Lower respiratory infections are more prevalent in developing countries due to socioeconomic and environmental factors
the verdict
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the weight of evidence
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Retrieved evidence partially supports the claim that lower respiratory infections and associated conditions are prominent in low- and middle-income countries and linked to socioeconomic and environmental factors, but lacks comprehensive comparative data to fully substantiate the broad claim across all contexts.
<h4>Background</h4>Wheezing episodes are common in childhood and can occur due to different health conditions. Globally, Indigenous children are particularly affected, with a high burden of respiratory diseases related to socioeconomic inequalities, demographic characteristics, and exposure to environmental risks.<h4>Objective</h4>We summarize the knowledge available in the global literature on the determinants of wheezing in Indigenous children and adolescents and develop a theoretical model for analyzing them in Indigenous Brazilian children.<h4>Methods</h4>Systematic review conducted under the PRISMA 2020 criteria for studies, registered in PROSPERO (CRD42023395661). The Medline, Scopus, Web of Science, and LILACS databases were searched until September 2024. The inclusion criterion was analytical observational studies that showed risk factors for wheezing in children and adolescents (0-19 years). Studies that did not show specific results in the age group of interest, even if they included children and adolescents in their samples, book chapters, conference annals, or outcomes associated with chronic lung disease complications were excluded. Quality assessment was performed using the Newcastle-Ottawa Scale.<h4>Results</h4>Seventeen of the 263 analyzed studies were included in this systematic review, with a total of 139,783 participants. The most common design was cross-sectional (76.5%); most studies were conducted in North America (76.5%). Asthma was the most common type of wheezing episodes (88.2%). Male patients showed a more significant association with wheezing outcomes. Wheezing, when combined with asthma, was directly associated with age and inversely associated with age when accompanied by cold.<h4>Conclusion</h4>We identified three main factors for wheezing in Indigenous children and adolescents: Environmental (tobacco smoke, indoor pollution, and housing), socioeconomic (income, healthcare, and residence), and biological/clinical (sex, birth weight, in
Asthma was the most common type of wheezing episodes (88.2%). Male patients showed a more significant association with wheezing outcomes. Wheezing, when combined with asthma, was directly associated with age and inversely associated with age when accompanied by cold. Conclusion We identified three main factors for wheezing in Indigenous children and adolescents: Environmental (tobacco smoke, indoor pollution, and housing), socioeconomic (income, healthcare, and residence), and biological/clinical (sex, birth weight, infections, and allergies). We propose a model to analyze these factors in Indigenous Brazilian children.
For instance, based on hospitalization data of Guarani children under five who were prospectively followed for three years to conduct a case-control study on factors associated with the incidence of hospitalization due to acute respiratory infection of the lower respiratory tract, a prevalence of wheezing of 64.7% was identified in hospitalized children under one year of age, with symptoms concentrated in the autumn in the Southern Hemisphere (April–June) (64.2%). Wheezing was the main comorbidity associated with hospitalization [ 30 ].
There was a higher proportion of wheezing among Indigenous children hospitalized due to acute respiratory infections of a presumed viral etiology (40.8%) [ 31 ]. The relevance of acute respiratory diseases and wheezing among Indigenous Guarani children prompted the creation of the first cohort of Indigenous births in Brazil, the Guarani Birth Cohort, which aimed to describe the wheezing profile in the first year of life and identify factors associated with the incidence of wheezing in the cohort.
Socioeconomic factors Regarding annual income, one study found an association between high income and the risk of wheezing [ 39 ], whereas two others found an association with low income [ 58 , 59 ]. The association between wheezing and higher income was attributed to the fact that these parents also had higher levels of education and better access to healthcare and diagnostic services [ 39 ]. Conversely, a study that found a higher occurrence of wheezing among those with lower incomes reported greater vulnerability to viral infections, which were triggers of asthma in this population, as well as a higher rate of hospitalization due to asthma [ 59 ].
Genetic factors Regarding the genetic risks for developing asthma, only one study contributed to increasing the knowledge about these factors in the indigenous population, which has historically been excluded from genetic studies of asthma [ 37 ]. Infectious factors The predisposition to wheezing associated with respiratory infections should be understood in a broader context. Therefore, an important concept is that of a single airway, in which the upper and lower airway management must be understood as a single physiological unit, meaning that an inflammatory condition affecting one system tends to affect another similarly [ 81 ].
