A multilevel analysis of the social determinants associated with symptoms of acute respiratory infection among preschool age children in Pakistan: A population-based survey

Background
As advocated by WHO in “Closing the Health Gap in a Generation”, dramatic differences in child health are closely linked to degrees of social disadvantage, both within and between communities. Nevertheless, research has not examined whether child health inequalities include, but are not confined to, worse acute respiratory infection (ARI) symptoms among the socioeconomic disadvantaged in Pakistan. In addition to such disadvantages as the child’s gender, maternal education, and household poverty, the present study also examined the linkages between the community environment and ARI symptoms among Pakistan children under five. Furthermore, we have assessed gender contingencies related to the aforementioned associations.

Methods
Using data from the nationally representative 2017–2018 Pakistan Demographic and Health Survey, a total of 11,908 surviving preschool age children (0–59 months old) living in 561 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between ARI symptoms and individual-level and community-level social factors.

Results
The social factors at individual and community levels were found to be significantly associated with an increased risk of the child suffering from ARI symptoms. A particularly higher risk was observed among girls who resided in urban areas (AOR = 1.42; p<0.01) and who had a birth order of three or greater.

Discussions
Our results underscore the need for socioeconomic interventions in Pakistan that are targeted at densely populated households and communities within urban areas, with a particular emphasis on out-migration, in order to improve unequal economic underdevelopment. This could be done by targeting improvements in socio-economic structures, including maternal education.