title: Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.
authors.forename: Jean-Modeste
authors.initials: JM
authors.lastname: Harerimana
authors.affiliation: University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.
authors.forename: Leatitia
authors.initials: L
authors.lastname: Nyirazinyoye
authors.affiliation: University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
authors.forename: Dana R
authors.initials: DR
authors.lastname: Thomson
authors.affiliation: University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
keywords: ALRI; ARI; Community; Demographic and health survey; Integration