|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 3 | Page : 344-347
Sociodemographic and environmental factors influencing acute respiratory infections among under-five children of chars (riverine islands) of Tinsukia District, Assam: A community-based cross-sectional study
Ishan Phukan1, Rupali Baruah2, Sultana Jesmin Ahmed3, Tulika Goswami Mahanta2, Baidurjya Mahanta4, Farhana Shaheen Hussain4
1 Senior Resident, Department of Community Medicine, AMCH, Dibrugarh, Assam, India
2 Professor, Department of Community Medicine, AMCH, Dibrugarh, Assam, India
3 Associate Professor, Department of Community Medicine, AMCH, Dibrugarh, Assam, India
4 Junior Resident, Department of Community Medicine, AMCH, Dibrugarh, Assam, India
|Date of Submission||24-Aug-2021|
|Date of Decision||06-Jun-2022|
|Date of Acceptance||16-Jun-2022|
|Date of Web Publication||22-Sep-2022|
Near Dibru College, P.O. Boiragimoth, Dibrugarh - 786 003, Assam
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Acute respiratory tract infections (ARIs) are a major cause of morbidity and mortality in under-five children worldwide. Assam has around 2500 river islands (locally called Chars/Chaporis) in the Brahmaputra River with socioeconomically deprived inhabitants lacking access to basic health-care facilities. A community-based cross-sectional study was carried out among 380 under-five children living in the Char areas of Tinsukia District to estimate the prevalence of ARI and determine the associated risk factors. The prevalence of ARI among under-five children was found to be 56.32%. Prevalence was significantly higher among children living in Dibru-Saikhowa island, with families having >2 children, belonging to socioeconomic class 5 (modified BG Prasad scale), having a positive history of smoking or ARI in family members, having homes with attached kitchens or using wood for cooking, inadequate ventilation or overcrowding and residences of katcha ghars.
Keywords: Acute respiratory tract infection, river islands (Char/Chaporis), under-five children
|How to cite this article:|
Phukan I, Baruah R, Ahmed SJ, Mahanta TG, Mahanta B, Hussain FS. Sociodemographic and environmental factors influencing acute respiratory infections among under-five children of chars (riverine islands) of Tinsukia District, Assam: A community-based cross-sectional study. Indian J Public Health 2022;66:344-7
|How to cite this URL:|
Phukan I, Baruah R, Ahmed SJ, Mahanta TG, Mahanta B, Hussain FS. Sociodemographic and environmental factors influencing acute respiratory infections among under-five children of chars (riverine islands) of Tinsukia District, Assam: A community-based cross-sectional study. Indian J Public Health [serial online] 2022 [cited 2022 Sep 28];66:344-7. Available from: https://www.ijph.in/text.asp?2022/66/3/344/356593
Worldwide, one-fifth of deaths of under-five children are due to acute respiratory tract infection (ARI) and in developing countries, it causes approximately 70% of their morbidities. In India, the prevalence of ARI in under-five children varies throughout the country and as per some studies, it is as high as 59% in some rural areas.
Brahmaputra River flows through the entire length of Assam and is a classic example of a braided river. Due to its excessive siltation, a unique geographical phenomenon is created, which is the riverine areas (islands) in the river Brahmaputra, locally known as “Char/Chapori.” They are semipermanent in nature and Assam has around 2500 such islands, which cover about 3.60 lakh hectares of land and has a population of more than 3 million people., Due to frequent floods, most settlements in these riverine areas are temporary, use wood for cooking, and encounter high amounts of dust due to strong winds in the sandy alluvial soil of these regions.
Research on ARI and its associated factors in children residing in riverine areas have been abysmally low, as only a few such islands exist in the world, and also due to the challenges to reach these regions. Hence, the present study was carried out in the Char areas of Tinsukia district, where health care to these marginalized populations is mainly provided through the Boat Clinics of Assam.
This was a community-based cross-sectional analytical study carried out for 1 year from April 2019 to March 2020 among 380 rural under-five children living in the Char areas of Tinsukia district. Children who were severely ill due to other systemic diseases or had congenital malformations or mothers/caregivers unwilling to participate were excluded.
Taking the prevalence (p) of ARI in under-five children in rural India to be 53.7%, with 10% relative error (d), 10% nonresponse rate, and rounding up, the sample size calculated was 380 at a 95% level of the confidence interval. Tinsukia district of Assam, selected by simple random sampling, has two main Char areas: Dibru-Saikhowa (with four villages) and Amarpur Char (with 15 villages). As per administrative data from Centre for North East Studies and Policy Research (C-NES) (the NGO operating the Boat Clinics), the total population of these Char areas covered by Boat Clinics is 11,603 and the total under-five population is 1,019. Hence, 102 children from Dibru-Saikhowa Char and 278 children from Amarpur Char were enrolled through proportional allocation. To obtain the required sample size, two and seven villages were selected from Dibru-Saikhowa and Amarpur Char, respectively.
As these two Char areas/islands were far away from the district headquarters, the Boat Clinic would visit each of these two Char areas twice a month, and data were collected during these periods of stay from the Boat Clinic.
A child was considered to have ARI if the caregiver reported that the child had any of the symptoms, namely, cough, sore throat, nasal discharge, ear discharge, or respiratory distress with or without fever in the past 2 weeks.
