Prevalence of acute respiratory infections among children in India: Regional inequalities and risk factors.

AIM: The high incidence of acute respiratory infection (ARI)-related morbidity and mortality is a major public health concern in developing countries. This study aimed to quantify regional inequalities and the degree of association between childhood ARI and background factors. METHODS: This study utilised information of 238 945 children aged below five years extracted from the Fourth Indian National Family Health Survey conducted in 2015-16. Inter-state and regional inequality in the prevalence of ARI were quantified and presented using a map of India and forest plot. The association of background characteristics and ARI was quantified using bivariate and multivariable binary logistic regression models. RESULTS: Significant inequalities in the prevalence of childhood ARI were observed across the six regions of India. Considering the children from north-east region as a reference, those from north, central and east regions were 0.68, 1.02 and 0.57 times more likely to suffer from ARI. Comorbidity, sex, age and nutritional status of children were significantly associated with the prevalence of ARI. CONCLUSIONS: ARI remains a significant public health concern among Indian children. The results of this study showed that significant regional disparities in the prevalence of ARI exist in India. This study adds value to the better understanding of inequality patterns and quantifies within- and intra-region inequalities in the prevalence of ARI in India.

Dynamics in child undernutrition in Bangladesh: Evidence from nationally representative surveys between 1997 and 2014.

BACKGROUND: Bangladesh has been struggling to reduce the prevalence of childhood undernutrition, which impedes physical and mental capability and accelerates morbidity and mortality. OBJECTIVES: The objective of the paper is to examine the changes over time in the association between potential covariates and nutritional status of Bangladeshi children. METHODS: The study combined and analyzed data from six waves of Demographic and Health Surveys between 1997 and 2014. Multivariable binary logistic regression models have been fitted to data from individual waves. Overall association has been investigated using forest plots, and meta-regression has been utilized to assess the pace of change in the association over time. RESULTS: Parental education and place of residence showed a consistent association with nutritional status of children. Children from parents with no little education were more likely to be undernourished than those from parents with secondary or higher level of education (odds ratio [OR] in 1997 = 3.34, 95% confidence interval [CI] = 2.65-4.22, OR in 2004 = 1.93, 95% CI = 1.58-2.37). On the other hand, gaps in the association of wealth and childhood nutrition have been widening consistently so that in 2014 children from households from the lowest 40% wealth category were 2.66 times (OR = 2.66, 95% CI = 2.13-3.33) as likely as to be undernourished than those from upper 20%. CONCLUSIONS: The findings have policy implications in terms of developing programs directed to mothers with a relatively poor socioeconomic background. A specific example would be providing nutritional education in relation to importance of childhood nutrition or cheaper nutritious food.

Differences in levels of E. coli contamination of point of use drinking water in Bangladesh.

This study aimed to quantify the inequalities and identify the associated factors of the UN sustainable development goal (SDG) targets in relation to safe drinking water. The concentration of the gut bacterium Escherichia coli in drinking water at the point of use (POU) and other information were extracted from the latest wave of the nationally representative Bangladesh Multiple Indicator Cluster Survey (MICS 2019). Bivariate and multivariable multinomial logistic regression models were used to identify potential predictors of contamination, whereas, classification trees were used to determine specific combinations of background characteristics with significantly higher rates of contamination. A higher risk of contamination from drinking water was observed for households categorized as middle or low wealth who collected water from sources with higher concentrations of E. coli. Treatment of drinking water significantly reduced the risk of higher levels of contamination, whereas owning a pet was significantly associated with recontamination. Regional differences in the concentrations of E. coli present in drinking water were also observed. Interventions in relation to water sources should emphasize reducing the level of E. coli contamination. Our results may help in developing effective policies for reducing diarrheal diseases by reducing water contamination risks.

Yield, profitability, and prospects of irrigated Boro rice cultivation in the North-West region of Bangladesh.

The North-West (NW) region of Bangladesh is pivotal for the country's agricultural development, mainly in producing irrigated Boro rice. However, increasing cost of irrigation water, fertilizers, labour and other inputs, and the spatio-temporal variation in actual yield, market price and profitability of rice, have added uncertainty to the sustainability of Boro rice cultivation. In this study, we evaluated the productivity, profitability, and prospect of Boro rice production using comprehensive field data collected directly from 420 farmers' fields over two consecutive seasons (2015-16 and 2016-17), across seven geographically distributed locations in the NW region. We also analyzed the risk and return trade of popular Boro rice cultivars using Monte-Carlo simulation. The results show that there were significant (p≤0.05) variations in rice yield between sites, irrigation pump-types, and rice varieties, with Hybrid rice and BRRI dhan29 producing highest yields (6.0-7.5 t/ha). Due to different pricing systems, the cost of irrigation water varied from site to site and from year to year, but always comprised the highest input cost (20-25% of total production). The total paid-out cost, gross benefit, and gross income of rice significantly (p≤0.05) differed between sites, type of irrigation pumps, rice varieties, transplanting dates, and two cropping years. The variations in observed yield and profitability reveal considerable scope to improve rice production systems. Market variation in the price of rice affected overall profitability significantly. Probability and risk analysis results show that Minikit and BRRI dhan29 are the most stable varieties for yield and profitability. Hybrid rice, which has the maximum attainable yield among the cultivated rice varieties, also has the risk of negative net income. Based on the analysis, we discussed ways to improve yield and profitability and the prospect of Boro rice cultivation in the region. The study provides valuable information for policy-makers to sustain irrigated rice cultivation in both the NW region and nationally.

