Individual and community-level factors associated with symptoms of acute lower respiratory infections among children under 5 years of age in Eswatini

Abstract

Background. Despite initiatives and efforts implemented over the years that would impact positively on child health, acute lower respiratory infections (ALRIs) remain a serious challenge for under-5s.
Objective. To investigate the individual- and community-level factors associated with child ALRIs in Eswatini.
Methods. Using the combined data for 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys, data for 4 265 children under 5 years of age were analysed. Univariable, bivariable and multivariable multilevel logistic regression analyses were conducted.
Results. We found that the prevalence of ALRIs was 11.1% (95% confidence interval (CI) 10.0 - 12.4). Higher odds of ALRIs were observed among children who had reported diarrhoea in the same time period (adjusted odds ratio (aOR) 1.75; 95% CI 1.37 - 2.23) compared with those who did not report diarrhoea, and those born to women with no formal education (aOR 2.16; 95% CI 1.13 - 4.16) and those with primary education (aOR 2.60; 95% CI 1.34 - 5.04) compared with those born to women with tertiary education. Place of residence was a community-level variable associated with higher odds of ALRIs among children from urban areas (aOR 1.59; 95% CI 1.15 - 2.20) compared with rural residents. Those from Manzini (aOR 2.19; 95% CI 1.59 - 3.12), Shiselweni (aOR 1.73; 95% CI 1.23 - 2.44) and Lubombo (aOR 1.77; 95% CI 1.25 - 2.51) were more likely to be infected with ALRIs compared with those from the Hhohho region. In addition, higher odds of ALRIs were observed in children from communities with a low proportion of households with electricity (aOR 1.46; 95% CI 1.10 - 1.95) compared with those from communities with high access to electricity.
Conclusions. We found that individual- and community-level factors were associated with child ALRIs across communities in Eswatini.
Programmes and policies that aim to mitigate child morbidity due to ALRIs should integrate the individual and community factors.