The first household was selected randomly, and every consecutive house starting toward the right was visited till the required number of children was obtained. Written consent was taken from the mother/caregivers before data collection. All the under-five children in a house were selected and included in the study. Parents/caregivers were interviewed to obtain information on their socioeconomic status and various environmental factors.
Ethical clearance for the study was obtained from the Institutional Ethics Committee (Human) of Assam Medical College and Hospital, Dibrugarh. Data were analyzed using the SPSS version 16 (IBM SPSS Statistics Version 16, IBM Corp., Armonk, New York, USA) and analytical statistics such as odds ratio (OR) and multivariate regression were used.
The prevalence of ARI among under-five children was found to be 56.32% (confidence interval [CI]: 0.51–0.61). Prevalence was significantly higher among the children living in the Chars of Dibru-Saikhowa Island (67.6%) than that of Amarpur Chars (52.16%) [Table 1].
|Table 1: Prevalence of acute respiratory tract infections in Chars/riverine islands with respect to different factors|
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Majority (30.2%) of the study participants were in the age group of 1–2 years and the majority were male. ARI prevalence was higher in children belonging to socioeconomic class 5 of BG Prasad's socioeconomic classification (59.9%, P < 0.05, CI: 1.49–5.83) and living in families having >2 children (67.2%).
ARI prevalence was also found to be higher in children having history of family members smoking (77.3%, P < 0.05, CI: 2.20–6.14), with history of ARI in family members (79.1%, P < 0.05, CI: 1.98–6.73), living in homes having attached kitchens to living rooms (62.9%, P < 0.05, CI: 1.50–3.62), using wood as cooking fuel (58.1%, P < 0.05, CI: 1.41–9.67), homes with overcrowding present (76.9%, P < 0.05, CI: 1.49–5.83), homes having inadequate ventilation (67.3%, P < 0.05, CI: 1.38–3.25), and children residing in katcha ghars (72.2%, P < 0.05, CI: 1.81–4.21).
In the final multivariate analysis, the following factors were significantly associated with presence of ARI: socioeconomic status, fathers' education, overcrowding, inadequate ventilation (adjusted OR [aOR] = 4.56, P < 0.00, CI: 2.44–8.5), kitchen attached (aOR = 2.17, P = 0.01, CI: 1.19–3.98), family history of ARI present (aOR = 2.42, P = 0.03, CI: 1.07–5.5), and family history of smoking present (aOR = 3.04, P < 0.00, CI: 1.47–6.3) [Table 2].
|Table 2: Bivariate and multivariate analysis of factors associated with acute respiratory tract infections in under-five children in riverine islands (Chars)|
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Our present study revealed the prevalence of ARI to be 56% among the under-five children of Char areas of Tinsukia, which was in accordance with the findings of Kumar et al. at Puducherry. However, it is higher than the findings of Islam et al. at Guwahati, Reddy et al. at Andhra Pradesh, and Savitha and Gopalakrishnan at Tamil Nadu.,, Furthermore, the prevalence of ARI was higher in Dibru-Saikhowa Char (67.65%) compared to the Char of Amarpur (52.16%). The high number of cases might have been due to the recent floods and massive soil erosion in Dibru-Saikhowa Island in 2020 which wiped out a number of villages and forced several families into temporary shelters. It may also be attributed to the socioenvironmental conditions in these Char regions where the parents would go to their paddy fields early in the morning, leaving the young children under the care of their older siblings who would then spend their entire day playing in unhygienic conditions. Furthermore, being near the riverside, children playing in these sandy areas are often exposed to respirable particulate matter, thus leading to cardiorespiratory morbidity.
The prevalence of ARI was highest in children in the age group of 36–48 months, slightly higher in girls (57.54%) than boys (55.22%) but was not statistically significant. Similar findings were found in the study by Islam et al. However, studies done by Savitha and Gopalakrishnan and Siziya et al. in Iraq found ARI prevalence higher among boys.,
With respect to the type of families, ARI prevalence was found to be more in children living in joint families (58.21%) than in nuclear families (54.19%) but the difference was not statistically significant and contradicted the findings by Islam et al.
In our study area, majority of the population belonged to the Mishing tribe and these people usually live in stilt houses where the kitchen is often attached to their living rooms. The prevalence of ARI was higher in children living in houses having kitchens attached to the living room (62.93%) compared to houses having a separate kitchen (42.15%) (OR = 2.33, 95% CI: 1.50–3.62, P = 0.000). Our findings are in concordance with the findings of Islam et al. and Savitha et al. This was probably because having an attached kitchen to the living room leads to the bulk of the emissions from the cooking fuel getting released into the living spaces which aggravates indoor pollution and thus predisposing to ARI.,
The prevalence of ARI (56%) among the under-five children of these Char areas was very high. This study had focused on only one childhood illness of the children of Tinsukia riverine (Char) areas and as such, there is scope for studies to be conducted regarding other health-care aspects of people in these Chars. As constructing permanent health facilities in these flood-prone regions is nearly impossible, the Boat Clinics could be used as a game changer to deliver proper health-care services to these marginalized people and also to provide necessary Behavioural Change Communication to those inhabitants.
We would like to thank all the under-five children and their caregivers for having consented to participate in this study. We also thank all the crew of the Tinsukia district Boat Clinic for their support in the field and C-NES for allowing us to use their Boat Clinic for data collection in the river islands.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]