Determining the risk factors for Acute Respiratory Infections in Tanzanian children under five

Acute respiratory infections (ARIs) are a common cause of childhood morbidity and mortality around the world. This includes upper respiratory tract infections such as rhinitis and sinusitis, and lower respiratory tract infections such as pneumonia. Evidence from the World Health Organisation has shown that ARIs have an especially high burden in developing countries with over 90% of total global cases being in developing countries. Africa in particular is heavily affected with 45% of global ARI deaths occurring within the continent. Our research has been commissioned by Kite International, a youth-led NGO based in Dar Es Salaam, with the aim to understand the risk factors associated with acute respiratory infections in under 5s in the east African country of Tanzania. 

Similar to neighbouring countries, Tanzania has a high prevalence of acute respiratory infections. In 2000, the percentage of childhood deaths attributable to ARIs in Tanzania was estimated at 20-25%. However, research using data from 2019 Demographic and Health Surveys places this number even higher at 35.2%, among the highest in the east African region. By determining the associated risk factors we will then be able to formulate potential interventions to combat the burden of ARIs on an individual, community and national level.

Certain demographic groups have an increased risk of ARIs. It has been shown that ARIs are more common in the young, elderly and immunocompromised. In Tanzania, the prevalence of HIV in children under 5 is high with 90% of infections in children resulting from vertical transmission. HIV status can, with other factors such as malnourishment, further increase the risk of infection. Research has shown that HIV-infected children have a 62% increased risk of ARI, while being underweight increases the risk by 58%. In children who were exposed to HIV but uninfected, the increased risk due to being underweight was 73%. Among HIV-exposed infants, low food consistency, diversity and food group frequency were associated with an increased risk of ARI as well.

Wider intersectional factors also pose challenges in accessing health services and essential treatment, consequently increasing ARI prevalence. The characteristics of caregivers appear to play a vital role in influencing patterns and differentiation in the utilization of health services. For example, parents’ educational attainment consistently correlates with ARI prevalence; children living with an uneducated caregiver are far less likely to receive care in comparison to those with educated parents. Socioeconomic status plays an important role in health care utilisation and its direct health outcomes, particularly in children. Children from poorer households recorded a higher prevalence of ARIs, in comparison to their more affluent counterparts who are usually able to pay for healthcare out-of-pocket. Similarly, findings relating to the role of toilet facilities in the development of ARI among children in sub-Saharan Africa undoubtedly establishes that appropriate living conditions, especially proper sanitation, are crucial in reducing infections among children under five.

Inadequate health services pose a further challenge. Children under five seeking medical intervention for respiratory illnesses were often improperly assessed in Tanzania unless they presented with evident and explicit ARI symptoms including tussis or dyspnoea. This can cause undertreated health conditions to escalate to critical levels. It has been shown that the relevant examinations for ARI symptoms, including stethoscope use and chest exposure, were conducted far more frequently in longer consultations. Duration and comprehensiveness of clinical consultations observed seemed insufficient to guide a respiratory diagnosis in children. This inadvertently had a worse outcome upon those of a lower socioeconomic status, as many could not afford to pay for longer consultations (which were synonymous with the more expensive hospitals). 

In conclusion, ARIs are one of the leading causes of mortality and morbidity in children under-five with a high prevalence, despite increased efforts and initiatives performed in Tanzania. Therefore, it is imperative to identify the key risk factors for ARIs, to ensure effective policies and strategies to disrupt transmission and improve health outcomes. This research will also help us understand the current status of ARIs in the country as well as propose specific solutions to reduce the mortality of the future generation. Solutions will aim to mitigate the risk factors involved on an individual and community level in addition to devising ways of increasing early diagnosis and treatment of ARIs. 

Researchers:

Dhruti Devshi is a PhD student in Immunology at King’s College London. She also volunteers with MSF, focusing on health interventions in resource-poor settings.

Arif Jalal is a Medical Student at University College London with an interest in strengthening public health in developing countries.

Hannah Yusuf is a Medical Student at University College London with an interest in Maternal and Child Health, in particular how different policies and strategies implemented can reduce such global disparities. 

Emilia Lindquist is an incoming Global Health Policy student at the London School of Economics and Political Science with an interest in health equity, health policy and infectious diseases.

Onyeka Onwuegbunam is an MSc Global Health and Development student at University College London with an interest in infectious diseases and health systems strengthening.

Ayesha Ali has just finished her third year of Medicine at Imperial College and will be undertaking an BSc in Management. She has a strong interest in refugee health.

Editor:

Rowan Eastabrook is a MSc Population Health student at University College London with an interest in global Maternal and Child Health and a background in medical anthropology. 

Commissioner:

Knowledge and Innovation for Technological Enterprise (KITE DSM) is a Non-Governmental Organisation, located in Dar es Salaam City, Tanzania. It is a non-profit organisation led by the youth which aims to promote sustainable developmental goals such as no poverty, quality education, clean water and sanitation. Its core values include sustainability through partnerships, personal development of volunteers and ending global inequality. Their philosophy is “Youth Powering Change.” This is the belief that the youth have a significant role to play in solving problems both locally and internationally.

Further Reading: 

1. Seidu A, Dickson K, Ahinkorah B, Amu H, Darteh E, Kumi-Kyereme A. Prevalence and determinants of Acute Lower Respiratory Infections among children under-five years in sub–Saharan Africa: Evidence from demographic and health surveys. 2020.

2. Mwiru R, Spiegelman D, Hertzmark E, Duggan C, Msamanga G, Aboud S, et al. Nutritional predictors of acute respiratory infections among children born to HIV-infected women in Tanzania. J Trop Pediatr. 2013;59(3):203-8.

3. Pattemore P, Jennings L. Epidemiology of Respiratory Infections. Pediatric Respiratory Medicine. 2008;:435-452. doi:10.1016/B978-032304048-8.50035-9

4. Arunda MO, Choudhry V, Ekman B, Asamoah BO. Under-five mortality and maternal HIV status in Tanzania: analysis of trends between 2003 and 2012 using AIDS Indicator Survey data. Glob Health Action. 2016;9:31676.

5. Kamenju P, Liu E, Hertzmark E, Spiegelman D, Kisenge R, Kupka R et al. Complementary Feeding and Diarrhea and Respiratory Infection Among HIV-Exposed Tanzanian Infants. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2017;74(3):265-272.