Background
Globally, infant and child mortality rates are critical issues and fundamental indicators of a country’s population’s health, quality of life, and socioeconomic situation [
1]. A remarkable decline of 60% in under-five mortality has been observed over the last three decades. However, 7.4 million annual global mortalities are estimated due to preventable and treatable diseases in young children. Besides, 70% of these deaths occur in children under the age of 5 years, and 95% are from South Asia and sub-Saharan Africa, i.e., on average, about 1 in 13 children in sub-Saharan Africa die before the age of five [
2]. Various factors may contribute to high mortality rates, such as poor living conditions and other socio-economic factors of countries’ populations where childhood acute respiratory infections (ARI) remain among the top leading morbidities in low-income countries, particularly in sub-Saharan Africa [
3].
The ARI disease and its related symptoms are typically caused by contagious viruses and bacterial infections that spread rapidly through droplets from either person-to-person or contaminated food or drinking water due to poor hygiene [
4]. According to WHO 2019, ARI diseases are the fourth most common childhood disease among those with a higher rate of morbidity. When combined with malaria, ARI diseases become the top communicable diseases causing more deaths than other comorbidities [
5‐
7]. In addition, the symptoms of ARI disease coincide with those of diarrhea and malaria diseases could lead to childhood death [
8].
In Uganda, ARI has remained the leading cause of morbidity and mortality in children under the age of 5 years, accounting for about 9% of the ARI prevalence, with 81.3% in urban areas. The under-five mortality rate accounted for 1 in 16 child deaths, and 42% of these deaths occurred in the neonatal period [
9]. The heavy loss of young lives from childhood ARI mortalities poses a heavy burden to families and healthcare providers in Uganda. Therefore, conducting research regarding the assessment of risk factors related to such diseases can greatly help policy decision-making and reduce these morbidity and mortality rates, especially in under-five children.
Traditional analysis methods such as logistic regression and chi-square test approaches are commonly applied in social science and medical literature. However, in diagnosing cardiopulmonary diseases using medical data, machine learning tools have become popular and frequently used in recent research [
10]. The appropriate usage of machine learning algorithms has revealed significant performance in the prediction and classification of disease outcomes [
11]. This study aims to determine potential risk factors contributing to ARI disease symptoms in children under the age of 5 years in Uganda using well-performed methods to predict the ARI symptom outcomes between traditional and machine learning analysis methods. The study findings could help in making research-based decisions to address the associated risk factors of ARI disease symptoms relevant to the disease’s control and spread among children.
Discussion
This study builds upon the analysis of risk factors for ARI disease symptoms among children under the age of 5 years and compares various methods’ performances in predicting childhood ARI symptom outcomes. Using well-performing methods, we analyzed socio-demographic, behavioral, and environmental factors contributing to childhood ARI disease symptoms in Uganda using the 2016 UDHS dataset. The results revealed that the random forest method performed better in accuracy than other methods considered in the analysis, followed by the logistic regression method (Table
5). As shown in two methods, the employment of mothers in farming activities, the season effect, the region of residence, and the fuel used for cooking, such as firewood and charcoal, were found to be potential risk factors contributing to the childhood ARI disease symptoms in Uganda. In addition, the young ages of mothers and children, breastfeeding, and wealth status were also found to be factors associated with ARI disease symptoms among children in this study.
Other studies conducted in Uganda also showed that these higher prevalence results for childhood ARI diseases were consistent with the current findings [
19,
20], and the high risk of childhood ARI disease symptoms due to factors such as season and geographical regions was also in concurrence with other findings from studies conducted in neighboring countries such as Rwanda and Kenya [
21‐
23]. A vulnerable region in Uganda, like the northern region where people were forced to settle in camps because of the civil war in 1986, suffered from overcrowding and poor sanitation that speeded up the disease occurrence [
19]. More efforts in sanitation and appropriate health services from the government should be established in highly risk areas to eliminate regional differences against ARI diseases. However, a study conducted in the Gulu district, northern Uganda, reported that children living in urban areas were more likely to develop ARI symptoms than those living in rural areas [
24].
The study findings also revealed that the ARI symptoms increased among the children exposed to firewood smoke compared to those exposed to charcoal smoke. These results of the association between wood fuel and ARI symptoms were similar to others conducted in sub-Saharan African countries [
23,
25‐
28]. According to WHO reports, “Children exposed to cooking fuels and parental smoking are more likely to be at a high risk of having pneumonia and other respiratory infection diseases” [
8]. The need for parents’ and community education about the dangers of smoking to children must be addressed, especially in places where smoking and firewood are used frequently [
29].
The ARI factors, such as the education and employment of mothers, are consistent with other results found in Kenya, Ethiopia, and Rwanda [
22,
30,
31]. However, the factors contradict findings from another study conducted in northern Uganda because of the discrepancies in living standards and characteristics of the population studied. In the northern part, people suffered from overcrowding and poor sanitation, and most people were living in camps that encouraged disease occurrence and easy spread [
19]. In the current study, children younger than 1 year old showed a higher risk of having ARI disease symptoms than children aged 48–59 months. These findings are supported by similar findings [
29,
32‐
34]. The factors were related to the low rates of immunization in young children, low maternal literacy, and the young mothers in farming activities that do not allow the care of young children, particularly in sub-Saharan African countries, where health facilities and maternal healthcare education have to be improved.
Aside from the foregoing, this study provides evidence on parental behavior factors such as breastfeeding, which contradicts other findings [
19,
20]. The current study showed that non-breastfed children whose mothers were teenaged were found to be more likely to develop ARI disease symptoms than breastfed ones, and generally, breastfeeding is more important to the child’s nutrition and the good functionality of the child’s immunity system.
Despite the strengths, limitations also have to be discussed. Parental smoking and childbirth weight factors were found to be significantly associated with ARI disease among children under the age of five in other studies [
26,
29,
35,
36]. Due to the much missing information presented in these two variables in the current study, these two risk factors were limited in the 2016 UDHS dataset. In general, smoking harms the natural human defense of the respiratory system [
37], especially in low birth-weight children. The government and community campaigns should educate people about the dangers of smoking on people’s health, particularly in young children’s households.
In terms of the analysis methods, we used both new and traditional supervised analysis methods, such as machine learning algorithms and multivariate regression methods, to predict the childhood outcomes of ARI disease symptoms. Furthermore, these findings complement other comparative machine learning findings [
38‐
41] in providing evidence of the better performance of the random forest algorithm (88.7%) than traditional methods of analysis. However, other studies [
42,
43] contradicted these findings. Further research is needed to overcome these challenges and compare various analysis methods using nationwide cross-sectional survey datasets like the DHS data. Moreover, longitudinal data analysis can better examine the potential risk factors of ARI disease in children under the age of 5 years.
In summary, this paper revealed that the mother’s employment and age, child age, breastfeeding, wealth status, season effect, region of residence, and cooking fuel such as firewood and charcoal were found to be potential risk factors for ARI disease symptoms in children under the age of 5 years. In this study, non-breastfed children whose mothers were teenagers had a significant effect on the development of ARI disease symptoms. Based on the results, policy-makers and health stakeholders should initiate target-oriented approaches to address the problems regarding poor children’s healthcare, improper environmental conditions, and childcare facilities. The government and child family interventions have to encourage maternal education and especially child breastfeeding. For the sake of early child care, the government should promote child breastfeeding and maternal education.
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