臺灣博碩士論文加值系統

Background: Nigeria has the second highest estimated number of deaths due to acute respiratory infection (ARI) among children under five in the world. A common hypothesis is that the inequitable distribution of socioeconomic resources shapes individual lifestyles and health behaviors, which leads to poorer health, including symptoms of ARI. In addition, burgeoning evidence suggests a synergetic interplay between distal determinants involving the political, social and economic contexts on health outcomes. Attestation to the close association between relative gradations in social standing and disparities in health is evident in Northern and Southern regions with differential exposures to symptoms of ARI over time. This dissertation firstly examines whether lifestyle factors are associated with ARI risk among Nigerian children aged less than 5 years, taking individual-level and contextual-level risk factors into consideration and secondly we examined trends and regional disparities in ARI symptoms from 2003 to 2013 among under-fives in relation to individual and community membership, with a specific focus on south-north differences.

Methods: Data were obtained from the nationally representative 2013 Nigeria Demographic and Health dataset from 2003, 2008 and 2013. A total of 58,954 surviving children aged 5 years or younger living in 896 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between socioeconomic disparities, regional specific lifestyle factors, and household lifestyle factors and ARI symptoms.

Findings: First batch of the multivariate results from multilevel regressions using 2013 dataset indicated that the odds of having ARI symptoms were increased by a number of lifestyle factors such as in-house biomass cooking (OR = 2.30; p < 0.01) and no hand-washing (OR = 1.66; p < 0.001). An increased risk of ARI symptoms was also significantly associated with living in the North West region and the community with a high proportion of orphaned/vulnerable children (OR = 1.74; p < 0.001). Second batch of the multivariate results from multilevel regressions using 2003, 2008, 2013 dataset examined individual-level characteristics across regions of residence which showed differences in indicators over time between the Northern regions and the Southern regions. In the South southern regions, mothers were more educated over the years and wealth index improved over the years, in contrast, Northwestern region showed low education attainment amongst mothers and progressively diminishing wealth index.
Over the years, North western region showed an increasing high trend in proportion of worse community indicators such as biomass cooking fuel, wealth index and orphanhood yet contrast in the south southern region. Multivariate results from multilevel logistic regressions indicated a significant drop in ARI prevalence from 2003 to 2013 yet indicators of ARI risks differs between regions but trace an impressively linear socio-economic gradients with increased risk amongst low socioeconomic gradient as the North East (OR=3.08; p<0.01) and South-South region (OR=2.75; p<0.01) , in addition, vulnerable groups such as orphans children in the North East were less likely to have ARI symptoms as compared to orphans in residing in the South South region

Conclusion: Our findings firstly underscore the importance of Nigerian children’s lifestyle within the neighborhoods where they reside above their individual characteristics. Program-based strategies that are aimed at reducing ARI symptoms should consider policies that embrace making available basic housing standards, providing improved cooking stoves and enhancing healthy behaviors. Secondly, our findings showed that ARIs was significantly associated with region of residence, with higher risks of ARI symptoms for children resident in the North Western region and South South region after adjusting for individual- and community-level risk factors. The risk of ARIs was higher in the North West region after adjusting for year of survey and seasonal factor; these differences were increased and gained more significance once lifestyle factors and household level variables were added. In the Northern and southern regions, the two regions been compared in this study had the worse indicators. This may be associated with spatial inequality in social development in the community within regions, which may also be associated with population density, differential levels of regional development, political and religious situations, as well as varying economic resources. Our findings corroborate previous findings and longstanding historical concerns that the South South region of Nigeria, is been reported to have been marginalized with developmental resources, deficient of social infrastructures, high unemployment, social deprivation, and endemic conflict, in spite of the region accounting for more than 90% of Nigeria's proven gas and oil reserves and the nation's wealth

Background: Nigeria has the second highest estimated number of deaths due to acute respiratory infection (ARI) among children under five in the world. A common hypothesis is that the inequitable distribution of socioeconomic resources shapes individual lifestyles and health behaviors, which leads to poorer health, including symptoms of ARI. In addition, burgeoning evidence suggests a synergetic interplay between distal determinants involving the political, social and economic contexts on health outcomes. Attestation to the close association between relative gradations in social standing and disparities in health is evident in Northern and Southern regions with differential exposures to symptoms of ARI over time. This dissertation firstly examines whether lifestyle factors are associated with ARI risk among Nigerian children aged less than 5 years, taking individual-level and contextual-level risk factors into consideration and secondly we examined trends and regional disparities in ARI symptoms from 2003 to 2013 among under-fives in relation to individual and community membership, with a specific focus on south-north differences.

