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

Abstract

Background Acute Respiratory Infections (ARIs) account for more than 6% of the worldwide disease burden in children under the age of five, with the majority occurring in Sub-Saharan Africa. Rural children are more vulnerable to and disproportionately affected by ARIs. As a result, we examined the rural–urban disparity in the prevalence of ARI symptoms and associated factors among children under the age of five in Sub-Saharan Africa. Methods We used the most recent Demographic and Health Survey (DHS) data from 36 countries in Sub-Saharan Africa. The study included 199,130 weighted samples in total. To identify variables associated with ARIs symptoms, a multilevel binary logistic regression model was fitted. The Adjusted Odds Ratio (AOR) with a 95% CI was used to determine the statistical significance and strength of the association. To explain the rural–urban disparity in ARI prevalence, a logit-based multivariate decomposition analysis was used. Results Being female, ever breastfeeding, belonging to a poorer, better wealth status, and having better maternal educational status were significantly associated with lower odds of ARIs among under-five children. Whereas, small size or large size at birth, not taking vitamin A supplementation, being severely underweight, having diarrhea, didn’t have media exposure, never had the vaccination, being aged 36–47 months, and being aged 48–59 months were significantly associated with higher odds of ARIs among under-five children. The multivariate decomposition analysis revealed that the difference in characteristics (endowment) across residences explained 64.7% of the overall rural–urban difference in the prevalence of ARIs, while the difference in the effect of characteristics (change in coefficient) explained 35.3%. Conclusion This study found that rural children were highly affected by ARIs in SSA. To reduce the excess ARIs in rural children, public health interventions aimed at impoverished households, home births, and unvaccinated and malnourished children are crucial.

Exploring the association between household access to water, sanitation and hygiene (WASH) services and common childhood diseases using data from the 2017–2018 Demographic and Health Survey in Benin: focus on diarrhoea and acute respiratory infection

“…At the national level, the prevalence of ARI seems to be trending downward over the past 20 years: 12.0% in 2001, 9.5% in 2006 and 2.6% in 2014 47 48 57. According to the latest estimates, the percentage of ARI among children under 5 years in sub-Saharan Africa (8.6%) was higher than what we found 69. In the West African subregion, the prevalence of ARI in children under 5 years was: 1.1% in Togo (2017),66 2% in Sierra Leone (2019),59 2.1% in Guinea (2018),70 2.0% in Mali (2018),65 2.6% in Nigeria (2018),61 3.6% in Ghana (2014),60 4.4% in Liberia (2019–2020),64 4.6% in Gambia (2019–2020)67 and 5.0% in Senegal (2019) 62.…”

“…47 48 57 According to the latest estimates, the percentage of ARI among children under 5 years in sub-Saharan Africa (8.6%) was higher than what we found. 69 In the West African subregion, the prevalence of ARI in children under 5 years was: 1.1% in Togo (2017), 66 2% in Sierra Leone (2019), 59 2.1% in Guinea (2018), 70 2.0% in Mali (2018), 65 2.6% in Nigeria (2018), 61 3.6% in Ghana (2014), 60 4.4% in Liberia (2019–2020), 64 4.6% in Gambia (2019–2020) 67 and 5.0% in Senegal (2019). 62 In Indonesia, 4.2% of children under 5 years suffer from ARI in a study in 2022.…”

Geographical weighted regression analysis of hotspots of acute respiratory infection and its associated factors among under- five children in Ethiopia, spatial and multilevel analysis

“…Children who had diarrhea recently were more likely to develop ARI than those who did not have diarrhea. This study is supported by a previous study conducted in Ethiopia [20,35]. This is because children with concomitant illnesses such as diarrhea may have lowered immunity, making them more vulnerable to diseases such as ARI [20,38,39].…”

“…The higher risk of ARI among younger children might be due to their less developed immunity [20,34]. In contrast, other studies have suggested that children older than 36 months are less likely to develop ARI [33,35].…”

Elevated Immunoglobulin E Serum Levels: Possible Underlying Factors That Can Cause an Inborn Error of Immunity in the Pediatric Population with Recurrent Infections

“…In contrast to rural areas, where the number of positive patients was 1.2 times higher than the number of negative patients, urban environments corresponded to approximately 1.6 times more positive patients than negative patients. This result suggests that urban areas may have greater rates of infectious transmission [38]. From an environmental standpoint, metropolitan areas have a higher rate of mutation development than rural ones, which determines the body's increased production of IgE [39].…”