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Abstract
Background: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in under-five children
worldwide. On an average, children below 5 years of age suffer about 5 episodes of ARI per child per year, thus
accounting for about 238 million attacks and about 13 million deaths every year in the world. Identification of modifiable
risk factors of ARI may help in reducing the burden of disease.
Objective: To study the social demographic factors and prevalence of ARI in under five children living in urban
and rural area of Meerut district.
Materials and methods: A cross sectional study covering 450 under-five children living in urban and rural area
of Meerut district from October 2011 to March 2012.
Results: Prevalence of ARI was found to be 52%. It was higher in children with lower socioeconomic status
(35.89%), illiterate mother (49.14%), overcrowded conditions (70.94%), inadequate ventilation (74.35%), and use of
smoky chullah (56.83%), malnutrition (26.49) and parental smoking (78.20%).
Conclusion: The present study found that low socioeconomic status, maternal illiteracy, poor nutritional status,
overcrowding, indoor air pollution and parental smoking behavior were the significant social and demographic risk
factors responsible for ARI in under-five children. These observations emphasize the need for research aimed at
health system to determine the most appropriate approaches to control acute respiratory infection and thus could be
utilized to strengthen the ARI control programme.
Introduction
Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in
Under-Five Children of Meerut District, India. J Community Med Health Educ 2:176. doi:10.4172/2161-0711.1000176
Page 2 of 4
Results
Socio-demographic characteristics
Out of 450 children, the sex wise distribution was almost equal with
52% males and 48% females. In the study, about 47.55% (214) were
in between 1-4 yrs, 39.33% (177) were below age of 1 yr and 13.11%
(59) were in between 4-5 yrs of age. No major difference was found
in rural and urban area. Males were more in urban area (58.22%) and
females were more in rural area (54.22%). Majority were Hindus (76%)
followed by Muslims (21%). About one-fifth (19%) of children belonged
to upper social class (I, II) and remaining (79%) were in low social class
(III, IV, V). 42% of children were living in proper houses, it was more
in urban area (61%) as compared to rural area (23%). Overcrowding
was present in more than half of the houses (56%), it was more in rural
area (71%). Cross ventilation was present in 42% of houses, it was more
in urban (61%) as compare to rural area (23%). 34% children were from
households using smokeless fuel which is more in urban area (58%) as
compare to rural area (33%). 34% father and 52% mother of children
were illiterate (more in rural area 46%, 73% respectively). According to
occupational status of parents, 46% fathers were laborers, 71% mothers
were housewives, 16% were laborers. History of parental smoking
was present in 66% of houses, it was more in rural area (74%). About
29% were malnourished children (13% had grade-I, 11% had grade-II
and remaining had grade-III and IV), it was more in rural area (46%).
According to symptoms, about 71% of children having cough, 60%
nasal discharge, 30% fever, 16% fast breathing and 2% stopped feeding.
Prevalence of ARI
The overall prevalence of ARI was 52%. A total of 234 ARI cases
were found during the study. The mean number of episodes of ARI
was 2.25 per child per year. According to sex-wise 53.84% were males
and 46.15% were females. More ARI cases were seen in 1-4 years of age
group (46.15%) and in this age group 45.24% were males and 47.22%
were females (Table 1). According to social class, prevalence of ARI
was higher in low social class (in class III - 20.94%, class IV -32.9%, and
class V- 35.89% respectively) (Table 2). This difference was statistically
significant (x2=13.72, p<0.001). In social class IV and class V, prevalence
of ARI was more in rural area (34.43%, 37.77%) as compare to urban
area (30.12%, 32.53%). This difference was statistically significant
(x2=15.7, p<0.05) (Table 2).
Prevalence of ARI was highest in children of illiterate (49.14%)
and primary (34.43%) mothers. According to occupation of father,
prevalence of ARI was highest in children of fathers who were engaged
in agriculture (35.47%) and laborers (23.93%). Prevalence of ARI was
more in those children having history of parental smoking (78.20%) as
compared history of non-parental smoking (21.79%). Overcrowding
and inadequate ventilation has a direct relationship with prevalence
of ARI. ARI was higher in children (70.94%) who were living in
overcrowded houses as compare to no overcrowding (29.05%) and
inadequate ventilation was 74.35%. Prevalence of ARI was higher
in children of mothers who were using smoky chullhas (56.83%) as
compared to using smokeless chullhas (30.34%). Nutrition status of
children had also a direct bearing on childrens susceptibility to ARI. It
was more in Grade-I (26.49%), Grade-II (19.23%), Grade-III (15.38%)
and Grade-IV (09.82 %) respectively.
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Discussion
In the study overall prevalence of ARI was found to be 52%. Our
findings are similar to the findings of a study done by Rahman and
Rahman [3] in Bangladesh where prevalence of ARI was found to
be 58.7%. Our findings are in contrast to the findings of the studies
conducted by Prajapati et al. [4] in Gujrat where the prevalence of
ARI was found to be 22% and Gupta et al. [5] where the prevalence of
ARI was 4.5%. In present study 53.84% of ARI cases were males and
46.15% were females. This study showed that ARI was more prevalent
among male children and similar study conducted in London, United
Kingdom by Leeder et al. [6] had similar results showing male sex was
more prone as compared to female.