Conclusion In this systematic review we summarize evidence from 17 studies on factors associated with wheezing in Indigenous children and adolescents globally, identifying three main domains of determinants: environmental factors (tobacco smoke exposure, indoor air pollution from wood-burning stoves, and housing conditions, including mold and humidity), socioeconomic factors (income level, healthcare access, and rural-urban residence), and biological/clinical factors (male sex, age, low birth weight, obesity, breastfeeding, allergic sensitization, respiratory infections, and parasitic infections).
Based on these findings, we proposed a theoretical model to analyze the determinants of wheezing in Indigenous Brazilian children, accounting for the complex interplay among these three domains within the specific context of Brazil’s 305 indigenous ethnic groups. Wheezing in Indigenous children is not solely a clinical issue, but a reflection of structural and environmental determinants. Our systematic review
BACKGROUND: Febrile diseases such as Malaria, Typhoid fever, HIV/AIDS, Tuberculosis, respiratory tract infections, and urinary tract infections remain major public health concerns in low-to-middle-income countries (LMICs). Their prevalence is driven by interacting socioeconomic, environmental, behavioral, and biological factors such as vector exposure, poor sanitation, overcrowding, and high-risk behaviors including intravenous drug use and smoking. This study investigates the key risk factors influencing the prevalence and diagnosis of febrile diseases in Southern Nigeria. METHODS: A cross-sectional quantitative research design was adopted, with data collected between May 2021 and December 2021 from four states in southern Nigeria. A total of 4,868 valid responses were obtained, with distribution across states as follows: Cross River accounted for 31% (n = 1,531), Rivers 25% (n = 1,232), Akwa Ibom 25% (n = 1,223), and Imo 18% (n = 882). Participants were aged < 19 years (40%, n = 1,934), 19–24 years (9%, n = 424), 25–44 years (32%, n = 1,557), 45–60 years (12%, n = 600), and > 60 years (7%, n = 353). The sample comprised 55% females (n = 2,693) and 45% males (n = 2,175). Among female participants, 409 were pregnant, distributed as 0–3 months (34%), 4–6 months (45%), and 7–9 months (21%), while 153 were nursing mothers, with the largest proportion (41%) breastfeeding for over 9 months. Statistical analyses included Pearson correlation and multiple linear regression to determine the relationships between identified risk factors and confirmed diagnoses of febrile diseases. RESULTS: The analysis showed that several risk factors were significantly associated with disease diagnoses, while others had minimal influence. The strongest predictor observed was mosquito bites on confirmed Malaria diagnosis (t = 41.68, p < 0.01). Direct contact with infected persons significantly influenced diagnoses of Tuberculosis (t = 18.54, p < 0.01) and HIV/AIDS (t = 17.39, p < 0.01). Other
Background Febrile diseases such as Malaria, Typhoid fever, HIV/AIDS, Tuberculosis, respiratory tract infections, and urinary tract infections remain major public health concerns in low-to-middle-income countries (LMICs). Their prevalence is driven by interacting socioeconomic, environmental, behavioral, and biological factors such as vector exposure, poor sanitation, overcrowding, and high-risk behaviors including intravenous drug use and smoking. This study investigates the key risk factors influencing the prevalence and diagnosis of febrile diseases in Southern Nigeria.
These illnesses, which disproportionately affect people in tropical and subtropical regions and raise morbidity and mortality rates, include malaria, dengue fever, enteric fever, Lassa fever, tuberculosis, respiratory and urinary tract infections (RTIs/UTIs), and others. These diseases have significant socioeconomic effects because they can impede economic growth, aggravate poverty, and put a burden on healthcare systems [ 1 ]. Although these risk factors are complex, they can be broadly divided into biological, socioeconomic, and environmental factors [ 2 ]. Developing effective prevention and control strategies requires an understanding of the risk factors associated with febrile diseases.
