Trends and factors associated with acute respiratory infection among under-five children in Zambia

Abstract

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. The study therefore sought to assess trends and factors associated with ARI using demographic health survey data from 1996 to 2014. We conducted a cross-sectional secondary analysis of Zambia Demographic and health survey data from 1996, 2002, 2007 and 2014 involving under five children and their mothers. We extracted data using a data extraction tool from the women’s file and prepared for analysis. We assessed trends using chi-square for trends. We conducted a complex survey logistic regression analysis using STATA version 14.0 and reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values. The highest prevalence of ARI was in 2002 and a drop in 2007 and 2014 (Non-Parametric-trend p-0.001). Occurrence of ARI was associated with nutritional status, underweight children were more likely to develop ARI (Adjusted odds ratio [AOR] 1.50 95% [confidence interval] CI 1.25 – 1.68) compared with children who were not. Use of cooking fuels such as charcoal and firewood were associated with high odds for ARI compared to electricity use (AOR 2.67 95%CI 2.09 – 3.42 p-<0.001 and 2.79 95%CI 2.45 -3.19 p<0.001) respectively. Children with co-morbidities such as malaria and diarrhea (AOR 5.85 95%CI 5.01 – 6.64 p-<0.001 and AOR 1.45 95%CI 1.25 – 1.68 p-<0.001 respectively) compared to those who did not have. ARI was less likely among children with mothers who had secondary or higher education (AOR 0.30 95% 0.15-0.58 p-<0.001). Receiving micronutrients such as vitamin A was protective from ARI (AOR 0.46 95%CI 0.40 – 0.52). Interventions to reduce the burden of ARI should be targeted at health promotion and sensitization of mothers to avoid crowded places, use of cooking fuels such as firewood and charcoal as well as seeking healthcare early should signs of ARI occur. Furthermore, vaccination monitoring and ARI surveillance should continue in the community and health facilities in order to identify high burden areas. Key terms: 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. The study therefore sought to assess trends and factors associated with ARI using demographic health survey data from 1996 to 2014. We conducted a cross-sectional secondary analysis of Zambia Demographic and health survey data from 1996, 2002, 2007 and 2014 involving under five children and their mothers. We extracted data using a data extraction tool from the women’s file and prepared for analysis. We assessed trends using chi-square for trends. We conducted a complex survey logistic regression analysis using STATA version 14.0 and reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values. The highest prevalence of ARI was in 2002 and a drop in 2007 and 2014 (Non-Parametric-trend p-0.001). Occurrence of ARI was associated with nutritional status, underweight children were more likely to develop ARI (Adjusted odds ratio [AOR] 1.50 95% [confidence interval] CI 1.25 – 1.68) compared with children who were not. Use of cooking fuels such as charcoal and firewood were associated with high odds for ARI compared to electricity use (AOR 2.67 95%CI 2.09 – 3.42 p-<0.001 and 2.79 95%CI 2.45 -3.19 p<0.001) respectively. Children with co-morbidities such as malaria and diarrhea (AOR 5.85 95%CI 5.01 – 6.64 p-<0.001 and AOR 1.45 95%CI 1.25 – 1.68 p-<0.001 respectively) compared to those who did not have. ARI was less likely among children with mothers who had secondary or higher education (AOR 0.30 95% 0.15-0.58 p-<0.001). Receiving micronutrients such as vitamin A was protective from ARI (AOR 0.46 95%CI 0.40 – 0.52). Interventions to reduce the burden of ARI should be targeted at health promotion and sensitization of mothers to avoid crowded places, use of cooking fuels such as firewood and charcoal as well as seeking healthcare early should signs of ARI occur. Furthermore, vaccination monitoring and ARI surveillance should continue in the community and health facilities in order to identify high burden areas. Key terms: ARI Under-five children Underweight Factors Trends Co-morbidities Zambia Underweight Factors Trends Co-morbidities Zambia