indonesia. Socio-demographic characteristic is considered one of the factors causing ARI in Indonesia. However, no study analyzed the prevalence of ARI among toddlers and the differences among the determinant factors in multiple periods. Thus, this study aimed to analyze the prevalence trends and determinant factors associated with ARI symptoms in children under 5 in Indonesia in 2007, 2012, and 2017. Methods. This study analyzed cross-sectional survey data from the Demographic and Health Survey (DHS) in Indonesia during 2007, 2012, and 2017. Bivariate and multivariate analysis with logistic regression was performed using Stata version 15. The final results were expressed in Adjusted Odds Ratio (AORs) and 95% Confidence Interval (CI). Results. The findings showed a progress in prevalence trends with a decrease in the percentage of children with ARI symptoms from 11.25% (2007), then 5.12% (2012) to 4.22% (2017). Risk factors for toddlers experiencing ARI symptoms were as follows: younger maternal age (OR: 1.13, 95% Cl 0.70-1.81 in 2007, OR: 1.72, 95% Cl 1.03-2.88 in 2012 and OR: 0.98, 95% Cl 0.48-1.97 in 2017), smoking habits of family members (OR: 1.12, 95% Cl 0.85-1.48 in 2012, OR: 1.23, 95% Cl in 2017), poor drinking water quality (OR: 1.12, 95% Cl 0.85-1.48 in 2012 and OR: 1.23, 95% Cl in 2017), unavailable toilet facilities (OR: 1.27, 95% Cl 1.04-1.56 in 2007, OR: 1.24, 95% Cl 0.95-1.63 in 2012 and OR: 1.28, 95% Cl 0.97-1.68 in 2017). Conclusion. There was a decrease in the prevalence of ARI symptoms among children in 2007, 2012, and 2017, with no prominent differences in other related factors. The lifestyle and household environmental factors such as the use of dirty fuel, the presence of smokers in the household, the poor quality of drinking water, unavailable toilet facilities in addition to the maternal age and child age were the determinant factors that must be prioritized and improved. Family self-awareness should also be enhanced for better prospects for toddler survival.

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.

Housing conditions as predictors of common childhood illness: Evidence from Nigeria Demographic and Health Surveys, 2008-2018

Several studies have examined the impacts of water, sanitation, hygiene, and general housing conditions on childhood health in developing countries. However, up-to-date knowledge and change pattern in common childhood illness prevalence over time are scarce in Nigeria. To contribute toward meeting the Sustainable Development Goals three and six, we used pooled data (N = 94,053) from the Nigeria Demographic Health Surveys from 2008 to 2018 to examine the trend and determinants of four childhood illnesses: diarrhea, fever, cough, and respiratory infection. Multivariate logistic regression was used to estimate the determinants of the four health outcomes. Our results indicate that between 2008 and 2018, the prevalence of childhood diarrhea, cough, and fever slowly declined. However, there was a drastic decline in childhood-related respiratory illness. Housing conditions, sanitation facilities, and water sources were significantly associated with childhood illness based on the logistic regression analysis. Based on our findings, we recommend general improvement in housing conditions that can eradicate childhood cough, fever, and respiratory infections.

Determinants of acute respiratory infection among under-five children in rural Ethiopia

INTRODUCTION

In low- and middle-income nations, acute respiratory infection (ARI) is the primary cause of morbidity and mortality. According to some studies, Ethiopia has a higher prevalence of childhood acute respiratory infection, ranging from 16 to 33.5%. The goal of this study was to determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia.

METHODS

A cross-sectional study involving 7911 children under the age of five from rural Ethiopia was carried out from January 18 to June 27, 2016. A two stage cluster sampling technique was used recruit study subjects and SPSS version 20 was used to extract and analyze data. A binary logistic regression model was used to identify factors associated with a childhood acute respiratory infection. The multivariable logistic regression analysis includes variables with a p-value less than 0.2 during the bivariate logistic regression analysis. Adjusted odds ratios were used as measures of effect with a 95% confidence interval (CI) and variables with a p-value less than 0.05 were considered as significantly associated with an acute respiratory infection.