Inequality in access to improved drinking water sources and childhood diarrhoea in low- and middle-income countries.

In addition to the conventional wisdom of categorizing countries based on nationally-averaged coverage in access to improved drinking water sources (IDWS), this study incorporated sub-national inequality into a novel categorisation framework. The association between access to IDWS and the incidence of childhood diarrhoea (ICD) was also quantified. Information from 1.63 million households obtained through nationally representative and cross-sectional demographic and health survey (DHS) and multiple indicator cluster survey (MICS) from 81 countries were analysed. Sub-national inequalities in the access to IDWS were measured using proportional variability (PV). Most studied countries with low coverage and high inequalities in accessing IDWS were from Sub-Saharan Africa (SSA). Wealth status of households showed a higher variability in the IDWS than the variability across locations. Significant negative associations between accessing IDWS and ICD were observed for regional models, except for SSA. This study adds knowledge towards understanding the state of sustainable development goal achievements in terms of accessing IDWS. The knowledge may be helpful in designing country-specific, achievable, short- and long-term strategies. The non-decisive relation between access to IDWS and ICD indicates the adoption of additional measures in the modelling mechanism.

How sustainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia: analysis of survey data from Bangladesh, Nepal and Pakistan.

OBJECTIVES: Prevalence of diarrhoea and acute respiratory infection (ARI) is considerably high among South Asian children. The objective of this study is to compare the associations of sustainable household environment and knowledge of healthy practices with episodes of these diseases among the children in the region. DESIGN: The study analysed the latest, nationally representative and cross-sectional Demographic and Health Survey data. SETTING: Data from three countries were analysed: Bangladesh, Nepal and Pakistan. PARTICIPANTS: Women aged between 12 and 49 years living in selected households provided information on 23 940 of their children under the age of 5 years. PRIMARY OUTCOMES MEASURES: The morbidity status of the children was recorded with respect to episodes of diarrhoea and/or ARI in the 2 weeks preceding data collection. RESULTS: Consuming unhygienic drinking water increased the risks of childhood diarrhoea, and use of solid fuel for indoor cooking increased the risk of ARI, across all three countries investigated. However, far more significant were the effects of mother's education, with incomplete primary education leading to an odds of diarrhoea approaching twice that of a mother with secondary education or higher (OR 1.70 in Bangladesh, 95% CI 1.16 to 2.49). CONCLUSIONS: Results from the current research underline the importance of developing and implementing integrated strategic plans for mothers and children in the countries investigated. Promoting hygienic water and sanitation facilities can help reduce the prevalence of childhood diarrhoea. Replacing indoor solid fuel cooking arrangements with cleaner fuel or more airy conditions can help reduce the prevalence of ARI. However, these strategies need to be integrated with education for women to raise the likelihood that reduced risks are actually realised.

Determinants of childhood morbidity in Bangladesh: evidence from the Demographic and Health Survey 2011.

OBJECTIVES: The present study aims to estimate the incidence of preventable infectious diseases or associated symptoms among young children in Bangladesh and also determine the factors affecting these conditions. The study hypothesised that various background characteristics of children as well as their parents influence the incidence of morbidity of children aged below 5 years. SETTING: The study used data from the most recent nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) conducted in 2011. PARTICIPANTS: A total of 7550 children aged below 5 years during the survey from mothers aged between 12 and 49 years are the participants of the study. RESULTS: In general, younger children were more likely to suffer from multiple health conditions than their older counterparts. Children belonging to households classified as poor (OR=1.425, 95% CI (1.130 to 1.796)) or middle (OR=1.349, 95% CI (1.113 to 1.636)) faced greater risk of illness than those from well-off households. A combination of source and treatment practices of drinking water showed a significant impact on incidence of childhood morbidity. Children from households using untreated non-piped water were 85.8% (OR=1.860, 95% CI (1.269 to 2.728)) more likely to suffer from comorbidity than those who treat their piped drinking water. However, we observed that water treatment alone has no impact unless the water itself was sourced from a pipe. CONCLUSIONS: Accelerated programmes promoting access to safe drinking water along with water treatment practices, and better household environment may prove effective in reducing the incidence of childhood morbidity in Bangladesh.