However, they note that differential diagnosis is challenging because mild and moderate forms of the disease can be confused with various other infectious diseases affecting the respiratory, digestive, and urinary systems. Due to environmental
Understanding the risk factors associated with febrile illnesses in adults within LMICs is crucial for developing targeted public health interventions and policies. The aim of this study is to analyze the risk factors associated with febrile illnesses among adults in LMICs, in order to identify key intervention areas and strategies to mitigate disease burden. The study seeks to understand how biological, socioeconomic, environmental, and behavioural factors contribute to the occurrence and spread of febrile diseases, including malaria, typhoid, HIV/AIDS, urinary tract infections, respiratory tract infections, tuberculosis, Lassa fever, yellow fever, and dengue fever.
This age distribution suggests that children and young adults represent a significant proportion of the study population, which is consistent with the high prevalence of febrile illnesses and infectious diseases among these groups, as found in previous studies [ 15 , 16 ]. In particular, children are known to be more vulnerable to infections due to their developing immune systems and exposure to crowded environments like schools [ 17 ]. The study by Ssentongo et al. [ 18 ] found that in 27 Sub-Saharan African countries, childhood febrile illness was most strongly associated with recent respiratory infections and diarrhea.
Socioeconomic conditions like poorer household, older child age, delayed breastfeeding, and lower maternal education influenced disease likelihood while environmental factors like unsafe water showed weaker or inconsistent links to disease prevalence. Furthermore, 55% of the participants were female, which is a common trend in healthcare studies, as women tend to utilize healthcare services more frequently than men [ 19 ], especially during pregnancy and child-bearing stages. The study also notes that 8.4% of the female participants were pregnant, and 3.1% were nursing mothers.
Studies such as [ 7 ] and [ 24 ] noted that urban infrastructure, population density, and environmental factors, such as the presence of mosquito breeding sites, are major contributors to the increasing global incidence of dengue. Despite its preventable nature, the rising incidence of dengue highlights the need for ongoing vector control efforts and public health education. Conclusion and recommendations In conclusion, this study highlights the multifaceted nature of febrile illnesses in LMICs, including malaria, typhoid, HIV/AIDS, and respiratory tract infections.
Background: Acute respiratory tract infections (ARTIs) remain among the leading causes of morbidity and mortality in children worldwide, particularly in low- and middle-income countries. These infections, including pneumonia, bronchitis, influenza, and bronchiolitis, are more prevalent in children due to their developing immune systems. They are commonly classified as upper or lower respiratory tract infections and occur more frequently in colder seasons and rural settings. Objective: The study aimed to determine the frequency and types of acute respiratory tract infections in children under five years of age and to identify the demographic and preventive factors associated with their occurrence. Methods: A cross-sectional study was conducted over ten months at Ayub Medical Complex, Abbottabad, involving 173 children aged ≤5 years. Participants were selected through stratified random sampling. Data were collected using a pretested structured questionnaire administered to parents, covering demographics, vaccination status, and infection history. Descriptive and inferential analyses were performed using IBM SPSS version 16. Quantitative variables were expressed as mean ± standard deviation, while categorical variables were reported as frequencies and percentages. Results: Out of 173 participants, 63 (36.4%) had acute respiratory tract infections, while 110 (63.6%) were infection-free. Males constituted 110 (63.6%) and females 63 (36.4%). Most participants resided in rural areas
Conflict of Interest: None Grant Support & Financial Support: None ABSTRACT Background: Acute respiratory tract infections (ARTIs) remain among the leading causes of morbidity and mortality in children worldwide, particularly in low- and middle-income countries. These infections, including pneumonia, bronchitis, influenza, and bronchiolitis, are more prevalent in children due to their developing immune systems. They are commonly classified as upper or lower respiratory tract infections and occur more frequently in colder seasons and rural settings.
Open access under CC BY License (Creative Commons). Freely distributable with appropriate citation. 426 INTRODUCTION Acute respiratory tract infections (ARTIs) represent one of the most prevalent causes of morbidity and mortality worldwide, e specially among infants and young children. These infections are broadly classified into upper and lower respiratory tract infections based on the anatomical location involved. The upper tract extends from the nostrils to the vocal cords, encompassing the sinuses and midd le ear, whereas the lower tract comprises the trachea, bronchi, bronchioles, and alveoli.
