Links to Exploration step
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda</title><author><name sortKey="Harerimana, Jean Modeste" sort="Harerimana, Jean Modeste" uniqKey="Harerimana J" first="Jean-Modeste" last="Harerimana">Jean-Modeste Harerimana</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Nyirazinyoye, Leatitia" sort="Nyirazinyoye, Leatitia" uniqKey="Nyirazinyoye L" first="Leatitia" last="Nyirazinyoye">Leatitia Nyirazinyoye</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Thomson, Dana R" sort="Thomson, Dana R" uniqKey="Thomson D" first="Dana R." last="Thomson">Dana R. Thomson</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA</nlm:aff></affiliation></author><author><name sortKey="Ntaganira, Joseph" sort="Ntaganira, Joseph" uniqKey="Ntaganira J" first="Joseph" last="Ntaganira">Joseph Ntaganira</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27217955</idno><idno type="pmc">4876567</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876567</idno><idno type="RBID">PMC:4876567</idno><idno type="doi">10.1186/s13690-016-0132-1</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000554</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000554</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda</title><author><name sortKey="Harerimana, Jean Modeste" sort="Harerimana, Jean Modeste" uniqKey="Harerimana J" first="Jean-Modeste" last="Harerimana">Jean-Modeste Harerimana</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Nyirazinyoye, Leatitia" sort="Nyirazinyoye, Leatitia" uniqKey="Nyirazinyoye L" first="Leatitia" last="Nyirazinyoye">Leatitia Nyirazinyoye</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Thomson, Dana R" sort="Thomson, Dana R" uniqKey="Thomson D" first="Dana R." last="Thomson">Dana R. Thomson</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA</nlm:aff></affiliation></author><author><name sortKey="Ntaganira, Joseph" sort="Ntaganira, Joseph" uniqKey="Ntaganira J" first="Joseph" last="Ntaganira">Joseph Ntaganira</name><affiliation><nlm:aff id="Aff1">University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</nlm:aff></affiliation></author></analytic><series><title level="j">Archives of Public Health</title><idno type="ISSN">0778-7367</idno><idno type="eISSN">2049-3258</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>In low and middle-income countries, acute lower respiratory illness is responsible for roughly 1 in every 5 child deaths. Rwanda has made major health system improvements including its community health worker systems, and it is one of the few countries in Africa to meet the 2015 Millennium Development Goals, although prevalence of acute lower respiratory infections (4 %) is similar to other countries in sub-Saharan Africa. This study aims to assess social, economic, and environmental factors associated with acute lower respiratory infections among children under five to inform potential further improvements in the health system.</p></sec><sec><title>Methods</title><p>This is a cross-sectional study using data collected from women interviewed in the 2010 DHS about 8,484 surviving children under five. Based on a literature review, we defined 19 health, social, economic, and environmental potential risk factors, tested bivariate associations with acute lower respiratory infections, and advanced variables significant at the 0.1 confidence level to logistic regression modelling. We used manual backward stepwise regression to arrive at a final model. All analyses were performed in Stata v13 and adjusted for complex sample design.</p></sec><sec><title>Results</title><p>The following factors were independently associated with acute lower respiratory infections: child’s age, anemia level, and receipt of Vitamin A; household toilet type and residence, and season of interview. In multivariate regression, being in the bottom ten percent of households (OR: 1.27, 95 % CI: 0.85-1.87) or being interviewed during the rainy season (OR: 1.61, 95 % CI: 1.24-2.09) was positively associated with acute lower respiratory infections, while urban residence (OR: 0.58, 95 % CI: 0.38-0.88) and being age 24–59 months versus 0–11 months (OR: 0.53, 95 % CI: 0.40-0.69) was negatively associated with acute lower respiratory infections.</p></sec><sec><title>Conclusion</title><p>Potential areas for intervention including community campaigns about acute lower respiratory infections symptoms and treatment, and continued poverty reduction through rural electrification and modern stove distribution which may reduce use of dirty cooking fuel, improve living conditions, and reduce barriers to health care.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zar, Hj" uniqKey="Zar H">HJ Zar</name></author><author><name sortKey="Ferkol, Tw" uniqKey="Ferkol T">TW Ferkol</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author><author><name sortKey="Morris, Ss" uniqKey="Morris S">SS Morris</name></author><author><name sortKey="Bryce, J" uniqKey="Bryce J">J Bryce</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Moura, Fea" uniqKey="Moura F">FEA Moura</name></author><author><name sortKey="Perdigao, Acb" uniqKey="Perdigao A">ACB Perdigão</name></author><author><name sortKey="Siqueira, Mm" uniqKey="Siqueira M">MM Siqueira</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Goel, K" uniqKey="Goel K">K Goel</name></author><author><name sortKey="Ahmad, S" uniqKey="Ahmad S">S Ahmad</name></author><author><name sortKey="Agarwal, G" uniqKey="Agarwal G">G Agarwal</name></author><author><name sortKey="Goel, P" uniqKey="Goel P">P Goel</name></author><author><name sortKey="Kumar, V" uniqKey="Kumar V">V Kumar</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Murray, El" uniqKey="Murray E">EL Murray</name></author><author><name sortKey="Klein, M" uniqKey="Klein M">M Klein</name></author><author><name sortKey="Brondi, L" uniqKey="Brondi L">L Brondi</name></author><author><name sortKey="Mcgowan, Je" uniqKey="Mcgowan J">JE McGOWAN</name></author><author><name sortKey="Van Mels, C" uniqKey="Van Mels C">C Van Mels</name></author><author><name sortKey="Brooks, Wa" uniqKey="Brooks W">WA Brooks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tchidjou, Hk" uniqKey="Tchidjou H">HK Tchidjou</name></author><author><name sortKey="Vescio, F" uniqKey="Vescio F">F Vescio</name></author><author><name sortKey="Boros, S" uniqKey="Boros S">S Boros</name></author><author><name sortKey="Guemkam, G" uniqKey="Guemkam G">G Guemkam</name></author><author><name sortKey="Minka, E" uniqKey="Minka E">E Minka</name></author><author><name sortKey="Lobe, M" uniqKey="Lobe M">M Lobe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tamerius, J" uniqKey="Tamerius J">J Tamerius</name></author><author><name sortKey="Nelson, Mi" uniqKey="Nelson M">MI Nelson</name></author><author><name sortKey="Zhou, Sz" uniqKey="Zhou S">SZ Zhou</name></author><author><name sortKey="Viboud, C" uniqKey="Viboud C">C Viboud</name></author><author><name sortKey="Miller, Ma" uniqKey="Miller M">MA Miller</name></author><author><name sortKey="Alonso, Wj" uniqKey="Alonso W">WJ Alonso</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Imai, C" uniqKey="Imai C">C Imai</name></author><author><name