Risk Factors for Acute Respiratory Infections in Children Between 0 and 23 Months of Age in a Peri-Urban District in Pakistan: A Matched Case–Control Study

Abstract

Background: Acute respiratory infection (ARI) accounts for nearly 15% of all childhood mortality in South Asia, with children from rural areas at higher risk due to inaccessibility to healthcare facilities. We therefore aimed to identify risk factors associated with ARI in children under 2 years of age in rural Pakistan.Methods: A retrospective 1:2 matched case–control study was conducted between October and December 2018 in Taluka Kotri, Jamshoro District of Pakistan. Cases were identified as children between 0 and 23 months of age with a history of fever, cough, sore throat, fast breathing, difficulty breathing, or chest indrawing in the 2 weeks prior to the survey. Controls were participants without symptoms of ARI, matched based on age in months. Data analysis was conducted using STATA version 15. Univariate and multivariable conditional logistic regression analyses were used to identify factors associated with ARI, and p < 0.05 was considered statistically significant.Results: We identified 1,071 cases of ARI who were matched with 2,142 controls. Multivariable analysis revealed that female gender [odds ratio (OR) 0.78, 95% confidence interval (CI): 0.67–0.91], exclusive breastfeeding (OR 0.81, 95% CI: 0.69–0.97), and comorbidity with diarrhea (OR: 1.64, 95% CI: 1.40–1.91) were significantly associated with ARI.Conclusion: Pakistan continues to progress toward reducing childhood mortality, particularly ARI-related deaths, for which it bears a great burden. This study identifies risk factors such as the male gender, breastfeeding, and comorbidities with diarrhea, which could open grounds for further programmatic implications in targeting a multifaceted approach to reducing incidences of ARI in rural areas of the country.

Understanding the rural–urban disparity in acute respiratory infection symptoms among under-five children in Sub-Saharan Africa: a multivariate decomposition analysis

“…They account for 6% of the global disease burden, which is greater than the burden of diarrheal illnesses and malaria combined [4][5][6]. Globally, ARIs are responsible for 12 million morbidities and 1.3 million fatalities in children under the age of five [7,8], with three-fourths occurring in Sub-Saharan Africa (SSA) [9][10][11][12][13][14][15][16][17][18]. ARIs are responsible for the huge burden of infant and under-five mortality in rural areas [19].…”

Exclusive Breastfeeding and Childhood Morbidity: A Narrative Review

“…A total of 17 articles examined the relationship between ARI/acute lower respiratory infections and EBF, of which the majority of the articles noted a decrease in ARI in the EBF group ( n = 13) [ 13 , 14 , 24 , 36 , 46 , 53 , 55 , 59 , 63 , 69 , 73 , 74 ]. A total of three papers found no significant relationship between EBF and ARI [ 50 , 68 , 77 ].…”

Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets

“…Acute lower respiratory tract infections (ALRIs) and diarrhea are the major causes of morbidity and mortality among children under 5 years ( 40 ). A study conducted among infants aged 0–23 months in Pakistan reported children comorbid with diarrhea to have higher odds of ARI ( 41 ). A quantitative analysis among Nepali and Indian children found the incidence of ARI to increase when an episode of diarrhea occurred within 28 days before the onset of ARI ( 40 ).…”