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      Acute lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia

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          Abstract

          Background

          Lower respiratory infections are a leading cause of morbidity and mortality worldwide, particularly in children younger than 5 years. Even if the burden of lower respiratory infections in children under 5 years old had decreased dramatically in the last 10 years, it is still the main cause of morbidity and mortality in children under-5 years old in developing countries, so the aim of this study was to assess the magnitude of lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital.

          Method

          A cross-sectional study was conducted from 1st to 30th April 2019, among under-five child/mother or caretaker pairs visiting Wolaita Sodo University Teaching and Referral Hospital. Child/mother or caretaker pairs who visits outpatient department for curative care service or follow up were recruited for the study. Data were collected using a semi-structured pre-tested interviewer-guided questionnaire. Epi-info (version 7.1.2.0) was used for data entry, and Statistical Package for Social Sciences version 20 was used for analysis. Bivariate and multivariate logistic regression, crude and adjusted odds ratios with their 95 % confidence intervals was computed. Finally, a p-value ≤ 0.05 was used to identify variables that had a significant association with acute lower respiratory infection.

          Result

          A total of 414 child/mother or caretaker pairs were recruited for the study. The magnitude of acute lower respiratory infections among under-five children was 40.3 % (95 % CI: 35.7- 44.9 %). Unvaccinated children (AOR: 2, 95 % CI, (1.27–3.16)), non-exclusive/replacement feeding (AOR: 1.85, 95 % CI, (1.18–2.91)), households mainly used unclean fuel for cooking (AOR: 2.12, 95 % CI, (1.07–4.19)), absence of separate kitchen (AOR: 1.7, 95 % CI, (1.09–2.65)), and absence of window in the kitchen room (AOR: 1.69, 95 % CI, (1.07–2.68)) showed significant association with acute lower respiratory infection.

          Conclusions

          The magnitude of acute lower respiratory tract infections among under-five children visiting outpatient department was 40.3 %. Unvaccinated children, non-exclusive/replacement feeding, using unclean fuel for cooking, absence of a separate kitchen, and absence of window in the kitchen showed significant association with acute lower respiratory infection. Therefore, special attention should be given to the environmental sanitation and family health components of health extension packages.

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          Most cited references20

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          Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015

          Summary Background The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. Methods We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs. Findings In 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000–763 000) and 60.6 million DALYs (95ÙI 56·0–65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI −0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940–2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction. Interpretation LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI. Funding Bill & Melinda Gates Foundation.
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            Risk factors for severe acute lower respiratory infections in children – a systematic review and meta-analysis

            Aim To identify the risk factors in children under five years of age for severe acute lower respiratory infections (ALRI), which are the leading cause of child mortality. Methods We performed a systematic review of published literature available in the public domain. We conducted a quality assessment of all eligible studies according to GRADE criteria and performed a meta-analysis to report the odds ratios for all risk factors identified in these studies. Results We identified 36 studies that investigated 19 risk factors for severe ALRI. Of these, 7 risk factors were significantly associated with severe ALRI in a consistent manner across studies, with the following meta-analysis estimates of odds ratios (with 95% confidence intervals): low birth weight 3.18 (1.02-9.90), lack of exclusive breastfeeding 2.34 (1.42-3.88), crowding – more than 7 persons per household 1.96 (1.53-2.52), exposure to indoor air pollution 1.57 (1.06-2.31), incomplete immunization 1.83 (1.32-2.52), undernutrition – weight-for-age less than 2 standard deviations 4.47 (2.10-9.49), and HIV infection 4.15 (2.57-9.74). Conclusion This study highlights the role of the above seven risk factors in the development of severe pneumonia in under-five children. In addition, it emphasizes the need for further studies investigating other potential risk factors. Since these risk factors are potentially preventable, health policies targeted at reducing their prevalence provide a basis for decreasing the burden of childhood pneumonia.
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              Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013

              Background Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990–2013. Methods We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used. Results Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1–4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap. Conclusions LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.
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                Author and article information

                Contributors
                birhanuwondimeneh@gmail.com
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                20 September 2021
                20 September 2021
                2021
                : 21
                : 413
                Affiliations
                [1 ]GRID grid.494633.f, ISNI 0000 0004 4901 9060, School of Nursing, College of Health Science and Medicine, , Wolaita Sodo University, ; Sodo, Ethiopia
                [2 ]GRID grid.467130.7, ISNI 0000 0004 0515 5212, Department of Paediatrics and Child Health Nursing, College of Medicine and Health Science, , Wollo University, ; Dessie, Ethiopia
                [3 ]GRID grid.467130.7, ISNI 0000 0004 0515 5212, Department of Comprehensive Nursing, College of Medicine and Health Science, , Wollo University, ; Dessie, Ethiopia
                Article
                2888
                10.1186/s12887-021-02888-6
                8451097
                677374d1-c488-45e3-b1af-a4284e67451b
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 16 February 2021
                : 27 August 2021
                Funding
                Funded by: Wolaita sodo university
                Award ID: PND/06/320/11
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Pediatrics
                acute,respiratory tract infection,associated factors,under-five,ethiopia
                Pediatrics
                acute, respiratory tract infection, associated factors, under-five, ethiopia

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