Abstract
BackgroundAcute respiratory infections (ARI) are major causes of morbidity and mortality in many low-income countries. Although factors associated with ARI symptoms in children under 5 years of age have been identified; however, variation in their prevalence resulting from regional-specific proximate determinants has received little attention. Therefore, we aim to investigate the specific regional determinants of overall and wealth-related inequality in children having ARI in Nigeria over a decade.MethodsWe analyzed trends in development of ARI symptoms among children under 5 years of age in Nigeria using nationally representative cross sectional surveys carried out in 2003, 2008 and 2013. Overall- and household wealth index based- inequality in the distribution of prevalence of ARI symptoms were estimated by region using Gini index and Concentration Index, respectively. Multivariate logistic regressions for complex survey and decomposition analysis for both indexes were used to calculate percentual contribution.ResultsWe found a decreasing trend in development of ARI symptoms over the decade between regions. Children in South Western region had reduced likelihood of developing the symptoms. Concentration index (CI) for the prevalence of ARI symptoms over the years and across regions had negative values (all p < 0.05). Gini index (GI) varies from 0.21 in North East to 0.62 in South Western region. Furthermore, the mapping showed that the extent at which both inequalities contribute to ARI symptoms prevalence in each region is different. The four major sources of wealth-related inequalities were poor households, no maternal education, biomass cooking, and rural area.The major contributors to overall inequalities were having a child aged 6 to 23 months, having no maternal education, having no vaccination card, and having a high birth order/short birth interval.ConclusionsAlthough ARI prevalence decreased over the decade, it has remained unequally distributed between regions and over the time. The sources of those inequalities are context sensitive. Thus, in future health promotion initiatives, it is imperative to account for regional variations in the distribution of ARI.
Highlights
Acute respiratory infections (ARI) are major causes of morbidity and mortality in many low-income countries
The primary sample unit (PSU), which was regarded as a cluster for NDHS, in the first stage was derived from the prior Nigerian population census enumeration areas (EAs)
The prevalence of ARI symptoms has dropped across the years and ranges from 0.8 to 16.2
Summary
Acute respiratory infections (ARI) are major causes of morbidity and mortality in many low-income countries. ARI symptoms have been identified as the most significant determinants of morbidity and mortality in low-income countries [7], geographical location has seldom been considered as an explanatory factor for the large regional variations seen in childhood morbidity [8]. The International Vaccine Access Center (IVAC) developed an intervention score assessing the overall performance in adopting and implementing high impact strategies aiming at achieving the intervention target at 84% coverage by 2015. It is measured by the national rate of childhood vaccination, under-5 with suspected pneumonia receiving antibiotics, being taken to appropriate health care provider, and exclusive breastfeeding. Results show that Nigeria lags behind in achieving the goal, with its intervention score at 25 and 37% in 2013 and 2014, respectively, while Kenya had 57 and 65% in the same years [12, 13]
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