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      Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia’s demographic and health surveys (1996-2014)

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          Abstract

          Introduction

          acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under the age of five years globally accounting for 16% of deaths. In Zambia, ARI accounts for 30-40% of children's outpatient attendance and 20-30% of hospital admissions. We assessed trends and factors associated with ARI among under-five children in Zambia from 1996 to 2014.

          Methods

          we analysed the Zambia demographic and health survey data for 1996, 2002, 2007 and 2014 of under five children and their mothers. We extracted data using a data extraction tool from the women's file. We analysed trends using chi square for trends. We conducted a complex survey multivariable logistic regression analysis, reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values.

          Results

          we included a total of 6,854 and 2,389 (8%) had symptoms consistent with ARI. A 2% upward trend was noted between the 1996 and 2002 surveys but a sharp decline of 10% occurred in 2007. The chi2 trend test was significant p < 0.001. Children whose mothers had secondary or higher education were less likely to have ARI (AOR 0.30 95% CI 0.15-0.58) compared to those with no education. Underweight children had 1.50 times increased odds of having ARI (AOR 1.50 95% CI 1.25 - 1.68) compared with children who were not. Use of biomass fuels such as charcoal (AOR 2.67 95% CI 2.09 - 3.42) and wood (2.79 95% CI 2.45 -3.19) were associated with high odds for ARI compared to electricity.

          Conclusion

          the prevalence of ARI has declined in Zambia from 1996 to 2014. Factors associated with occurrence of ARI included being a child under one year, underweight, use of biomass fuel such as charcoal and wood. Interventions to reduce the burden of ARI should be targeted at scaling up nutrition programs, as well as promoting use of cleaner fuels.

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          Most cited references29

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          Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009–2013)

          Background Severe acute malnutrition has continued to be growing problem in Sub Saharan Africa. We investigated the factors associated with morbidity and mortality of under-five children admitted and managed in hospital for severe acute malnutrition. Methods It was a retrospective quantitative review of hospital based records using patient files, ward death and discharge registers. It was conducted focussing on demographic, clinical and mortality data which was extracted on all children aged 0–60 months admitted to the University Teaching Hospital in Zambia from 2009 to 2013. Cox proportional Hazards regression was used to identify predictors of mortality and Kaplan Meier curves where used to predict the length of stay on the ward. Results Overall (n = 9540) under-five children with severe acute malnutrition were admitted during the period under review, comprising 5148 (54%) males and 4386 (46%) females. Kwashiorkor was the most common type of severe acute malnutrition (62%) while diarrhoea and pneumonia were the most common co-morbidities. Overall mortality was at 46% with children with marasmus having the lowest survival rates on Kaplan Meier graphs. HIV infected children were 80% more likely to die compared to HIV uninfected children (HR = 1.8; 95%CI: 1.6-1.2). However, over time (2009–2013), admissions and mortality rates declined significantly (mortality 51% vs. 35%, P < 0.0001). Conclusions We find evidence of declining mortality among the core morbid nutritional conditions, namely kwashiorkor, marasmus and marasmic-kwashiorkor among under-five children admitted at this hospital. The reasons for this are unclear or could be beyond the scope of this study. This decline in numbers could be either be associated with declining admissions or due to the interventions that have been implemented at community level to combat malnutrition such as provision of “Ready to Use therapeutic food” and prevention of mother to child transmission of HIV at health centre level. Strategies that enhance and expand growth monitoring interventions at community level to detect malnutrition early to reduce incidence of severe cases and mortality need to be strengthened.
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            Risk Factors for Acute Respiratory Tract Infections in Under-five Children in Enugu Southeast Nigeria

