A Spatio-Temporal Mapping and Bayesian Modelling of Fever, Cough and short Rapid Breaths, as Symptoms of Pneumonia in Under-Five Children in Nigeria

Abstract

Background Pneumonia remains a public health challenge in most parts of the world, with Nigeria having the highest number of pneumonia-related deaths. Understanding the geographical distribution, trends and risk factors associated with some symptoms of pneumonia can aid an appropriate preventive intervention towards abating its burden in Nigeria. Method This cross-sectional study used data from the 2008, 2013, and 2018 Nigeria Demographic Health Surveys. The outcome variables include fever, cough, and short, rapid breaths as selected symptoms of pneumonia. Optimized hotspot analysis was used to identify areas with a significantly high prevalence of fever, cough, and short rapid breaths, and a MCMC random-intercept logistic regression model was fitted to each symptom. Results The prevalence of cough was 12.1%, 10.1% and 16.9% in 2008, 2013 and 2018 respectively, 16.2%, 13.3%, and 25.7% for fever; and 41.7%, 42.5% and 6.5% for short rapid breaths respectively with variations across the states. Children aged 6-11 months had the highest higher odds (adjusted odds ratio (aOR) =1.95, 95% Credible Interval (CrI): 1.77, 2.18) of having cough, compared to children of other age groups. Similar pattern was noticed for fever and short rapid breaths. Other significantly associated factors with symptoms include the mother’s education, mother’s age, residence type, housing quality, wealth index and region. Conclusion The northern states were more characterized by short, rapid breaths while the southern states were more characterized by fever but both regions have a fair share of cough among under-five children. For cough and fever symptoms, the increased prevalence between 2013 and 2018 indicates more attention is needed. There are also higher odds of finding the symptoms amongst children aged 6-11 months compared to children of other age groups, especially in the North-eastern part of the country. Hence, government needs to strengthen immunization against diseases such as Hib, pneumococcus, measles and whooping cough (pertussis) which has been shown to be the most effective way to prevent pneumonia. Adequate nutrition is also key to improving children's natural defenses. Educated mothers needs to be adequately sensitized to understand that exclusive breastfeeding for the first 6 months of life of a child is paramount.