RESULTS

The total ARI prevalence rate among 7911 under-five children from rural Ethiopia was 7.8%, according to the findings of the study. The highest prevalence of ARI was found in Oromia (12.8%), followed by Tigray (12.7%), with the lowest frequency found in Benishangul Gumuz (2.4%). A multivariable logistic regression model revealed that child from Poor household (AOR = 2.170, 95% CI: 1.631-2.887), mother's no education (AOR = 2.050,95% CI: 1.017-4.133), mother's Primary education (AOR = 2.387, 95% CI:1.176-4.845), child had not received vitamin A (AOR = 1.926, 95% CI:1.578-2.351), child had no diarrhea (AOR = 0.257, 95% CI: 0.210-0.314), mothers not working (AOR = 0.773, 95% CI:0.630-0.948), not stunted (AOR = 0.663, 95% CI: 0.552-0.796), and not improved water source (AOR = 1.715, 95% CI: 1.395-2.109). Similarly, among under-five children, the age of the child, the month of data collection, anemia status, and the province were all substantially linked to ARI.

CONCLUSIONS

Childhood ARI morbidity is a serious health challenge in rural Ethiopia, according to this study, with demographic, socioeconomic, nutritional, health, and environmental factors all having a role. As a result, regional governments, healthcare staff, and concerned groups should place a priority on reducing ARI, and attempts to solve the issue should take these variables into account.

Determinants of Acute Respiratory Infection Among Children Under-Five Years in Indonesia

BACKGROUND

Acute respiratory infection (ARI) among children under five years has been identified as a risk factor for child morbidity, leading to child mortality in Indonesia. Many factors may cause ARI; however, determinants associated with ARI remain unclear in Indonesia.

OBJECTIVES

This study sought to analyze the determinants of ARI among children aged under five years in Indonesia.

METHODS

This study was cross-sectional and utilized secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 15,993 children under five years old were selected as respondents. Chi-squared test and binary logistic regression were used to examine the determinants of ARI among children under five years in Indonesia.

RESULTS

Children aged 1 year [Odds Ratio (OR) = 1.43, 95% CI = 1.04-1.97], children aged 2 years [OR = 1.54, 95% CI = 1.12-2.11], mother's occupation [OR = 1.24, 95% CI = 1.01-2.154], poorest wealth index [OR = 1.91, 95% CI = 1.26-2.89], poor [OR = 1.50, 95% CI = 1.01-2.21], region of residence: Western Indonesia [OR = 1.96, 95% CI = 1.28-2.00], Middle of Indonesia [OR = 2.19, 95% CI = 1.44-3.33] were significantly associated with ARI among children under five years in Indonesia.

CONCLUSIONS

This study revealed that the determinants of ARI among children under five years in Indonesia remain related to the socio-demographic aspect. This research highlighted that the family's and the living area's wealth index remains essential in improving children's health outcomes.

PRACTICE IMPLICATIONS

Our findings support increasing awareness of the low-income family through adequate information and health promotion. Advancing the feasibility, accessibility, and affordability of health information and health services across all Indonesian regions should be strengthened.

A kindergarten-based, family-involved intervention to improve children's hand hygiene behavior: A cluster-randomized controlled trial

OBJECTIVE

The present study determined the feasibility and initial efficacy of a kindergarten-based, family-involved intervention in improving children's hand hygiene (HH) behaviors.

DESIGN

A cluster-randomized controlled trial was performed, with a cluster defined as a kindergarten class.

SAMPLE

Participants were recruited from 20 classes in six kindergartens. A total of 289 children and their families were enrolled in the intervention group, and 293 children and their families were enrolled in the control group.

MEASUREMENTS

HH behavior and a related knowledge survey, as well as data on absences due to infection, were collected.

INTERVENTION

An 8-week training session on HH for children and an education program combining a seminar and WeChat groups for parents were provided to participants in the intervention group.

RESULTS

Two HH behaviors of children, namely, HH after playing outside and 7-stage HH compliance, were significantly different between the two groups after the intervention. The two HH behaviors and knowledge of infections of parents/legal guardians in the intervention group were better than those in the control group after the intervention. The number of absences due to infections in children was lower in the intervention group than in the control group.

CONCLUSIONS

Kindergarten-based, family-involved interventions effectively improved the HH behavior of kindergarten children and decreased absences due to infections.

