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

Abstract

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.

Gendered Impact of Age, Toilet Facilities, and Cooking Fuels on the Occurrence of Acute Respiratory Infections in Toddlers in Indonesia and the Philippines

“…DHS 2017 data showed that ARI in the Philippines (1.51%) was lower than in Indonesia (4.22%). However, previous studies showed that the percentage of ARI in toddlers was 5.7% in 2013 in the Philippines [ 14 ] and 5.12% in 2012 in Indonesia [ 20 ]. It can be concluded that the number of ARI cases in under-five children is much lower in the Philippines compared to Indonesia.…”

Maternal Characteristics as Predictors of the Incidence of Acute Upper Respiratory Infection in Children Under Five Years Old in Indonesia

“…In Indonesia, the percentage of children under five years of age experiencing ARI in 2018 was 12.8 percent, with the highest percentage in the province of East Nusa Tenggara [9]. Morbidity and mortality caused by ARI in Indonesia are still relatively high and become a health problem [10][11][12].…”

“…Since 2007, 2012, and 2017 there has been a downward trend in the prevalence of factors associated with ARI symptoms in children under five years of age in Indonesia [10]. However, community awareness about the dangers of ARI still needs to be considered because research showed that children aged two years or over two years old are less likely to seek health care when they have symptoms of ARI compared with children less than two years of age with ARI symptoms [13].…”

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

“…Studies in the SSA region and other emerging economies have observed a correlation between ARIs and age, 7 , 11 - 13 sex, 12 , 14 immunization status, 12 HIV infection, 3 diarrheal comorbidity, 2 , 14 malnutrition 14 , 15 and improper weaning timing. 15 Several research has demonstrated the association between parental characteristics and ARIs, including parent age, 13 , 16 - 18 work status 12 and educational level. 3 , 12 Other variables have been implicated to an elevated risk of ARIs, such as socioeconomic status, 11 , 15 home type 18 and household size, as well as lack of hygiene and sanitation facilities, 17 have been linked with increased risk of ARIs.…”

“…Smokers in the household, type of fuel used for cooking, poor drinking water quality, and lack of toilets are some examples of lifestyle and environmental factors that increase the risk of developing ARIs. 3 , 15 , 17 …”