sortKey="Brooks, Wa" uniqKey="Brooks W">WA Brooks</name></author><author><name sortKey="Chung, Y" uniqKey="Chung Y">Y Chung</name></author><author><name sortKey="Goswami, D" uniqKey="Goswami D">D Goswami</name></author><author><name sortKey="Anjali, Ba" uniqKey="Anjali B">BA Anjali</name></author><author><name sortKey="Dewan, A" uniqKey="Dewan A">A Dewan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Azad, Kmak" uniqKey="Azad K">KMAK Azad</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ujunwa, F" uniqKey="Ujunwa F">F Ujunwa</name></author><author><name sortKey="Ezeonu, C" uniqKey="Ezeonu C">C Ezeonu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Astale, T" uniqKey="Astale T">T Astale</name></author><author><name sortKey="Michelene, C" uniqKey="Michelene C">C Michelene</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mugeni, C" uniqKey="Mugeni C">C Mugeni</name></author><author><name sortKey="Levine, Ac" uniqKey="Levine A">AC Levine</name></author><author><name sortKey="Munyaneza, Rm" uniqKey="Munyaneza R">RM Munyaneza</name></author><author><name sortKey="Mulindahabi, E" uniqKey="Mulindahabi E">E Mulindahabi</name></author><author><name sortKey="Cockrell, Hc" uniqKey="Cockrell H">HC Cockrell</name></author><author><name sortKey="Glavis Bloom, J" uniqKey="Glavis Bloom J">J Glavis-Bloom</name></author><author><name sortKey="Nutt, C" uniqKey="Nutt C">C Nutt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Skiles, Mp" uniqKey="Skiles M">MP Skiles</name></author><author><name sortKey="Curtis, Sl" uniqKey="Curtis S">SL Curtis</name></author><author><name sortKey="Basinga, P" uniqKey="Basinga P">P Basinga</name></author><author><name sortKey="Angeles, G" uniqKey="Angeles G">G Angeles</name></author><author><name sortKey="Thirumurthy, H" uniqKey="Thirumurthy H">H Thirumurthy</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Amugsi, Da" uniqKey="Amugsi D">DA Amugsi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Henninger, Sm" uniqKey="Henninger S">SM Henninger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harris, Am" uniqKey="Harris A">AM Harris</name></author><author><name sortKey="Sempertegui, F" uniqKey="Sempertegui F">F Sempértegui</name></author><author><name sortKey="Estrella, B" uniqKey="Estrella B">B Estrella</name></author><author><name sortKey="Narvaez, X" uniqKey="Narvaez X">X Narváez</name></author><author><name sortKey="Egas, J" uniqKey="Egas J">J Egas</name></author><author><name sortKey="Woodin, M" uniqKey="Woodin M">M Woodin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alemayehu, M" uniqKey="Alemayehu M">M Alemayehu</name></author><author><name sortKey="Alemu, K" uniqKey="Alemu K">K Alemu</name></author><author><name sortKey="Sharma, Hr" uniqKey="Sharma H">HR Sharma</name></author><author><name sortKey="Gizaw, Z" uniqKey="Gizaw Z">Z Gizaw</name></author><author><name sortKey="Shibru, A" uniqKey="Shibru A">A Shibru</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ezeh, Ok" uniqKey="Ezeh O">OK Ezeh</name></author><author><name sortKey="Agho, Ke" uniqKey="Agho K">KE Agho</name></author><author><name sortKey="Dibley, Mj" uniqKey="Dibley M">MJ Dibley</name></author><author><name sortKey="Hall, Jj" uniqKey="Hall J">JJ Hall</name></author><author><name sortKey="Page, An" uniqKey="Page A">AN Page</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Toplulu Un, Ba" uniqKey="Toplulu Un B">BA Topluluğun</name></author><author><name sortKey="Pi Irmede, H" uniqKey="Pi Irmede H">H Pişirmede</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ramesh Bhat, Y" uniqKey="Ramesh Bhat Y">Y Ramesh Bhat</name></author><author><name sortKey="Manjunath, N" uniqKey="Manjunath N">N Manjunath</name></author><author><name sortKey="Sanjay, D" uniqKey="Sanjay D">D Sanjay</name></author><author><name sortKey="Dhanya, Y" uniqKey="Dhanya Y">Y Dhanya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jackson, S" uniqKey="Jackson S">S Jackson</name></author><author><name sortKey="Mathews, Kh" uniqKey="Mathews K">KH Mathews</name></author><author><name sortKey="Pulanic, D" uniqKey="Pulanic D">D Pulanic</name></author><author><name sortKey="Falconer, R" uniqKey="Falconer R">R Falconer</name></author><author><name sortKey="Rudan, I" uniqKey="Rudan I">I Rudan</name></author><author><name sortKey="Campbell, H" uniqKey="Campbell H">H Campbell</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Arch Public Health</journal-id><journal-id journal-id-type="iso-abbrev">Arch Public Health</journal-id><journal-title-group><journal-title>Archives of Public Health</journal-title></journal-title-group><issn pub-type="ppub">0778-7367</issn><issn pub-type="epub">2049-3258</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27217955</article-id><article-id pub-id-type="pmc">4876567</article-id><article-id pub-id-type="publisher-id">132</article-id><article-id pub-id-type="doi">10.1186/s13690-016-0132-1</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Harerimana</surname><given-names>Jean-Modeste</given-names></name><address><phone>+250-788300935</phone><email>modesteharera@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Nyirazinyoye</surname><given-names>Leatitia</given-names></name><address><email>lnyirazi@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Thomson</surname><given-names>Dana R.</given-names></name><address><email>dana.r.thomson@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Ntaganira</surname><given-names>Joseph</given-names></name><address><email>jntaganira@yahoo.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><label></label>University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda</aff><aff id="Aff2"><label></label>Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA</aff></contrib-group><pub-date pub-type="epub"><day>23</day><month>5</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>23</day><month>5</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>74</volume><elocation-id>19</elocation-id><history><date date-type="received"><day>28</day><month>10</month><year>2015</year></date><date date-type="accepted"><day>18</day><month>3</month><year>2016</year></date></history><permissions><copyright-statement>© Harerimana et al. 2016</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>In low and middle-income countries, acute lower respiratory illness is responsible for roughly 1 in every 5 child deaths. Rwanda has made major health system improvements including its community health worker systems, and it is one of the few countries in Africa to meet the 2015 Millennium Development Goals, although prevalence of acute lower respiratory infections (4 %) is similar to other countries in sub-Saharan Africa. This study aims to assess social, economic, and environmental factors associated with acute lower respiratory infections among children under five to inform potential further improvements in the health system.