            Background: Acute respiratory tract infections (ARIs) constitute the major causes of mortality and morbidity among under-five children of the developing world. The prevalence of ARIs is determined individually or collectively by a number of factors which may be prevalent in our environment. Aim: The present study is aimed to determine the risk factors that affect the prevalence of ARIs in under-five children in Enugu. Subjects and Methods: A cross-sectional study of 436 under-five children diagnosed with ARI was carried out in three hospitals in Enugu. Participants were consecutively enrolled after being diagnosed as a case of ARI. Structured pro foma was used to collect sociodemographic characteristics, anthropometric data and risk profile. Data were analyzed using Epi info version 6.0 and significant probability value was 5%. Results: A total of 436 patients were enrolled for the study 224 males and 212 females M: F 1.06:1. The mean age of the population was 18.75(13.38) months and there were 31.6%(138/436) cases of pneumonia 6.9%(30/436) cases of bronchiolitis and 61.5%(268/436) cases of acute upper respiratory tract infections. Children less than 20 months accounted for 60.9% (84/138 cases) of pneumonia, 86.7% (26/30 cases) of bronchiolitis, and 64.5% (173/268 cases) of acute upper respiratory tract infections. Pneumonia was noted in about 75.7% (56/74) of inadequately nourished children compared to 22.6% (82/362) in adequately nourished children. Other risk factors identified in the study include inadequate breast feeding, poor immunization statues, attendance to daycare centers, large family size, poor parental educational statues, parental smoking, living in the urban area and use of biofuels. Conclusion: ARIs are affected by socio-demographic and socio-cultural risk factors, which can be modified with simple strategies. It is recommended that control program for ARIs should be multifaceted with a strong political will.
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              Determinants of diarrhoea and acute respiratory infection among under-fives in Uganda.

              E Bbaale (2010)
              Diarrhoea and acute respiratory infection (ARI) are leading causes of mortality and morbidity in children under the age of five in developing countries. On the African continent, pneumonia (14%) and diarrhoea (17%) cause more child deaths than Malaria (16%), HIV/AIDS (4%), and measles (1%) combined. This paper set out to investigate the factors associated with the occurrence of diarrhoea and ARI incidence for children under five years in Uganda. We used a nationally representative Uganda Demographic and Health Survey (UDHS) (2006). Sampling was done in two stages. In the first stage 321 clusters were selected from among a list of clusters sampled in the 2005/06 Uganda National Household Survey (UNHS), 17 clusters from the 2002 Census frame from Karamoja, and 30 internally displaced camps (IDPs). In the second stage, households in each cluster were selected as per UNHS listing. In addition 20 households were randomly selected in each cluster. Questionnaires were used during data collection. During the analysis, a maximum likelihood probit model was used in order to ascertain the probability of occurrence of diseases. On average, 32% and 48% of children in the survey suffered from diarrhoea and ARI in the two weeks prior to the survey date. The occurrence was concentrated amongst children aged 0-24 months. Mother's education, especially at postsecondary level, reduced the probability of diarrhoea occurrence but had no effect on ARI occurrence. First hour initiation and exclusive breastfeeding reduced the probability occurrence of both diarrhoea and ARI. Other significant factors associated with the occurrence of both diseases include: regional and location differentials, wealth status, type of dwelling, mother's occupation, child age, and child nutritional status. Policy interventions should target female education, eliminate location and regional disadvantages, and educate the population to adopt breastfeeding practices recommended by the World Health Organization (WHO). The government should also ensure proper dwelling places for the population that are associated with favourable health outcomes. Other proper feeding practices together with breastfeeding (after six months), should be made known to the masses so as to reduce the number of children that are malnourished and growth retarded.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                20 July 2020
                2020
                : 36
                : 197
                Affiliations
                [1 ]Zambia Field Epidemiology Training Program, Lusaka, Zambia,
                [2 ]School of Public Health, University of Zambia, Lusaka, Zambia,
                [3 ]Zambia National Public Health Institute, Lusaka, Zambia,
                [4 ]Ministry of Health, National Tuberculosis and Leprosy Program, Lusaka, Zambia
                Author notes
                Corresponding author: Nelia Langa Mulambya, Zambia Field Epidemiology Training Program, Lusaka, Zambia. langanm99@ 123456gmail.com
                Article
                PAMJ-36-197
                10.11604/pamj.2020.36.197.18799
                7467616
                32952841
                ea0488b5-f41a-4be0-b36a-ce0469874fb6
                Copyright: Nelia Langa Mulambya et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 April 2019
                : 09 April 2020
                Categories
                Research

                Medicine
                acute respiratory infection,children,under-five underweight trends,zambia
                Medicine
                acute respiratory infection, children, under-five underweight trends, zambia

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