Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda

Abstract

BackgroundIn low and middle-income countries, acute lower respiratory illness is responsible for roughly 1 in every 5 child deaths. Rwanda has made major health system improvements including its community health worker systems, and it is one of the few countries in Africa to meet the 2015 Millennium Development Goals, although prevalence of acute lower respiratory infections (4 %) is similar to other countries in sub-Saharan Africa. This study aims to assess social, economic, and environmental factors associated with acute lower respiratory infections among children under five to inform potential further improvements in the health system.MethodsThis is a cross-sectional study using data collected from women interviewed in the 2010 DHS about 8,484 surviving children under five. Based on a literature review, we defined 19 health, social, economic, and environmental potential risk factors, tested bivariate associations with acute lower respiratory infections, and advanced variables significant at the 0.1 confidence level to logistic regression modelling. We used manual backward stepwise regression to arrive at a final model. All analyses were performed in Stata v13 and adjusted for complex sample design.ResultsThe following factors were independently associated with acute lower respiratory infections: child’s age, anemia level, and receipt of Vitamin A; household toilet type and residence, and season of interview. In multivariate regression, being in the bottom ten percent of households (OR: 1.27, 95 % CI: 0.85-1.87) or being interviewed during the rainy season (OR: 1.61, 95 % CI: 1.24-2.09) was positively associated with acute lower respiratory infections, while urban residence (OR: 0.58, 95 % CI: 0.38-0.88) and being age 24–59 months versus 0–11 months (OR: 0.53, 95 % CI: 0.40-0.69) was negatively associated with acute lower respiratory infections.ConclusionPotential areas for intervention including community campaigns about acute lower respiratory infections symptoms and treatment, and continued poverty reduction through rural electrification and modern stove distribution which may reduce use of dirty cooking fuel, improve living conditions, and reduce barriers to health care.

Acute respiratory infection and its associated factors among children under-five years attending pediatrics ward at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: institution-based cross-sectional study

“…The odds of developing ARI was higher among children below 12 months of age as compared to those aged above 48 months. This was in line with a previous study [39]. Higher risk of ARI among lower age children might be due to less developed immunity [40].…”

“…Children from rural setup were more prone to develop ARI in the current study which is in line with several earlier studies [12,39,[44][45][46]. The probable justification for the greater ARI symptoms proportion for rural children may be due to lack of access to medical care, low socio-economic standards in rural regions [47] and most risk factors for ARI prevail in rural setup [48].…”

Acute Lower Respiratory Tract Infections and Associated Factors Among Under-five Children Visiting Wolaita Sodo University Teaching and Referral Hospital: A Cross-sectional Study

“…Different factors were identi ed for the increased risk of LRTIs in children. Of these, poverty, restricted family income, low parental education level, low birth weight, malnutrition, lack of breastfeeding, maternal literacy, smoking, cow dung use for fuel, low socio-demographic status, solid fuels for cooking and heating, immune impaired populations, improved toilet facilities, season, and residence [8,10,12,13]. Similarly, the risk of death from LRTIs will be determined by very severe pneumonia, age below two months, diagnosis of Pneumocystis Carinii, chronic underlying diseases including HIV/ AIDS, severe malnutrition, young maternal age, low maternal education, low socioeconomic status, second-hand smoke exposure, and indoor air pollution [14].…”

A Study of 0-14-Year-Old Children’s Access to Health Centers in Rural Areas Using a Buffer Model (a Case Study of Villages Based in Kermanshah Province, Iran)

“…Providing health for everyone in societies is among the fundamental rights of humans, which is known by the World Health Organization as the main social goal of societies, and its enjoyment is seen as the basis for sustainable development and one of the main pillars of social justice [1,2]. Hence, one of the goals of policymakers in the health sector in any country is facilitating the access to health services, so that all walks of life can use these services properly [3].…”