According to social class, prevalence of ARI was higher in low
social class. The present study found a significant association between
ARI and social class (p<0.001). Various studies like by Gupta et al. [5],
Deb et al. [7] and Mitra [8] found similar association.
According to area, Prevalence of ARI was lower in urban area
(36.89%) as compared to rural area (67.11%). Similar observations
were seen in study done by Deb [7].
The present study found no association between ARI and literacy
status of mothers (p>0.05). Similar findings observed in study done by
Mitra [8].
Prevalence of ARI was more in those children having history of
parental smoking (78.20%). Similar findings were observed in a study
by Rahman and Rahman [3] in Bangladesh. Studies done on exposure
of cigarette smoke in Australia and risk of parental smoking in UK
have increased risk of hospitalization with ARI [9,10].
Prevalence of ARI was higher in children of mothers who were
using smoky chullhas (56.83%). Similar study in rural areas of Australia
also showed increase risk of developing LRTI among those using wood
fuel [11].
Age group (yrs)
Male
No.
0-1
Female
(%)
No.
(%)
Total
No.
(%)
53
(42.06)
45
(41.66)
98
(41.88)
1-4
57
(45.24)
51
(47.22)
108
(46.15)
4-5
16
(12.69)
12
(11.11)
28
(11.96)
Total
126
(53.84)
108
234
(100.00)
(46.15)
Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in
Under-Five Children of Meerut District, India. J Community Med Health Educ 2:176. doi:10.4172/2161-0711.1000176
Page 3 of 4
Urban (%)
Rural (%)
Total (%)
ARI Present
83
(36.89)
151
(67.11)
234 (52.00)
ARI Absent
142
(63.11)
74
(32.89)
216 (48.00)
Male
56
(67.46)
70
(46.36)
126 (53.84)
Female
27
(32.53)
81
(53.64)
108 (46.16)
25
(30.12)
73 (48.34)
98 (41.88)
1-4 Yrs
42
(50.60)
66 (43.70)
108 (46.15)
4-5 Yrs
16
(19.27)
12 (07.94)
28 (11.96)
07 (02.99)
06 (07.22)
01
(00.66)
Social class II
09 (10.84)
08
(05.29)
17 (07.26)
16 (19.27)
33
(21.85)
49 (20.94)
Social class IV
25 (30.12)
52
(34.43)
77 (32.90)
Social class V
27 (32.53)
57
(37.74)
84 (35.89)
Illiterate
36 (43.37)
79 (52.31)
115 (49.14)
Primary
21 (25.30)
31 (20.52)
52
High school
12 (14.45)
22 (14.56)
34 (14.52)
Intermediate
08 (09.63)
11 (07.28)
19 (08.11)
Above Intermediate
06 (07.22)
08 (05.29)
14 (05.98)
56 (23.93)
Fathers occupation
Laborer
19 (22.89)
37 (24.50)
Pvt. Service
26 (31.32)
11 (07.28)
37 (15.81)
Agricultural
00 (00.00)
83 (54.96)
83
(35.47)
Business
32 (38.55)
16 (10.59)
48
(20.51)
Govt. Service
06 (07.22)
04 (02.64)
10
(04.27)
Yes
52
( 62.65)
131 (86.75)
183 (78.20)
No
31
(37.34)
20
51
Yes
47
(56.62)
119 (78.80)
166 (70.94)
No
36
(43.37)
32
(21.19)
68 (29.05)
Inadequate ventilation
45
(54.21)
129 (85.43)
174 (74.35)
Adequate ventilation
38
(45.78)
22
(14.56)
60 (25.64)
Smoky Chullah
19
(22.89)
114 (75.49)
133 (56.83)
Smokeless Chullah
41
(49.39)
30
(19.86)
71 (30.34)
Others
23
(27.71)
07
(04.63)
30 (12.82)
Normal
15
(18.07)
53
(35.09)
68 (29.05)
Grade I
23
(27.71)
39
(25.82)
62 (26.49)
Grade II
19
(22.89)
26
(17.21)
45 (19.23)
Grade III
15
(18.07)
21
(13.90)
36 (15.38)
Grade IV
11
(13.25)
12
( 07.94)
23 (09.82)
(21.79)
Overcrowding
Cross ventilation
Table 2: Social demographic factors and ARI cases in under five children of Meerut.
Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in
Under-Five Children of Meerut District, India. J Community Med Health Educ 2:176. doi:10.4172/2161-0711.1000176
Page 4 of 4
Conclusion
6. Leeder SR, Corkhill R, Irwig LM, Holland WW, Colley JR (1976) Influences of
family factors on the incidence of lower respiratory illness during the first year
of life. Br J Prev Soc Med 30: 203212.
References
1. Lal S (2011) Epidemiology of Communicable Diseases and Related National
Health Programmes. Textbook of Community Medicine. (3rdedn), M/S CBS
Publishers & Distributons.
2. Park K (2011) Epidemiology of Communicable Diseases. Parks Textbook of
Preventive and Social Medicine, (21stedn), M/S Banarsidas Bhanot Publishers.
3. Rahman MM, Rahman AM (1997) Prevalence of acute respiratory tract
infection and its risk factors in under five children. Bangladesh Med Res Counc
Bull 23: 47-50.
Special features: