Sex-specific prevalence and trends in acute respiratory infection episodes among children less than 5 years in Nigeria.

Abstract

Biological sex is an important factor that influences childhood morbidity and mortality but its role in acute respiratory infections (ARI) in children is not well understood. We investigated the trends in sex-specific prevalence of childhood ARI episodes and associated factors in Nigerian children from 1990 to 2013. This secondary analysis used data from the Nigerian Demographic Health Surveys (NDHS) collected in 1990, 1999, 2003, 2008 and 2013. Variables extracted include: two ARI-related questions, household characteristics, children's anthropometry and vaccination status. We defined ARI as maternal report of cough accompanied by short, rapid breathing. Univariate and bivariate analyses were carried out to estimate prevalence of suspected ARI and compared between male and female children. We found an initial increase followed by a decreasing trend in prevalence of ARI-related symptoms among under-5 children; from 6.7% in 1990 to 11.6% in 1999 then to 3.8% in 2013 without consistent sex differences regardless of other factors except malnutrition. In the 2003 survey, more male than female children had ARI among underweight [OR = 1.22 (95% CI: 1.04, 1.43)] and stunted [OR = 1.23 (95% CI: 1.07, 1.43)] children. Similarly, the 2008 survey showed that more male (5.8%) than female (5.4%) children in the wasted category had ARI [OR = 1.13 (95% CI: 1.07, 2.01)]. The highest prevalence of suspected ARI was consistently recorded in the North-East region. The Nigeria Demographic Health Surveys demonstrated no consistent sex differences in burden and trends of childhood pneumonia-like episodes over a 24-year period. Malnutrition has some influence on the burden of ARI-related symptoms.