Socio-demographic and environmental determinants of infectious disease morbidity in children under 5 years in Ghana

Background: Globally, diarrhoea and acute respiratory infections (ARIs) have been identified as major threats to child survival. In Ghana, the two conditions are among the top three causes of morbidity and mortality among children under 5 years. An in-depth analysis of the factors associated with these two diseases is warranted, because of their high degree of fatality and also it provides a basis for intervention planning. Objectives: To investigate socio-demographic and environmental factors associated with infectious disease morbidity in children under 5 years old in Ghana. Design: Population-based cross-sectional survey. The study sample comprised 2,790 children aged 0 - 59 months, drawn from the Ghana Demographic and Health Surveys. The mothers reported whether their children under age 5 had been ill with a cough accompanied by short, rapid breathing (ARI), or diarrhoea with the presence of blood or mucus in the stool, in the 2 weeks preceding the survey. Results: Children in the 6 - 11, 12 - 23, and 24 - 59 months age groups had, respectively, 3.48 (95% CI = 2.23, 5.44), 4.57 (95% CI = 3.03, 6.90), and 1.93 (95% CI = 1.30, 2.87) increased odds of getting diarrhoea infection compared to those in the youngest age category (0 - 5). Similarly, children in the 6 - 11, 12 - 23, and 24 - 59 months age brackets were, respectively, 2.64 (95% CI = 1.76, 3.97), 2.63 (95% CI = 1.81, 3.83), and 1.83 (95% CI = 1.29, 2.59) times more likely to have cough compared to children in 0 - 5 months age brackets. Children who were not breastfeeding had higher odds of childhood diarrhoea (OR = 1.33, 95% CI = 1.03, 1.73) compared to those who were breastfeeding. Compared to children who were living in households without co-wives, children who were living in households with co-wives had 1.74 increased odds of diarrhoea (95% CI = 1.33, 2.27). A unit increase in maternal opinion regarding wife beating was associated with 14% reduced odds of diarrhoea (OR = 0.86, 95% CI = 0.80, 0.91), while a unit change in the women's attitude towards sex index was associated with 14% reduced odds of childhood cough (OR = 0.86, 95% CI = 0.77, 0.97). Conclusions: Our results show that breastfeeding, polygamous marriage, and maternal decision-making autonomy are significant predictors of child morbidity. Therefore, implementing effective educational programmes that aim at promoting breastfeeding, empowering women, and discouraging polygamous marriages could help save many children from infectious disease morbidity in Ghana.