Methods: Data were obtained from the nationally representative 2013 Nigeria Demographic and Health dataset from 2003, 2008 and 2013. A total of 58,954 surviving children aged 5 years or younger living in 896 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between socioeconomic disparities, regional specific lifestyle factors, and household lifestyle factors and ARI symptoms.

Findings: First batch of the multivariate results from multilevel regressions using 2013 dataset indicated that the odds of having ARI symptoms were increased by a number of lifestyle factors such as in-house biomass cooking (OR = 2.30; p < 0.01) and no hand-washing (OR = 1.66; p < 0.001). An increased risk of ARI symptoms was also significantly associated with living in the North West region and the community with a high proportion of orphaned/vulnerable children (OR = 1.74; p < 0.001). Second batch of the multivariate results from multilevel regressions using 2003, 2008, 2013 dataset examined individual-level characteristics across regions of residence which showed differences in indicators over time between the Northern regions and the Southern regions. In the South southern regions, mothers were more educated over the years and wealth index improved over the years, in contrast, Northwestern region showed low education attainment amongst mothers and progressively diminishing wealth index.
Over the years, North western region showed an increasing high trend in proportion of worse community indicators such as biomass cooking fuel, wealth index and orphanhood yet contrast in the south southern region. Multivariate results from multilevel logistic regressions indicated a significant drop in ARI prevalence from 2003 to 2013 yet indicators of ARI risks differs between regions but trace an impressively linear socio-economic gradients with increased risk amongst low socioeconomic gradient as the North East (OR=3.08; p<0.01) and South-South region (OR=2.75; p<0.01) , in addition, vulnerable groups such as orphans children in the North East were less likely to have ARI symptoms as compared to orphans in residing in the South South region

Conclusion: Our findings firstly underscore the importance of Nigerian children’s lifestyle within the neighborhoods where they reside above their individual characteristics. Program-based strategies that are aimed at reducing ARI symptoms should consider policies that embrace making available basic housing standards, providing improved cooking stoves and enhancing healthy behaviors. Secondly, our findings showed that ARIs was significantly associated with region of residence, with higher risks of ARI symptoms for children resident in the North Western region and South South region after adjusting for individual- and community-level risk factors. The risk of ARIs was higher in the North West region after adjusting for year of survey and seasonal factor; these differences were increased and gained more significance once lifestyle factors and household level variables were added. In the Northern and southern regions, the two regions been compared in this study had the worse indicators. This may be associated with spatial inequality in social development in the community within regions, which may also be associated with population density, differential levels of regional development, political and religious situations, as well as varying economic resources. Our findings corroborate previous findings and longstanding historical concerns that the South South region of Nigeria, is been reported to have been marginalized with developmental resources, deficient of social infrastructures, high unemployment, social deprivation, and endemic conflict, in spite of the region accounting for more than 90% of Nigeria's proven gas and oil reserves and the nation's wealth

