A spatio-temporal mapping and bayesian modelling of risk factors of pneumonia symptoms in under-five children in Nigeria

Background Pneumonia remains a public health challenge in most parts of the world, with Nigeria having the highest number of pneumonia-related deaths. Understanding the geographical distribution, trends and risk factors associated with pneumonia symptoms will aid an appropriate intervention of pneumonia and subsequently reduce its burden in Nigeria. Method This cross-sectional study used data from the 2008, 2013 and 2018 Nigeria Demographic Health Survey. In each of the survey round, a multi-stage cluster sampling technique was used to select the eligible respondents who are women of reproductive age. The outcome variables are the presence of key symptoms of pneumonia: fever, cough, and short rapid breaths. Optimized hotspot analysis was used to identify states with a significantly high prevalence of pneumonia symptoms, MCMC mixed-effect models were fitted to each symptom. Results The prevalence of cough was 12.1%, 10.1% and 16.9% in 2008, 2013 and 2018 respectively, 16.2%, 13.3%, and 25.7% for fever; and 41.7%, 42.5% and 6.5% for short rapid breaths respectively with variations across the states. The adjusted odds of having a cough among the children aged 6-11, 12-23, 24-35 and 36-47 months were 95% higher (adjusted odds ratio (aOR) =1.95, 95% Credible Interval (CrI): 1.77, 2.18), 92% higher (aOR=1.92, 95% CrI: 1.73, 2.12), 45% higher (aOR=1.45, 95% CrI: 1.31, 1.62) and 15% higher (aOR=1.15, 95% CrI: 1.03, 1.27) respectively, relative to ages 0-5 months. Similar patterns were noticed for fever and short rapid breaths. Mothers’ education was significant for cough and fever but not for short rapid breaths. Mothers’ age was significant only for short rapid breaths at higher odds. Other significantly associated factors with symptoms include residence type, housing quality, wealth index and region. Conclusion Fever, cough, and short rapid Breaths are prevalent among under-five children in Nigeria. These symptoms are associated with different characteristics and varied across states in Nigeria. Therefore, it is pertinent that mothers improve on the available preventive and management strategies with the view to mitigating the consequences of pneumonia symptoms among under-five children in Nigeria. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The owners of the secondary data used in this analysis obtained the necessary ethical approval and consent prior to data collection. There was no need for further approvals on our part as open-source secondary data. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data underlying the results presented in the study are available from www.dhsprogram.com/data