Abstract
Acute respiratory infections (ARIs), as a group of diseases and symptoms, are a leading cause of morbidity and mortality among under-five children in tropical countries like Bangladesh. Currently, no clear evidence has been published on the prevalence and socioeconomic correlates of ARIs in Bangladesh. In this regard, we carried out this study with the aim of assessing the prevalence and the socioeconomic predictors of ARIs among children aged 0–59 months, with a special focus on socioeconomic status and wealth-related indicators. Cross-sectional data on 32,998 mother-child (singleton) pairs were collected from six rounds of Bangladesh Demographic and Health Surveys (BDHS 1997–2014). The outcome variable were presence of the common symptoms of ARIs, fever and dyspnea, during the previous two weeks, which were measured based on mothers’ reports about the symptoms of these conditions. Explanatory variables included maternal demographic and socioeconomic factors such as age, education, occupation, wealth quintile, and child’s age and sex. The prevalence and predictors of ARIs were measured using descriptive and multivariate regression methods. The prevalence of both fever (31.00% in 1997 vs. 36.76% in 2014) and dyspnea (39.27% in 1997 vs. 43.27% in 2014) has increased gradually since 1997, and tended to be higher in households in the lower wealth quintiles. Multivariable analysis revealed that higher maternal educational status, access to improved water and sanitation facilities, and living in households in higher wealth quintiles had protective effects against both fever and dyspnea. Findings suggested a significantly negative association between lacking access to improved water and sanitation and use of biomass fuel with ARI symptoms. However, no sex difference was observed in these associations. Based on the findings, childhood ARI prevention strategies should address the risk factors stemming from parental socioeconomic marginalisation, household water and sanitation poverty, and use of unclean fuel.
Highlights
With the sixth largest population on earth, Bangladesh has the eighth largest population in poverty [1], and the highest percentage of the population below the national poverty line among all South Asian countries [2]
The combined prevalence of fever among boys and girls was 51.6% and 48.4% respectively- and that of dyspnoea was 52.7% and 47.3%—respectively
In 2014—the overall prevalence of fever was 36.76% and that of and dyspnoea was 43.27%—both being higher than their 1997 levels: fever 31.0% and dyspnoea at 39.27%
Summary
With the sixth largest population on earth, Bangladesh has the eighth largest population in poverty [1], and the highest percentage of the population below the national poverty line among all South Asian countries [2]. Since its independence in 1971, the country has made remarkable strides in reducing extreme poverty and promoting key population health indicators such as maternal and child mortality, and providing access to basic public health services [3,4]. Bangladesh continues to face overwhelming challenges in meeting the basic healthcare needs of the population. The situation is challenging among vulnerable groups of the population, such as women and children [5,6,7,8]. According to the United Nations International Children’s Emergency Fund (UNICEF), about half of all Bangladeshi children (~33 million) are living in poverty, with one-quarter being deprived of basic needs including food, education, health, and sanitation [9]. The persisting water and sanitation poverty represent a serious challenge for promoting child health in Bangladesh [10,15,16,17]
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