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

Using Demographic and Health Surveys from 48 low-income and middle-income countries (N = 432,860), we investigated whether or not the presence of symptoms of acute respiratory infection (ARI) are contingent on environmental vulnerabilities such as the region, the level of ambient air pollution, community orphanhood status, and household poverty among young children under five. In addition, we also examined whether such an effect may be a consequence of socioeconomic development and/or lifestyle. Using multilevel logistic regression models, environmental vulnerability was found to be significantly associated with the likelihood of childhood ARI symptoms and this association seemed to be related to the level of ambient air pollution. Our findings suggest that important roles are played by both geographic region and ambient air pollution, and that these factors may disproportionately shape a child's risk of ARI symptoms in a global context.

The burden and risks of pediatric pneumonia in Nigeria: A desk-based review of existing literature and data

BACKGROUND

Pneumonia is a leading killer of children under-5 years, with a high burden in Nigeria. We aimed to quantify the regional burden and risks of pediatric pneumonia in Nigeria, and specifically the states of Lagos and Jigawa.

METHODS

We conducted a scoping literature search for studies of pneumonia morbidity and mortality in under-5 children in Nigeria from 10th December 2018 to 26th April 2019, searching: Cochrane, PubMed, and Web of Science. We included grey literature from stakeholders' websites and information shared by organizations working in Nigeria. We conducted multivariable logistic regression using the 2016 to 2017 Multiple Cluster Indicators Survey data set to explore factors associated with pneumonia. Descriptive analyses of datasets from 2010 to 2019 was done to estimate trends in mortality, morbidity, and vaccination coverage.

RESULTS

We identified 25 relevant papers (10 from Jigawa, 8 from Lagos, and 14 national data). None included data on pneumonia or acute respiratory tract infection burden in the health system, inpatient case-fatality rates, severity, or age-specific pneumonia mortality rates at state level. Secondary data analysis found that no household or caregiver socioeconomic indicators were consistently associated with self-reported symptoms of cough and/or difficulty breathing, and seasonality was inconsistently associated, dependant on region.

CONCLUSION

There is a clear evidence gap around the burden of pediatric pneumonia in Nigeria, and challenges with the interpretation of existing household survey data. Improved survey approaches are needed to understand the risks of pediatric pneumonia in Nigeria, alongside the need for investment in reliable routine data systems to provide data on the clinical pneumonia burden in Nigeria.

Assessing Comorbidity of Diarrhea and Acute Respiratory Infections in Children Under 5 Years: Evidence From Kenya's Demographic Health Survey 2014

Background: Kenya is one among the 15 countries that account for three-quarters of the global mortality burden due to diarrhea and respiratory tract infections (RTIs). Comorbidity of diarrhea and acute respiratory infection (ARI) can either be simultaneous (both occurring at the same time) or sequential (where the occurrence of one leads to the occurrence of the other. This study aimed to determine the shared risks that influence comorbidity of diarrhea and RTIs among Kenya's children younger than 5 years. Methods: The study entailed an analysis of secondary data from the Kenya Demographic Health Survey (DHS) 2014 using STATA Corp 2010. Descriptive analysis of independent variables and logistic regression model was used to analyze risk factors associated with comorbidity from diarrhea and ARI in children <5 years. Results: A total of 18 702 children <5 years were in the study out of whom 411 had comorbidity from diarrhea and ARI in the 2 weeks prior to the survey. Comorbidity peaked at 6 to 11 months (4.6%). Child's age between 6 and 11 months (adjusted odds ratio [aOR] = 3.48, 95% CI = 2.02-5.99) and caregivers with incomplete primary education (aOR = 1.66, 95% CI = 1.11-2.50) were associated with higher odds of comorbidity from diarrhea and ARI. The main determinants associated with lower odds of combined morbidity from diarrhea and ARI were high wealth quintile (aOR = 0.58, 95% CI = 0.39-0.85) and older aged caregivers (aOR = 0.47, 95% CI = 0.23-0.95). However, we found no association between nutritional status of a child, sex, residence, exclusive breastfeeding between 0 and 6 months, and combined morbidity from diarrhea and ARI. Conclusion: Programs aimed at reducing comorbidity should target children between 6 and 11 months and deliberate emphasis should be placed on addressing barriers to wealth and caregivers' education.

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.