</p></sec><sec><title>Methods</title><p>This is a cross-sectional study using data collected from women interviewed in the 2010 DHS about 8,484 surviving children under five. Based on a literature review, we defined 19 health, social, economic, and environmental potential risk factors, tested bivariate associations with acute lower respiratory infections, and advanced variables significant at the 0.1 confidence level to logistic regression modelling. We used manual backward stepwise regression to arrive at a final model. All analyses were performed in Stata v13 and adjusted for complex sample design.</p></sec><sec><title>Results</title><p>The following factors were independently associated with acute lower respiratory infections: child’s age, anemia level, and receipt of Vitamin A; household toilet type and residence, and season of interview. In multivariate regression, being in the bottom ten percent of households (OR: 1.27, 95 % CI: 0.85-1.87) or being interviewed during the rainy season (OR: 1.61, 95 % CI: 1.24-2.09) was positively associated with acute lower respiratory infections, while urban residence (OR: 0.58, 95 % CI: 0.38-0.88) and being age 24–59 months versus 0–11 months (OR: 0.53, 95 % CI: 0.40-0.69) was negatively associated with acute lower respiratory infections.</p></sec><sec><title>Conclusion</title><p>Potential areas for intervention including community campaigns about acute lower respiratory infections symptoms and treatment, and continued poverty reduction through rural electrification and modern stove distribution which may reduce use of dirty cooking fuel, improve living conditions, and reduce barriers to health care.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>ALRI</kwd><kwd>ARI</kwd><kwd>Demographic and health survey</kwd><kwd>Community</kwd><kwd>Integration</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1" sec-type="introduction"><title>Background</title><p>Acute respiratory infections are a leading cause of mortality among children under five years of age [<xref ref-type="bibr" rid="CR1">1</xref>]. In low and middle-income countries, 6.9 million children died in 2011 and about one in five of these deaths was caused by an acute lower respiratory infection (ALRI) [<xref ref-type="bibr" rid="CR2">2</xref>]. ALRI is characterized by cough accompanied by short, rapid breathing that is chest-related, and is commonly linked to death through co-morbidities with other childhood illnesses [<xref ref-type="bibr" rid="CR3">3</xref>]. Ninety-seven percent of ALRI cases occur in the developing world with seventy percent of those cases occurring in south Asia and sub-Saharan Africa alone [<xref ref-type="bibr" rid="CR2">2</xref>].</p><p>The most common communicable diseases in Rwanda are malaria, ALRI, HIV and AIDS, diarrhoeal diseases and tuberculosis [<xref ref-type="bibr" rid="CR4">4</xref>]. In low-resource settings, prevalence of ALRI and other risk factors of child mortality are linked to community and household socioeconomic factors, access to health care, and weather among which housing, nutrition, and indoor air quality stand out [<xref ref-type="bibr" rid="CR5">5</xref>]. In 2010, four percent of children under-five in Rwanda had symptoms of ALRI in the previous two weeks, which is similar with other countries in sub-Saharan Africa [<xref ref-type="bibr" rid="CR6">6</xref>].</p><p>Interventions such as promotion of health service utilization and integrated management of childhood illnesses in Rwanda have contributed to improved child health outcomes in recent years [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR8">8</xref>]. Rwanda is one of the few countries in Africa to meet Millennium Development Goal (MDG) 4, the reduction of child mortality; between 2005 and 2010, under-five mortality declined from 152 to 76 deaths per 1,000 live births [<xref ref-type="bibr" rid="CR6">6</xref>]. Furthermore, close to three-quarters of the population in Rwanda lives within five kilometres of a health facility, 77 % of individuals report not having a geographical barrier to health services, 90 % of children between 12 and 23 months are fully immunised against preventable disease including haemophilus influenza type b, and the rate of access to nationalized health insurance has increased to 78 % [<xref ref-type="bibr" rid="CR6">6</xref>].</p><p>The Rwanda health system is a three-tiered system, with central (teaching hospitals), intermediate (district hospitals), and operational (heath center) levels. An additional level of community health workers help to identify and refer sick individuals to the health system, providing opportunities within the health system to respond to socioeconomic and contextual risk factors as well as medical risk factors for ALRI. In Rwanda, acute lower respiratory infections are managed at health facilities and through community case management.</p><p>In spite of health improvements, in 2010 Rwanda was still classified among the countries in the world with high early childhood mortality, 44 % of children under five suffered from chronic malnutrition, and 26 % of the population did not have access to an improved drinking water source [<xref ref-type="bibr" rid="CR6">6</xref>]. This study identifies social, economic, and weather risk factors for ALRI among children under five to further inform child health programs in communities.</p></sec><sec id="Sec2" sec-type="materials|methods"><title>Methods</title><p>This is a secondary data analysis of the 2010 Rwanda Demographic and Health Survey (RDHS). The 2010 RDHS was a national representative survey of 12,540 households chosen through multi-stage cluster sampling. Of the 13,790 women age 15 to 49 who were eligible to be interviewed, 13,671 (99.1 %) completed an interview. Oral interviews were conducted by trained interviewers at respondents’ homes, and their responses were recorded on paper questionnaires. Women were asked questions about all of their biological children under age five, including questions about acute lower respiratory infections symptoms experienced in the last two weeks. Women reported 8,484 surviving children under age five years. Anthropometry (height, weight) and blood samples were measured on children who stayed in the household on the night before the interview. Therefore, to assess the prevalence of ALRI, mothers were asked if their children under five had been ill with a cough in the two weeks preceding the survey accompanied by short and rapid breathing that was chest related. After excluding six children whose mother’s gave incomplete responses, the analysis included 8,478 children under five. The outcome, suffering from ALRI, was modeled as a binary variable. A literature search in Hinari, Google Scholar, and PubMed was performed to identify child, parent, household, and community factors associated with ALRI, and summarized in a conceptual framework (Fig. <xref rid="Fig1" ref-type="fig">1</xref>). Using this, we generated 19 variables for inclusion in this analysis.<fig id="Fig1"><label>Fig. 1</label><caption><p>Conceptual framework of risks factors for acute lower respiratory infection</p></caption><graphic xlink:href="13690_2016_132_Fig1_HTML" id="MO1"></graphic></fig></p><p>Child factors included: age modeled as 0–11 months, 12–23 month, and 24–59 months; sex; underweight defined as being less than –2 standard deviations from the international reference population [<xref ref-type="bibr" rid="CR9">9</xref>]; receipt of Bacillus Calmette–Guérin (BCG) vaccine; receipt of drugs for intestinal parasites in the last 6 months; anemia status categorized as not anemic (above 10.9 g/dl), mild or moderate anemia (7.0-10.0 g/dl), severe anemia (below 7.0 g/dl), and not-measured; receipt of vitamin A in the last 6 months. Vitamin A is routinely distributed to children age 6–59 months twice-yearly at ‘mothers and child health week’ events which are advertised through campaigns.