Associations and contribution of childhood diseases to fever risk among children less than five years in Uganda

Abstract

Background Despite massive investment in diseases responsible for fever among children less than five years in Uganda, the burden of the fever symptom remains high and disproportionately distributed across regions. In Uganda, studies assessing the relationship between fever prevalence and multiple childhood diseases, especially at a local scale are scanty. We analyse the 2016 Demographic and Health Survey (DHS) data to quantify the associations and contribution of childhood diseases to fever prevalence among children less than five years in Uganda at the national and regional level. Findings can lead to the development and implementation of preventive and treatment measures especially at a local scale to minimize fever-related diseases among the under-fives in Uganda. Methods Bayesian geostatistical logistic regression models with spatially varying coefficients were fitted to determine the associations and contribution of childhood diseases on fever prevalence at the national and regional levels. Region-specific spatially varying coefficients were modeled by a conditional autoregressive distribution. Cluster-specific random effects were introduced into the model to take into account spatial dependence in fever prevalence. Bayesian geostatistical stochastic search variable selection was applied to determine the most important predictors in explaining variation in fever prevalence. The contribution of childhood diseases to fever prevalence was estimated using population attributable fractions. Results The prevalence of fever was highest in Busoga and Teso regions and lowest in Bunyoro region. At the national level, the population attribution fraction of diarrhoea, acute respiratory infections (ARI) and malaria to the prevalence of fever in the under-five was 38.12 (95% Bayesian credible intervals, BCI=25.15-41.59), 30.99 (95% BCI=9.82-34.26) and 9.50 (95% BCI=2.34-25.15), respectively. The attribution of diarrhoea was common in all regions except Bunyoro, while ARI was more common in Bugisu, Karamoja and West Nile, and malaria was commonest in Bunyoro. In Lango, the attribution of diarrhoea and ARI was similar. Conclusions Majority of fevers among the under-five are due to diarrhoea, followed by ARI. Hand washing with soap and water/detergent should be strengthened in all regions. Vaccination against ARI should be encouraged, in the regions of Central 2, Bugisu, Teso, Karamoja, Lango, West-Nile and Tooro. The health system should be reinforced to treat diarrhoea and ARI.