Studies have demonstrated that children attending group day care centers are at higher risk of developing respiratory infections compared to those cared for at home, owing to increased exposure to pathogens such as Haemophilus influenzae type b (Hib) (7). Otitis media, one of the most frequent complications of URTIs, affects nearly 80% of children at least once during early life. The conditio n is often associated with eustachian tube dysfunction, impaired mucociliary clearance, and nasopharyngeal anatomical variations. Environmental and lifestyle factors —including parental smoking and occupational exposure —further exacerbate the risk (8).
However, gaps in vaccine coverage, antimicrobial misuse, and environmental factors continue to fuel disease transmission. Given the global burden of ARTIs and their contribution to preventable morbid ity, it is imperative to better understand their epidemiological distribution, management practices, and preventive strategies. Therefore, the objective of the present study is to determine the frequency of acute respiratory tract infections across differe nt age groups, evaluate drug utilization patterns, and assess the impact of vaccination in mitigating disease occurrence.
To assess potential determinants of acute respiratory tract infecti ons, associations between ARI occurrence and selected independent variables—including socioeconomic status, exclusive breastfeeding, and vaccination status—were analyzed using the Chi -square test. The findings indicated that ARI was more prevalent among ch ildren from poor socioeconomic backgrounds, with 50 out of 113 (44.2%) affected, compared to 10 out of 53 (18.9%) from lower middle -class families and 3 out of 7 (42.9%) from upper middle -class households. A significant association was observed between low socioeconomic status and increased ARI prevalence (p ≤ 0.05).
The distribution of cases by residence showed that a higher proportion of children were from rural areas (76.9%) compared to urban areas (23.1%). This rural predominance reflects disparities in livin g conditions, environmental exposure, and healthcare accessibility. Consistent with earlier epidemiological studies conducted in comparable settings, rural children experienced higher rates of ARI -related morbidity due to overcrowding, poor ventilation, an d lower vaccination coverage (20%) (13 -15). These environmental and socioeconomic factors collectively increase susceptibility to respiratory pathogens.
The results further emphasized that pneumonia accounted for nearly half of the total ARI cases identified, supporting previou s reports that link poor environmental hygiene
Socioeconomic deprivati on, incomplete immu nization, and inadequate feeding practices remain the principal contributing factors. Strengthening preventive healthcare, promoting maternal awareness, and ensuring equitable access to vaccination services are essential strategies for reducing the incidence and impact of ARIs in this population. CONCLUSION This study highlights acute respiratory tract infections as a major contributor to childhood morbidity in Abbottabad, particularly among children under five years of age. It underscores the multifactorial nature of these infections, influenced by demographic, socioeconomic, environmental, and behavioral factors.
lower birth weights increasing the risk; the causes of low birth weight include socioeconomic, psychological, behavioral, and environmental factors.
Infant mortality is the death of an infant before its first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.
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Malnutrition or undernutrition is defined as inadequate intake of nourishment, such as proteins and vitamins, which adversely affects the growth, energy, and development of people all over the world. It is especially prevalent during pregnancy and in infants and children under 5 who live in developing countries within the poorer regions of Africa, Asia, and Latin America. Children are especially vulnerable as they have yet to fully develop a strong immune system and are dependent on their parents to provide the necessary food and nutritional intake. It is estimated that about 3.5 million children die each year as a result of childhood or maternal malnutrition, with stunted growth, low body weight, and low birth weight accounting for about 2.2 million associated deaths. Socioeconomic and environmental factors contribute to malnutrition, as do gender, location, and cultural practices surrounding breastfeeding. It is difficult to assess the most pressing factor as they can intertwine and vary among regions.
Children suffering from malnutrition can become underweight, and experience stunting or wasting. In Africa, the number of stunted children has risen, while Asia has the most children under 5 suffering from wasting. Inadequate nutrients adversely affect physical and cognitive development, increasing susceptibility to severe health problems. Micronutrient deficiency has been linked to anemia, fatigue, blindness, goiter, poor brain development, and death. Malnutrition also decreases the immune system's ability to fight infections, resulting in higher rates of death from diseases such as malaria, respiratory disease, and diarrhea.
Folic acid during pregnancy is one way to combat iron deficiency. A few public health measures used to lower levels of iron deficiency anemia include added iodine to salt or drinking water and including vitamin A and multivitamin supplements in the diet. A deficiency of this vitamin causes certain types of anemia (low red blood cell count).
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