</p><p>Parent factors included: mother’s age group, mother’s employment status, and whether either mother or father had completed secondary school. Household and community factors included whether the household was in the bottom 10 % (calculated from the DHS household wealth factor score); whether the household uses improved cooking fuel (electricity, liquid petroleum gas, natural gas, biogas, kerosene, coal, lignite, charcoal) or unimproved cooking fuel (wood, animal dung, straw/shrubs/grass), whether the household has an improved water source (piped into dwelling, piped to yard/plot, public tap/standpipe, tube well or borehole, protected well, protected spring, bottled water) and whether the household has an improved toilet (flush to piped sewer system, flush to septic tank, flush to pit latrine, ventilated improved pit latrine, pit latrine with slab, composting toilet). The season of interview was defined as rainy (March-May, September-November) and dry (June-August, December-February) season, and residence (urban or rural) was defined in the RDHS.</p><p>The analysis was done in two steps; the first step was a bivariate analysis between each covariate and the outcome. We generated percentages and performed chi-square tests comparing children who did and did not suffer from acute lower respiratory infections. Variables associated with ALRI at <italic>p</italic> < 0.1 were kept for multivariable modeling. Two interaction terms were created for bottom 10 % and place of residence, and bottom 10 % and season, and we tested whether these interactions changed the relationship of residence or season with ALRI by more than 10 %. Since there was no evidence of effect modification by low wealth, the interaction terms were dropped from the analysis. None of the covariates were collinear (Pearson’s correlation coefficient <italic>r</italic> > 0.7).</p><p>In the second step, manual backward stepwise logistic regression was employed to identify factors that were significantly associated with ALRI at <italic>p</italic> < 0.05. Type of cooking fuel and bottom 10 % were included in all models because they were key risk factors identified in the conceptual framework. Odds ratios and 95 % confidence intervals are presented for the full model and a reduce model of variables remaining after backward stepwise regression. The analysis was performed in Stata version 13 using survey commands to adjust for sampling weights, clustering, and stratification [<xref ref-type="bibr" rid="CR10">10</xref>].</p></sec><sec id="Sec3" sec-type="results"><title>Results</title><p>The prevalence of ALRI in the two weeks preceding the survey was 4 % (Table <xref rid="Tab1" ref-type="table">1</xref>). The following factors were associated with ALRI at <italic>p</italic> < 0.1 in the bivariate analysis: child’s age, child’s level of anemia, child’s receipt of Vitamin A, toilet type, place of residence, and season of interview. ALRI was particularly high among children suffering from severe anemia (14.6 %), children less than two years (0–11 months: 5.2 %; 12–23 months: 5.1 %), children living in urban areas (5.2 %) and children who did not receive vitamin A in the last six months (4.9 %).<table-wrap id="Tab1"><label>Table 1</label><caption><p>Bivariate analysis of factors associated with acute lower respiratory infection among children under five in Rwanda, RDHS 2010</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Name of Variable</th><th>Children in study</th><th>Children suffering from ALRI in last two weeks</th><th rowspan="2">Chi-squared <italic>p</italic>-value</th></tr><tr><th>Number</th><th>Number (Percent)</th></tr></thead><tbody><tr><td>CHILD</td><td></td><td></td><td rowspan="5">0.001</td></tr><tr><td>Child age</td><td></td><td>82 (5.2)</td></tr><tr><td> 0-11 months</td><td>1, 573</td><td></td></tr><tr><td> 12-23 months</td><td>1, 615</td><td>82 (5.1)</td></tr><tr><td> 24-59 months</td><td>5, 411</td><td>157 (2.9)</td></tr><tr><td>Child sex</td><td></td><td></td><td rowspan="3">0.104</td></tr><tr><td> Boy</td><td>4,361</td><td>179 (4.1)</td></tr><tr><td> Girl</td><td>4,238</td><td>144 (3.4)</td></tr><tr><td>Child underweight<sup>a</sup></td><td></td><td></td><td rowspan="4">0.991</td></tr><tr><td> No</td><td>3,648</td><td>139 (3.8)</td></tr><tr><td> Yes</td><td>467</td><td>18 (3.8)</td></tr><tr><td> Not measured</td><td>4,424</td><td>164 (3.7)</td></tr><tr><td>Child received BCG</td><td></td><td></td><td rowspan="3">0.109</td></tr><tr><td> No</td><td>94</td><td>1 (0.9)</td></tr><tr><td> Yes</td><td>8,503</td><td>323 (3.8)</td></tr><tr><td>Child received intestinal drugs in last 6 months</td><td></td><td></td><td rowspan="3">0.119</td></tr><tr><td> No</td><td>94</td><td>4 (4.4)</td></tr><tr><td> Yes</td><td>8,503</td><td>306 (3.6)</td></tr><tr><td>Anemia level<sup>a</sup></td><td></td><td></td><td rowspan="5">0.083</td></tr><tr><td> Not anemic</td><td>2,316</td><td>74 (3.2)</td></tr><tr><td> Mild or moderate</td><td>1,441</td><td>60 (4.2)</td></tr><tr><td> Severe</td><td>17</td><td>2 (14.6)</td></tr><tr><td> Not measured</td><td>4,424</td><td>164 (3.7)</td></tr><tr><td>Child received vitamin A in last 6 months</td><td></td><td></td><td rowspan="3">0.040</td></tr><tr><td> No</td><td>1,109</td><td>54 (4.9)</td></tr><tr><td> Yes</td><td>7,484</td><td>269 (3.6)</td></tr><tr><td>Child delivered at a health facility</td><td></td><td></td><td rowspan="4">0.326</td></tr><tr><td> No</td><td>2,625</td><td>89 (3.4)</td></tr><tr><td> Yes</td><td>5,969</td><td>233 (3.9)</td></tr><tr><td>PARENT</td><td></td><td></td></tr><tr><td>Mother current age</td><td></td><td></td><td rowspan="3">0.178</td></tr><tr><td> <21 years</td><td>273</td><td>14 (5.3)</td></tr><tr><td> 21+ years</td><td>8,326</td><td>308 (3.7)</td></tr><tr><td> Mother employment status</td><td></td><td></td><td rowspan="3">0.225</td></tr><tr><td> Not working or self-employed agriculture</td><td>7,488</td><td>269 (3.6)</td></tr><tr><td>Working</td><td>1,100</td><td>50 (4.6)</td></tr><tr><td> Mother education level</td><td></td><td></td><td rowspan="3">0.210</td></tr><tr><td> Less than secondary</td><td>7,837</td><td>282 (3.6)</td></tr><tr><td> Secondary or high</td><td>762</td><td>37 (4.9)</td></tr><tr><td>Partner education level<sup>a</sup></td><td></td><td></td><td rowspan="3">0.406</td></tr><tr><td> Less than secondary</td><td>7,155</td><td>257 (3.6)</td></tr><tr><td> Secondary or higher</td><td>882</td><td>40 (4.4)</td></tr><tr><td>HOUSEHOLD</td><td></td><td></td><td rowspan="2">0.109</td></tr><tr><td>Bottom 10 % (wealth score)</td><td></td><td></td></tr><tr><td> No</td><td>7,737</td><td>278 (3.6)</td><td rowspan="2"></td></tr><tr><td> Yes</td><td>862</td><td>42 (4.9)</td></tr><tr><td>Cooking fuel