Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Sci Rep. 2023 Jan 17;13(1):868. doi: 10.1038/s41598-023-27728-8.
Although substantial progress has been made in reducing child mortality over the last three decades, the magnitude of the problem remains immense. Ethiopia is one of the countries with a high under-five mortality rate due to childhood illnesses including acute respiratory infections, diarrhea, and fever that varies from place to place. It is vital to have evidence of the factors associated with childhood illnesses and the spatial distribution across the country to prioritize and design targeted interventions. Thus, this study aimed to investigate the spatial cluster distribution and associated factors with common childhood illnesses. Secondary data analysis based on the 2016 Ethiopian Demographic and Health Survey data was carried out. A total weighted sample of 10,417 children was included. The study used ArcGIS and SaTScan software to explore spatial distribution. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with the problem. ICC, MOR, PCV, and deviance (-2LLR) were used to check model fitness and model comparison. In this study, the prevalence of common childhood illnesses among under-five children was 22.5% (95% CI: 21.6-23.3%). The spatial analysis depicted that common childhood illnesses have significant spatial variation across Ethiopia. The SaTScan analysis identified significant primary clusters in Tigray and Northern Amhara regions (log-likelihood ratio (LLR) = 60.19, p < 0.001). In the multilevel analysis, being rural residence [AOR = 1.39, 95% CI (1.01-1.98)], small child size at birth [AOR = 1.36, 95% CI (1.21-1.55)], high community poverty [AOR = 1.26, 95% CI (1.06-1.52)], mothers aged 35-49 [AOR = 0.81, 95% CI (0.69-0.94)], the household had electricity [AOR = 0.77, 95% CI (0.61-0.98)], the household had a refrigerator [AOR = 0.60, 95% CI (0.42-0.87)], improved drinking water [AOR = 0.82, 95% CI (0.70-0.95)], improved toilet [AOR = 0.72, 95% CI (0.54-0.94)], average child size at birth [AOR = 0.83, 95% CI (0.75-0.94)] were significantly associated with common childhood illnesses. Common childhood illnesses had spatial variations across Ethiopia. Hotspot areas of the problem were found in the Tigray, Northern Amhara, and Northeast SNNPR. Both individual and community-level factors affected common childhood illnesses distribution and prevalence in Ethiopia. Therefore, public health intervention should target the hotspot areas of common childhood illnesses to reduce their incidence in the country.
尽管在过去三十年中，儿童死亡率大幅下降，但问题的规模仍然巨大。埃塞俄比亚是五岁以下儿童死亡率较高的国家之一，其主要原因是包括急性呼吸道感染、腹泻和发热在内的儿童疾病。拥有与儿童疾病相关的因素以及全国范围内的空间分布证据，对于确定优先事项和设计有针对性的干预措施至关重要。因此，本研究旨在调查常见儿童疾病的空间聚类分布及其相关因素。本研究基于 2016 年埃塞俄比亚人口与健康调查数据进行了二次数据分析。共纳入了 10417 名加权总样本儿童。研究使用 ArcGIS 和 SaTScan 软件来探索空间分布。对于相关因素，使用 STATA V.14 软件拟合了多水平二元逻辑回归模型。采用调整后的优势比（AOR）和 95%置信区间（CI）和 p 值≤0.05 在多变量模型中用于声明与问题相关的显著因素。ICC、MOR、PCV 和方差（-2LLR）用于检查模型拟合度和模型比较。在这项研究中，五岁以下儿童常见儿童疾病的患病率为 22.5%（95%CI：21.6-23.3%）。空间分析表明，埃塞俄比亚常见儿童疾病存在显著的空间差异。SaTScan 分析在提格雷和阿姆哈拉北部地区发现了显著的初级集群（对数似然比（LLR）=60.19，p<0.001）。在多水平分析中，农村居住[OR=1.39，95%CI（1.01-1.98）]、出生时儿童体型小[AOR=1.36，95%CI（1.21-1.55）]、社区贫困程度高[AOR=1.26，95%CI（1.06-1.52）]、母亲年龄在 35-49 岁[AOR=0.81，95%CI（0.69-0.94）]、家庭有电[AOR=0.77，95%CI（0.61-0.98）]、家庭有冰箱[AOR=0.60，95%CI（0.42-0.87）]、饮用水改善[AOR=0.82，95%CI（0.70-0.95）]、厕所改善[AOR=0.72，95%CI（0.54-0.94）]、出生时儿童平均体型[AOR=0.83，95%CI（0.75-0.94）]与常见儿童疾病显著相关。埃塞俄比亚常见儿童疾病存在空间差异。问题的热点地区在提格雷、阿姆哈拉北部和东北 SNNPR 地区。个人和社区层面的因素都影响了埃塞俄比亚常见儿童疾病的分布和流行。因此，公共卫生干预措施应针对常见儿童疾病的热点地区，以降低该国的发病率。
