Ahmed Kedir Y, Dadi Abel F, Kibret Getiye Dejenu, Bizuayehu Habtamu Mellie, Hassen Tahir A, Amsalu Erkihun, Ketema Daniel Bekele, Kassa Zemenu Yohannes, Bore Meless G, Alebel Animut, Alemu Addisu Alehegn, Shifa Jemal E, Leshargie Cheru Tesema, Thapa Subash, Omar Syed Haris, Ross Allen G
Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia.
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
EClinicalMedicine. 2024 Feb 3;68:102444. doi: 10.1016/j.eclinm.2024.102444. eCollection 2024 Feb.
Identifying the critical modifiable risk factors for acute respiratory tract infections (ARIs) and diarrhoea is crucial to reduce the burden of disease and mortality among children under 5 years of age in sub-Saharan Africa (SSA) and ultimately achieving the Sustainable Development Goals (SDGs). We investigated the modifiable risk factors of ARI and diarrhoea among children under five using nationally representative surveys.
We used the most recent demographic and health survey (DHS) data (2014-2021) from 25 SSA countries, encompassing a total of 253,167 children. Countries were selected based on the availability of recent datasets (e.g., DHS-VII or DHS-VIII) that represent the current socioeconomic situations. Generalised linear latent mixed models were used to compute odds ratios (ORs). Population attributable fractions (PAFs) were calculated using adjusted ORs and prevalence estimates for key modifiable risk factors among ARI and diarrhoeal cases.
This study involved 253,167 children, with a mean age of 28.7 (±17.3) months, and 50.5% were male. The highest PAFs for ARI were attributed to unclean cooking fuel (PAF = 15.7%; 95% CI: 8.1, 23.1), poor maternal education (PAF = 13.4%; 95% CI: 8.7, 18.5), delayed initiation of breastfeeding (PAF = 12.4%; 95% CI: 9.0, 15.3), and poor toilets (PAF = 8.5%; 95% CI: 4.7, 11.9). These four modifiable risk factors contributed to 41.5% (95% CI: 27.2, 52.9) of ARI cases in SSA. The largest PAFs of diarrhoea were observed for unclean cooking fuel (PAF = 17.3%; 95% CI: 13.5, 22.3), delayed initiation of breastfeeding (PAF = 9.2%; 95% CI: 7.5, 10.5), household poverty (PAF = 7.0%; 95% CI: 5.0, 9.1) and poor maternal education (PAF = 5.6%; 95% CI: 2.9, 8.8). These four modifiable risk factors contributed to 34.0% (95% CI: 26.2, 42.3) of cases of diarrhoea in SSA.
This cross-sectional study identified four modifiable risk factors for ARI and diarrhoea that should be a priority for policymakers in SSA. Enhancing home-based care and leveraging female community health workers is crucial for accelerating the reduction in under-5 mortality linked to ARI and diarrhoea in SSA.
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确定急性呼吸道感染（ARI）和腹泻的关键可改变风险因素对于减轻撒哈拉以南非洲（SSA）5岁以下儿童的疾病负担和死亡率，并最终实现可持续发展目标（SDG）至关重要。我们利用具有全国代表性的调查，研究了5岁以下儿童中ARI和腹泻的可改变风险因素。
我们使用了来自25个SSA国家的最新人口与健康调查（DHS）数据（2014 - 2021年），涵盖总计253,167名儿童。根据能代表当前社会经济状况的近期数据集（如DHS - VII或DHS - VIII）的可获取情况来选择国家。使用广义线性潜在混合模型计算比值比（OR）。利用调整后的OR以及ARI和腹泻病例中关键可改变风险因素的患病率估计值来计算人群归因分数（PAF）。
本研究涉及253,167名儿童，平均年龄为28.7（±17.3）个月，50.5%为男性。ARI的最高PAF归因于不清洁的烹饪燃料（PAF = 15.7%；95%CI：8.1，23.1）、母亲教育程度低（PAF = 13.4%；95%CI：8.7，18.5）、母乳喂养开始延迟（PAF = 12.4%；95%CI：9.0，15.3）以及卫生条件差的厕所（PAF = 8.5%；95%CI：4.7，11.9）。这四个可改变风险因素导致了SSA地区41.5%（95%CI：27.2，52.9）的ARI病例。腹泻的最大PAF见于不清洁的烹饪燃料（PAF = 17.3%；95%CI：13.5，22.3）、母乳喂养开始延迟（PAF = 9.2%；95%CI：7.5，10.5）、家庭贫困（PAF = 7.0%；95%CI：5.0，9.1）以及母亲教育程度低（PAF = 5.6%；95%CI：2.9，8.8）。这四个可改变风险因素导致了SSA地区34.0%（95%CI：26.2，42.3）的腹泻病例。
这项横断面研究确定了ARI和腹泻的四个可改变风险因素，这应是SSA地区政策制定者的优先事项。加强家庭护理并利用女性社区卫生工作者对于加速降低SSA地区与ARI和腹泻相关的5岁以下儿童死亡率至关重要。
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