type<sup>a</sup></td><td></td><td></td><td rowspan="3">0.417</td></tr><tr><td> Unimproved</td><td>7,761</td><td>279 (3.6)</td></tr><tr><td> Improved</td><td>743</td><td>33 (4.5)</td></tr><tr><td>Residence</td><td></td><td></td><td rowspan="3">0.064</td></tr><tr><td> Rural</td><td>7,566</td><td>272 (3.6)</td></tr><tr><td> Urban</td><td>1,033</td><td>54 (5.2)</td></tr><tr><td>Household size</td><td></td><td></td><td rowspan="3">0.195</td></tr><tr><td> >5 members</td><td>3,796</td><td>152 (4.0)</td></tr><tr><td> <=5 members</td><td>4,803</td><td>168 (3.5)</td></tr><tr><td>Source of drinking water<sup>a</sup></td><td></td><td></td><td rowspan="3">0.322</td></tr><tr><td> Unimproved</td><td>2,423</td><td>99 (4.1)</td></tr><tr><td> Improved<sup>b</sup></td><td>6,088</td><td>213 (3.5)</td></tr><tr><td>Improved toilet<sup>a</sup></td><td></td><td></td><td rowspan="3">0.058</td></tr><tr><td> Unimproved</td><td>2,308</td><td>101 (4.4)</td></tr><tr><td> Improved<sup>c</sup></td><td>6,200</td><td>217 (3.5)</td></tr><tr><td>Season</td><td></td><td></td><td rowspan="3">0.001</td></tr><tr><td> Dry</td><td>4,837</td><td>144 (3.0)</td></tr><tr><td> Rainy</td><td>3,762</td><td>177 (4.7)</td></tr></tbody></table><table-wrap-foot><p><sup>a</sup>Missing observations</p><p><sup>b</sup>Includes: piped water, piped into dwelling, piped to yard/plot, public tap/standpipe, tube well or borehole, protected well, protected spring, bottled water</p><p><sup>c</sup>Includes: ventilated improved pit latrine, pit latrine with slab</p></table-wrap-foot></table-wrap></p><p>After adjusting for other covariates in the multivariate regression (Table <xref rid="Tab2" ref-type="table">2</xref>), children belonging to households in the bottom 10 % had 1.27 times the odds (95 % CI: 0.85-1.87) of ALRI than children living in better off households, and children of mothers interviewed during the rainy season had 1.61 the odds of ALRI (95 % CI: 1.24-2.09) than the dry season. The following factors were protective against ALRI: living in urban versus rural areas (OR: 0.58, 95 % CI: 0.38-0.88), and being age 24–59 months compare to 0–11 months (OR: 0.53, 95 % CI: 0.40-0.69).<table-wrap id="Tab2"><label>Table 2</label><caption><p>Multivariate logistic regression model of acute lower respiratory infection among children under five in Rwanda, RDHS 2010</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Variable</th><th>AOR (95 % CI)</th><th>AOR (95 % CI)</th></tr><tr><th>Full model</th><th>Reduced Model</th></tr></thead><tbody><tr><td>Cooking fuel type</td><td></td><td></td></tr><tr><td>Not improved</td><td>ref</td><td>ref</td></tr><tr><td>Improved</td><td>0.89 (0.51-1.54)</td><td>0.93 (0.55-1.58)</td></tr><tr><td>Bottom 10 % (wealth score)</td><td></td><td></td></tr><tr><td>Not bottom 10 %</td><td>ref</td><td>ref</td></tr><tr><td>Bottom 10 %</td><td>1.01 (0.65-1.58)</td><td>1.27 (0.85-1.87)</td></tr><tr><td>Child age</td><td></td><td></td></tr><tr><td>0-11 months</td><td>ref</td><td>ref</td></tr><tr><td>12-23 months</td><td>0.96 (0.65-1.42)</td><td>0.93 (0.67-1.31)</td></tr><tr><td>24-59 months</td><td>0.54 (0.39-0.77)</td><td>0.53 (0.40-0.69)</td></tr><tr><td>Anemia level</td><td></td><td></td></tr><tr><td>Not anemic</td><td>ref</td><td></td></tr><tr><td>Mild or moderate</td><td>1.11 (0.78-1.57)</td><td></td></tr><tr><td>Severe</td><td>3.49 (0.68-17.90)</td><td></td></tr><tr><td>Not measured</td><td>1.06 (0.79-1.43)</td><td></td></tr><tr><td>Child received vitamin A in last 6 months</td><td></td><td></td></tr><tr><td>No</td><td>ref</td><td></td></tr><tr><td>Yes</td><td>1.03 (0.69-1.52)</td><td></td></tr><tr><td>Residence place</td><td></td><td></td></tr><tr><td>Rural</td><td>ref</td><td>ref</td></tr><tr><td>Urban</td><td>0.50 (0.33-0.75-2.87)</td><td>0.58 (0.38-0.88)</td></tr><tr><td>Improved toilet</td><td></td><td></td></tr><tr><td>Unimproved</td><td>ref</td><td></td></tr><tr><td>Improved</td><td>0.82 (0.62-1.12)</td><td></td></tr><tr><td>Dry rainy season</td><td></td><td></td></tr><tr><td>Dry season</td><td>ref</td><td>ref</td></tr><tr><td>Rainy season</td><td>1.59 (1.20-2.09)</td><td>1.61 (1.24-2.09)</td></tr></tbody></table><table-wrap-foot><p><italic>CI</italic> confidence interval, <italic>AOR</italic> adjusted odds ratio, <italic>ref</italic> reference</p></table-wrap-foot></table-wrap></p></sec><sec id="Sec4" sec-type="discussion"><title>Discussion</title><p>This analysis identified several socioeconomic and weather risk factors for acute lower respiratory infections in Rwanda. The findings revealed that rainy season is associated with acute lower respiratory infections which is consistent with studies in other similar countries [<xref ref-type="bibr" rid="CR11">11</xref>]. There are both biological and social reasons that acute lower respiratory pathogens differ across geographic and climate zones. Studies from temperate and tropical regions found that temperature and humidity can explain influenza seasonality by diminishing the host immunity through, for example, the inhalation of cold air which causes vasoconstriction and reduction of blood flow while dry conditions, on the other hand, can reduce mucociliary clearance [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR13">13</xref>]. Social reasons that link ALRI and geography are that many households in tropical regions face crowding due to low income; crowding becomes more problematic during heavy rain which forces people to stay inside and can increase exposure to ALRI [<xref ref-type="bibr" rid="CR5">5</xref>]. Low income can have a similar effect on ALRI in colder regions where winter conditions cause people to stay inside with poor ventilation [<xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR15">15</xref>].</p><p>Given the greater environmental and social risks for acute lower respiratory infections during the rainy season, campaigns via public radio, television, and community dramatization should describe these risks to the public, and encourage households to ventilate homes and seek treatment for respiratory illness. The Rwanda Environment Management Authority has been producing drama-film sketches on Rwanda broadcast television for years tackling different aspects of sustainable development and environment protection [<xref ref-type="bibr" rid="CR16">16</xref>]. Use of film sketches like these to raise community awareness about respiratory diseases before and during the rainy season would be an example of creative solutions that leverage existing resources.