Prevalence and risk factors of acute lower respiratory infection among children living in biomass fuel using households: a community-based cross-sectional study in Northwest Ethiopia

Abstract

Background: Childhood acute lower respiratory infection in the form of pneumonia is recognized as the single largest cause of childhood death globally accounting for 16% of the overall deaths. Some studies also reported a higher prevalence of childhood acute respiratory infection in Ethiopia, which ranges from 16% up to 33.5%. Concerning the risk factors, there are limited community-based studies in Ethiopia in general, and in the current study region in particular. Therefore, the present study was conducted to investigate the prevalence of childhood acute respiratory infection and associated factors in Northwest Ethiopia. Methods: As part of the wider stove trial project, a cross-sectional study was conducted in May 2018 among a total of 5830 children aged less than 4 years old in randomly selected clusters. Binary logistic regression was applied to identify factors linked with childhood acute lower respiratory infection and adjusted odds ratios were used as measures of effect with a 95% confidence interval. Results: A total of 5830 children were included in the study within 100 clusters. Out of which 51.7% were male and 48.3% female. The prevalence of childhood lower acute respiratory infection was 19.2% (95% CI: 18.2-20.2) and found to decrease among children living in homes with chimney, eaves space and improved cookstove than children living in households with no chimney, eaves space and improved cookstove with estimated AOR of 0.60 (95% CI: 0.51-0.70), 0.70 (95% CI: 0.60-0.84) and 0.43 (95% CI: 0.28-0.67) respectively. It was also associated with other cooking-related factors such as cow dung fuel use [AOR = 1.54 (95% CI: 1.02-2.33)], child spending time near stove during cooking [AOR = 1.41 (95% CI: 1.06-1.88), presence of extra indoor burning events [AOR = 2.19 (95% CI: 1.41-3.40)] and with frequent cooking of meals [AOR = 1.55 (95% CI: 1.13-2.13)].(Continued on next page) Conclusion: High prevalence of childhood acute lower respiratory infection was demonstrated by this study and it was found to be associated with household ventilation, cooking technology, and behavioral factors. Therefore, we recommend a transition in household ventilation, cooking technologies as well as in child handling and in the peculiar local extra indoor burning practices.

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: Cluster randomized controlled trial

“…The predicted effect of the biomass-fuelled IBS intervention was not found to have a statistically signi cant effect on the risk of repeated childhood ALRI response among under 5 years old children in Northwest Ethiopia with an estimated AOR of 0.95 (95% CI: 0.89-1.02) compared with the continuation of an open burning TBS method. This nding mirrors the previous cross-sectional study, conducted as baseline part of this stove trial project, which reported that the odds of childhood ALRI did not show a signi cant association among children living in households with IBS when compared with children living in households with the TBS type with an estimated AOR of 0.78 (95% CI: 0.52-1.15)(23). Likewise, a recent policy research working paper reported no evidence that "Mirt" IBS intervention reduced the risk of respiratory symptoms among older children in rural Ethiopia(12).…”

“…Then, when the parents of the household agreed to be involved in the study, the eld staff administered a written consent form at that time and the consent procedure was conducted in Amharic (both national & local language). It was also explained that the allocation to intervention or the control group was based on the concept of a "lottery" method, and several special efforts were applied during recruitment to facilitate the enrolment process as described within our earlier research report (23), and there was no any household unwilling to participate in the study.…”

“…Research into the health effect of the "Mirt" stove had not been satisfactorily dealt with in earlier studies (12) emphasizing the need for further investigation on most vulnerable populations such as children who are often exposed to this intervention. More precisely, a crucial question whether the Ethiopian IBS intervention leads to a decrease in the occurrence of childhood acute lower respiratory infection (ALRI) must be answered through further trial investigation as recommended by a previous study (23). Thus, given the high magnitude of HAP problems in Ethiopia (19,24,25) and lack of IBS trials (17)(18)(19), there is a need to test the health effect of IBS intervention that could potentially reduce the negative health impacts of HAP.…”

“…Moreover, a Data Safety, and Monitoring Board was appointed to review and monitor the study procedures and potential adverse events. The study was being performed following good clinical practice standards, applicable local regulatory requirements, and the recommendations of the Declaration of Helsinki as reported in-depth within the baseline study of this stove trial project (23). Written informed consent (or thumbprint witnessed by someone independent of the study for those unable to read and write) was obtained from every parent or guardian for children to participate in the study following the distribution of written information sheets in "Amharic" (both o cial & study area language) to all participants.…”

Effect of Improved Cookstove Intervention on Childhood Acute Lower Respiratory Infection in Northwest Ethiopia: Cluster Randomized Controlled Trial

“…Then, when the parents of the household agreed to be involved in the study, the field staff administered a written consent form at that time and the consent procedure was conducted in Amharic (both national & local language). It was also explained that the allocation to intervention or the control group was based on the concept of a "lottery" method, and several special efforts were applied during recruitment to facilitate the enrolment process as described within our earlier research report (23), and there was no any household unwilling to participate in the study.…”