World Health & Population

World Health & Population November -0001 : 0-0.doi:10.12927/whp..17588

Community Economic Development and Acute Lower Respiratory Infection in Children

Antonio L. Cunha, Peter A. Margolis and Steven Wing


Background: Rates of acute lower respiratory illness (ALRI) vary among countries with levels of development, but variation in smaller geographic areas has not been evaluated.

Objectives: To assess the prevalence of ALRI among counties in northeastern Brazil; to determine whether rates of ALRI vary among counties at different levels of economic development and urbanization; and to examine the extent to which community economic development might modify the effect of low socio-economic status (SES) on rates of ALRI.

Design: Population-based cross-sectional study of children under five years of age in 70 counties in four states. Data on nutritional, environmental, social, and demographic risk factors for ALRI were measured during home interviews. County economic development was classified as the proportion of low SES families in the county.

Main outcome measure: Prevalence of ALRI.

Results: The prevalence of ALRI varied substantially among counties (range: 0 to 34.4%) and was highest in the least economically developed counties (POR: 1.65; 95% CI: 1.05-2.58). The prevalence of ALRI was 14% in low SES families, 10% in the middle SES group, and 7% in the high SES group (p <0.001 for linear trend). After controlling for other ALRI risk factors, family socio-economic status was strongly related to ALRI in the least developed counties (POR: 11.7, 95% CI: 4.1-33.2) but not in the most developed counties (POR: 1.3, 95% CI: 0.6-2.9).

Conclusion: Low SES children living in less economically developed communities appear to be at the highest risk for ALRI. Promoting community economic development may have important health benefits.

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