</p><p>This study found that children living in poor economic conditions are more likely to suffer from acute lower respiratory infections than children living in better off households. This finding is common around the world [<xref ref-type="bibr" rid="CR17">17</xref>]. Globally, poor living conditions present risk factors for illness and are associated with inadequate utilization of primary health care [<xref ref-type="bibr" rid="CR18">18</xref>]. In Rwanda, the Government has tried to overcome typical barriers to health care among the poor through a national low-cost health insurance scheme which is very popular, and community-based case management of childhood illness targetting children under five [<xref ref-type="bibr" rid="CR19">19</xref>], still children from poor households face a problem of healthcare utilization [<xref ref-type="bibr" rid="CR20">20</xref>]. Thus, broad rural poverty reduction and social protection strategies are likely needed still. The Second Economic Development and Poverty Reduction Strategy for 2013–2018 aims to implement Rwanda’s ambitious Vision 2020 plan, to move the nation from low-income to middle-income status [<xref ref-type="bibr" rid="CR21">21</xref>]. The strategy includes reducing poverty to below 30 % through national electrification programs and shifting cooking practices to modern biomass fuels, restructuring the economy to focus on services and industry, and implementing strong environmental protection and restoration inititives that could create jobs in rural areas.</p><p>The following factors were protective against acute lower respiratory infections. First, children between 24–59 months of age had a lower risk of ALRI than children age 0–11 months which is likely because children build their immunity systems over time enabling them to fight off infectious agents from the environment [<xref ref-type="bibr" rid="CR22">22</xref>]. Second, urban residence was also protective against acute lower respiratory infections. Rwanda’s urban population is expected to increase substantially from 17 % in 2012 to 30 % in 2032 [<xref ref-type="bibr" rid="CR4">4</xref>]. While Rwanda’s government closely monitors air pollution, and prioritizes modern transportation, renewable energy and environmental protection in its development strategies, it is wise for future studies to monitor links between urbanity, air pollution, and ALRI in Rwanda as urban air pollution is a key risk factor for ALRI in other similar settings [<xref ref-type="bibr" rid="CR23">23</xref>]. Type of cooking fuel was not associated with ALRI in either the bivariate or multivariate analysis. This is contrary to a number of other studies which show a strong association between ALRI and unimproved cooking fuel [<xref ref-type="bibr" rid="CR24">24</xref>–<xref ref-type="bibr" rid="CR26">26</xref>] due to poor ventilation [<xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR28">28</xref>]. The assumption of this null result was a statistical artefact because 98 % of household used unimproved cooking fuel and there was lack of statistical variability. The fact that the vast majority of households still cook with unimproved fuel, which is a major known risk factor for acute lower respiratory infections, should be addressed. Lack of wealth, particularly access to electricity, is a primary barrier to using improved cook stoves [<xref ref-type="bibr" rid="CR29">29</xref>].</p><p>Two key limitations of this analysis were that we were not able to measure causal effects because the analyses was based on cross-sectional data, and the dataset did not include some socioeconomic variables including duration of cooking, or use of multiple fuels together such as wood and charcoal.</p></sec><sec id="Sec5" sec-type="conclusion"><title>Conclusion</title><p>The study found that environmental and socioeconomic factors were associated with childhood acute lower respiratory infections, and these results point toward potential areas for intervention including community campaigns about acute lower respiratory infections symptoms and treatment of respiratory infection. Rwanda has initiated many strategies to reduce poverty including rural electrification and modern stove distribution which may reduce use of dirty cooking fuel, improve living conditions, and reduce barriers to health care in the future.</p></sec></body><back><glossary><title>Abbreviations</title><def-list><def-item><term>ALRI</term><def><p>acute lower respiratory infection</p></def></def-item><def-item><term>AOR</term><def><p>adjusted odds ratio</p></def></def-item><def-item><term>CI</term><def><p>confidence interval</p></def></def-item><def-item><term>RDHS</term><def><p>Rwanda demographic and health survey</p></def></def-item></def-list></glossary><fn-group><fn><p><bold>Competing interests</bold></p><p>We do not have no competing interests.</p></fn><fn><p><bold>Authors’ contributions</bold></p><p>JMH conceived and coordinated all study steps. All authors participated in study design, statistical analysis, results interpretation and manuscript section review, and all authors have read and approved the final manuscript.</p></fn><fn><p><bold>Authors’ information</bold></p><p>JHM, MPhil candidate at University of Rwanda College of Medicine and Health Sciences</p><p>JN, Professor at University of Rwanda College of Medicine and Health Sciences</p><p>NL, Senior Lecturer at University of Rwanda College of Medicine and Health Sciences</p><p>DRT, Research Associate at University of Rwanda College of Medicine and Health Sciences and Research Associate at Harvard Medical School</p></fn></fn-group><ack><title>Acknowledgement</title><p>We would like to thank Assumpta Mukabutera and staff at the University of Rwanda-College of Medicine and Health Sciences-School of Public Health Research Help Desk for their advice and support.</p></ack><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zar</surname><given-names>HJ</given-names></name><name><surname>Ferkol</surname><given-names>TW</given-names></name></person-group><article-title>The global burden of respiratory disease—impact on child health</article-title><source>Pediatr Pulmonol</source><year>2014</year><volume>49</volume><fpage>430</fpage><lpage>434</lpage><pub-id pub-id-type="doi">10.1002/ppul.23030</pub-id><pub-id pub-id-type="pmid">24610581</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><mixed-citation publication-type="other">UNICEF, WHO, World Bank, UN Population Division. Level and trends in children mortality 2012. New York, NY: UNICEF; 2012.</mixed-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Black</surname><given-names>RE</given-names></name><name><surname>Morris</surname><given-names>SS</given-names></name><name><surname>Bryce</surname><given-names>J</given-names></name></person-group><article-title>Where and why are 10 million children dying every year?</article-title><source>Lancet</source><year>2003</year><volume>361</volume><fpage>2226</fpage><lpage>2234</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(03)13779-8</pub-id><pub-id pub-id-type="pmid">12842379</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><mixed-citation publication-type="other">National Institute of Statistics of Rwanda (NISR), Ministry of Finance and Economic Planning (MINECOFIN) [Rwanda]. Rwanda Fourth Population and Housing Census. Thematic Report Population Size, Structure, and Distribution; 2012.</mixed-citation></ref><ref id="CR5"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moura</surname><given-names>FEA</given-names></name><name><surname>Perdigão</surname><given-names>ACB</given-names></name><name><surname>Siqueira</surname><given-names>MM</given-names></name></person-group><article-title>Seasonality of Influenza in the Tropics: A Distinct Pattern in Northeastern Brazil</article-title><source>Am J Trop Med Hyg</source><year>2009</year><volume>81</volume><fpage>180</fpage><lpage>183</lpage><pub-id pub-id-type="pmid">19556586</pub-id></element-citation></ref><ref id="CR6"><label>6.</label><mixed-citation publication-type="other">National Institute of Statistics of Rwanda (NISR) [Rwanda]. Ministry of Health (MOH) [Rwanda], and ICF International. Rwanda Demographic and Health Survey 2010. Calverton, Maryland: NISR, MOH, and ICF International; 2011.</mixed-citation></ref><ref id="CR7"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Goel</surname><given-names>K</given-names></name><name><surname>Ahmad</surname><given-names>S</given-names></name><name><surname>Agarwal</surname><given-names>G</given-names></name><name><surname>Goel</surname><given-names>P</given-names></name><name><surname>Kumar</surname><given-names>V</given-names></name></person-group><article-title>Community medicine and health education: a cross sectional study on prevalence of acute respiratory infections (ARI) in under-five children of Meerut District</article-title><source>India. J Commun Med Health Educ.</source><year>2012</year><volume>2</volume><fpage>2</fpage><lpage>5</lpage></element-citation></ref><ref id="CR8"><label>8.</label><mixed-citation publication-type="other">USAID. Improving child health in Rwanda: BASICS III report. 2009;30–6. Available from: <ext-link ext-link-type="uri" xlink:href="http://www.basics.org/reports/FinalReport/Rwanda-Final-Report_BASICS.pdf">http://www.basics.org/reports/FinalReport/Rwanda-Final-Report_BASICS.pdf</ext-link>. </mixed-citation></ref><ref id="CR9"><label>9.</label><mixed-citation publication-type="other">World Health Organization (WHO), Unicef. WHO child growth standards and the identification of severe acute malnutrition in infants and children: joint statement by the World Health Organization and the United Nations Children's Fund. Geneva; WHO; 2009.</mixed-citation></ref><ref id="CR10"><label>10.</label><mixed-citation publication-type="other">StataCorp. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.stata.com/">http://www.stata.com/</ext-link>. </mixed-citation></ref><ref id="CR11"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Murray</surname><given-names>EL</given-names></name><name><surname>Klein</surname><given-names>M</given-names></name><name><surname>Brondi</surname><given-names>L</given-names></name><name><surname>McGOWAN</surname><given-names>JE</given-names></name><name><surname>Van Mels</surname><given-names>C</given-names></name><name><surname>Brooks</surname><given-names>WA</given-names></name><etal></etal></person-group><article-title>Rainfall, household crowding, and acute respiratory infections in the tropics</article-title><source>Epidemiol Infect</source><year>2012</year><volume>140</volume><fpage>78</fpage><lpage>86</lpage><pub-id pub-id-type="doi">10.1017/S0950268811000252</pub-id><pub-id pub-id-type="pmid">21371367</pub-id></element-citation></ref><ref id="CR12"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tchidjou</surname><given-names>HK</given-names></name><name><surname>Vescio</surname><given-names>F</given-names></name><name><surname>Boros</surname><given-names>S</given-names></name><name><surname>Guemkam</surname><given-names>G</given-names></name><name><surname>Minka</surname><given-names>E</given-names></name><name><surname>Lobe</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Seasonal pattern of hospitalization from acute respiratory infections in Yaound? Cameroon</article-title><source>J Trop Pediatr</source><year>2010</year><volume>56</volume><fpage>317</fpage><lpage>320</lpage><pub-id pub-id-type="doi">10.1093/tropej/fmp127</pub-id><pub-id pub-id-type="pmid">20080936</pub-id></element-citation></ref><ref id="CR13"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tamerius</surname><given-names>J</given-names></name><name><surname>Nelson</surname><given-names>MI</given-names></name><name><surname>Zhou</surname><given-names>SZ</given-names></name><name><surname>Viboud</surname><given-names>C</given-names></name><name><surname>Miller</surname><given-names>MA</given-names></name><name><surname>Alonso</surname><given-names>WJ</given-names></name></person-group><article-title>Global influenza seasonality: Reconciling patterns across temperate and tropical regions</article-title><source>Environ Health Perspect</source><year>2011</year><volume>119</volume><fpage>439</fpage><lpage>445</lpage><pub-id pub-id-type="doi">10.1289/ehp.1002383</pub-id><pub-id pub-id-type="pmid">21097384</pub-id></element-citation></ref><ref id="CR14"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Imai</surname><given-names>C</given-names></name><name><surname>Brooks</surname><given-names>WA</given-names></name><name><surname>Chung</surname><given-names>Y</given-names></name><name><surname>Goswami</surname><given-names>D</given-names></name><name><surname>Anjali</surname><given-names>BA</given-names></name><name><surname>Dewan</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Tropical influenza and weather variability among children in an urban low-income population in Bangladesh</article-title><source>Glob Health Action</source><year>2014</year><volume>1</volume><fpage>1</fpage><lpage>8</lpage></element-citation></ref><ref id="CR15"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Azad</surname><given-names>KMAK</given-names></name></person-group><article-title>Risk factors for acute respiratory infections (ARI) among children under five years in Bangladesh</article-title><source>J Sci Res.</source><year>2009</year><volume>1</volume><fpage>72</fpage><lpage>81</lpage></element-citation></ref><ref id="CR16"><label>16.</label><mixed-citation publication-type="other">Rwanda Environmental Management Authority (REMA). 2014. Press room: Radio & TV Broadcasts. Accessed 21 Feb 2016. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.rema.gov.rw/">http://www.rema.gov.rw/</ext-link>. </mixed-citation></ref><ref id="CR17"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ujunwa</surname><given-names>F</given-names></name><name><surname>Ezeonu</surname><given-names>C</given-names></name></person-group><article-title>Risk Factors for Acute Respiratory Tract Infections in Under-five Children in Enugu Southeast Nigeria</article-title><source>Ann Med Health Sci Res</source><year>2014</year><volume>4</volume><fpage>95</fpage><lpage>99</lpage><pub-id pub-id-type="doi">10.4103/2141-9248.126610</pub-id><pub-id pub-id-type="pmid">24669339</pub-id></element-citation></ref><ref id="CR18"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Astale</surname><given-names>T</given-names></name><name><surname>Michelene</surname><given-names>C</given-names></name></person-group><article-title>Help-Seeking Behavior for Children with Acute Respiratory Infection in Ethiopia: Results from 2011 Ethiopia Demographic and Health Survey</article-title><source>PLoS One</source><year>2015</year><volume>10</volume><fpage>e0142553</fpage><pub-id pub-id-type="doi">10.1371/journal.pone.0142553</pub-id><pub-id pub-id-type="pmid">26560469</pub-id></element-citation></ref><ref id="CR19"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mugeni</surname><given-names>C</given-names></name><name><surname>Levine</surname><given-names>AC</given-names></name><name><surname>Munyaneza</surname><given-names>RM</given-names></name><name><surname>Mulindahabi</surname><given-names>E</given-names></name><name><surname>Cockrell</surname><given-names>HC</given-names></name><name><surname>Glavis-Bloom</surname><given-names>J</given-names></name><name><surname>Nutt</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Nationwide implementation of integrated community case management of childhood illness in Rwanda</article-title><source>Global Health Sci Pract</source><year>2014</year><volume>2</volume><fpage>328</fpage><lpage>341</lpage><pub-id pub-id-type="doi">10.9745/GHSP-D-14-00080</pub-id></element-citation></ref><ref id="CR20"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Skiles</surname><given-names>MP</given-names></name><name><surname>Curtis</surname><given-names>SL</given-names></name><name><surname>Basinga</surname><given-names>P</given-names></name><name><surname>Angeles</surname><given-names>G</given-names></name><name><surname>Thirumurthy</surname><given-names>H</given-names></name></person-group><article-title>The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda</article-title><source>BMC Health Serv Res</source><year>2015</year><volume>15</volume><fpage>1</fpage><pub-id pub-id-type="doi">10.1186/s12913-015-1033-7</pub-id><pub-id pub-id-type="pmid">25603697</pub-id></element-citation></ref><ref id="CR21"><label>21.</label><mixed-citation publication-type="other">[Rwanda] Ministry of Finance and Economic Planning (MINECOFIN). 2013. Economic development and poverty reduction strategy II 2013–2018. Kigali: MINECOFIN. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.rdb.rw/uploads/tx_sbdownloader/EDPRS_2_Main_Document.pdf">http://www.rdb.rw/uploads/tx_sbdownloader/EDPRS_2_Main_Document.pdf</ext-link>.</mixed-citation></ref><ref id="CR22"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Amugsi</surname><given-names>DA</given-names></name><etal></etal></person-group><article-title>Socio-demographic and environmental determinants of infectious disease morbidity in children under 5 years in Ghana</article-title><source>Glob Health Action</source><year>2015</year><volume>8</volume><fpage>29349</fpage><pub-id pub-id-type="pmid">26455493</pub-id></element-citation></ref><ref id="CR23"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Henninger</surname><given-names>SM</given-names></name></person-group><article-title>When air quality becomes deleterious — a case study for Kigali</article-title><source>Rwanda. J Environ Prot.</source><year>2013</year><volume>4</volume><fpage>1</fpage><lpage>7</lpage><pub-id pub-id-type="doi">10.4236/jep.2013.48A1001</pub-id></element-citation></ref><ref id="CR24"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Harris</surname><given-names>AM</given-names></name><name><surname>Sempértegui</surname><given-names>F</given-names></name><name><surname>Estrella</surname><given-names>B</given-names></name><name><surname>Narváez</surname><given-names>X</given-names></name><name><surname>Egas</surname><given-names>J</given-names></name><name><surname>Woodin</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Air pollution and anemia as risk factors for pneumonia in Ecuadorian children: a retrospective cohort analysis. Environ Health</article-title><source>BioMed Central Ltd</source><year>2011</year><volume>10</volume><fpage>93</fpage></element-citation></ref><ref id="CR25"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alemayehu</surname><given-names>M</given-names></name><name><surname>Alemu</surname><given-names>K</given-names></name><name><surname>Sharma</surname><given-names>HR</given-names></name><name><surname>Gizaw</surname><given-names>Z</given-names></name><name><surname>Shibru</surname><given-names>A</given-names></name></person-group><article-title>Household fuel use and acute respiratory infections in children under five years of age in Gondar city of Ethiopia</article-title><source>J Environ Earth Sci.</source><year>2014</year><volume>4</volume><fpage>77</fpage><lpage>86</lpage></element-citation></ref><ref id="CR26"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ezeh</surname><given-names>OK</given-names></name><name><surname>Agho</surname><given-names>KE</given-names></name><name><surname>Dibley</surname><given-names>MJ</given-names></name><name><surname>Hall</surname><given-names>JJ</given-names></name><name><surname>Page</surname><given-names>AN</given-names></name></person-group><article-title>The effect of solid fuel use on childhood mortality in Nigeria: evidence from the 2013 cross-sectional household survey</article-title><source>Environ Health</source><year>2014</year><volume>13</volume><fpage>1</fpage><lpage>10</lpage><pub-id pub-id-type="doi">10.1186/1476-069X-13-113</pub-id><pub-id pub-id-type="pmid">24405644</pub-id></element-citation></ref><ref id="CR27"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Topluluğun</surname><given-names>BA</given-names></name><name><surname>Pişirmede</surname><given-names>H</given-names></name></person-group><article-title>Household cooking fuel use among residents of a sub-urban community in Nigeria: implications for indoor air pollution</article-title><source>Eur J Med.</source><year>2014</year><volume>46</volume><fpage>203</fpage><lpage>8</lpage><pub-id pub-id-type="doi">10.5152/eajm.2014.0051</pub-id></element-citation></ref><ref id="CR28"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ramesh Bhat</surname><given-names>Y</given-names></name><name><surname>Manjunath</surname><given-names>N</given-names></name><name><surname>Sanjay</surname><given-names>D</given-names></name><name><surname>Dhanya</surname><given-names>Y</given-names></name></person-group><article-title>Association of indoor air pollution with acute lower respiratory tract infections in children under 5 years of age</article-title><source>Paediatr Int Child Health</source><year>2012</year><volume>32</volume><fpage>132</fpage><lpage>135</lpage><pub-id pub-id-type="doi">10.1179/2046905512Y.0000000027</pub-id><pub-id pub-id-type="pmid">22824659</pub-id></element-citation></ref><ref id="CR29"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jackson</surname><given-names>S</given-names></name><name><surname>Mathews</surname><given-names>KH</given-names></name><name><surname>Pulanic</surname><given-names>D</given-names></name><name><surname>Falconer</surname><given-names>R</given-names></name><name><surname>Rudan</surname><given-names>I</given-names></name><name><surname>Campbell</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Risk factors for severe acute lower respiratory infections in children: a systematic review and meta-analysis</article-title><source>Croat Med J</source><year>2013</year><volume>54</volume><fpage>110</fpage><lpage>121</lpage><pub-id pub-id-type="doi">10.3325/cmj.2013.54.110</pub-id><pub-id pub-id-type="pmid">23630139</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000554 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000554 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé=
|texte=
}}
| This area was generated with Dilib version V0.6.32. |  |