TABLE OF CONTENTS
ACKNOWLEDGEMENTS I
TABLE OF CONTENTS II
LIST OF TABLES IV
LIST OF FIGURES V
ABSTRACT VI
CHAPTER I: INTRODUCTION 1
1.1: Clinical acute respiratory infection 2
1.1.1: Acute respiratory infection symptoms 4
1.1.2: Predictors of Acute Respiratory Symptoms 4
1.2: Proximate determinants 5
1.2.1: Proximate determinants of ARI symptoms 7
1.2.2: Biologic determinants of ARI symptoms 8
1.3: Contextual structure determining child health 10
1.3.1: Provincial level factors and child health outcomes 12
1.3.2:Community level factors and child health outcome 13
1.3.3: Household level factors and child health outcome 14
1.4: Dissertation conceptual framework 15
1.5: Conceptual framework: Elaboration model describing variable relationships 17
1.6: Objectives of Dissertation 19
1.7: Contribution of this Dissertation 20
CHAPTER 2: LITERATURE REVIEW 21
2.1: Study Area and Rationale for Selection (Nigeria, West Africa) 21
2.1.1 Nigerian and Regional Differences on Acute Respiratory Symptoms 22
2.2 Outcome and major explanatory measures 26
2.2.1 Acute respiratory infection symptoms (ARI) 26
2.2.2 Air Pollution 26
2.2.3 Lifestyle and health behaviors 29
CHAPTER 3: DATA AND METHODS 35
3.1 Description of Data and Sample Design 35
3.2 Sample size flow chart 37
3.3 Operationalization of major variables 38
3.3.1 Covariates (Multilevel variables) 39
3.5 Ethical considerations 45
CHAPTER 4: A MULTILEVEL ANALYSIS OF LIFESTYLE VARIATIONS IN SYMPTOMS OF ACUTE RESPIRATORY INFECTION AMONG YOUNG CHILDREN UNDER FIVE IN NIGERIA 46
4.1: Background 46
4.2: Methods 51
4.2: Results 56
4.4 Discussion 58
Table 4. 1: Hypothesized neighborhood socioeconomic influences, together with the distribution and categorization of neighborhood-level variables, which were used to predict the likelihood of development of ARI symptoms; 2013 NDHS (children 0-5, n=896) 64
Table 4. 2: ARI prevalence by sample characteristics for children under five years of age [percentage or mean (Std Dev)], NDHS 2013 65
Table 4.3: Results of multilevel regressions of the odds of ARI symptoms among young children, 2013 NDHS (N=28,596) 66
Figure 4. 1: Prevalence of acute respiratory tract infection (ARI) symptoms among individuals with the status of orphans and vulnerable children (OVC) by region 68
CHAPTER 5: REGIONAL DIFFERENCES IN SYMPTOMS OF ACUTE RESPIRATORY INFECTION AMONG YOUNG CHILDREN UNDER FIVE IN NIGERIA: A MULTILEVEL ANALYSIS 69
5.1: Background 69
5.2: Methods 75
5.3: Results 80
5.4: Discussion 83
CHAPTER 6: A TALE OF TWO REGIONS: TRENDS AND WEALTH DISPARITIES IN SYMPTOMS OF ACUTE RESPIRATORY INFECTIONS (ARI) AMONG PRE-SCHOOL CHILDREN IN SOUTH-SOUTH AND NORTH-WEST NIGERIA 90
6.1: Background 90
6.2 Methods 101
6.3: Results 106
6.4: Discussion 111
Table 6.1: Hypothesized ARI symptoms; 2003, 2008 and 2013 NDHS (children 0–5) neighborhood socioeconomic influences, together with the distribution and categorization of neighborhood-level variables, which were used to predict the likelihood of development of ARI symptoms 117
Table 6.2: Summary statistics for individual and community variables used in statistical analysis of ARI symptoms by regions , NDHS 2003-2013 [percentage], NDHS 2003-2013(N=58,954) 118
Table 6.3: Results of the multilevel regression of the odds of ARI symptoms among young children, 2003-2013 NDHS (N=58,455) 122
Figure 6.4: ARI symptoms prevalence within the six geopolitical regions between 2003 to 2013 128
CHAPTER 7: CONCLUSIONS 129
Limitations, Strengths and Public Health significance 132
Public Health significance 133
REFRENCES 134
APPENDIX 148

LIST OF TABLES
Table 4. 1: Hypothesized neighborhood socioeconomic influences, together with the distribution and categorization of neighborhood-level variables, which were used to predict the likelihood of development of ARI symptoms; 2013 NDHS (children 0-5, n=896)

Table 4. 2: ARI prevalence by sample characteristics for children under five years of age [percentage or mean (Std Dev)], NDHS 2013

Table 4.3: Results of multilevel regressions of the odds of ARI symptoms among young children, 2013 NDHS (N=28,596)

Table 5.1: Hypothesized province specific neighborhood socioeconomic influences, together with the distribution and categorization of neighborhood-level variables, which were used to predict the likelihood of development of ARI symptoms; 2013 NDHS (children 0-5, n=896)

Table 5.2: ARI prevalence by province showing sample characteristics for children under five years of age [percentage or mean (Std Dev)], NDHS 2013


Table 5.3: Results of the multilevel regression of the odds of ARI symptoms among young children, 2013 NDHS (N=28,596)

Table 6.1: Hypothesized ARI symptoms; 2003, 2008 and 2013 NDHS (children 0–5) neighborhood socioeconomic influences, together with the distribution and categorization of neighborhood-level variables, which were used to predict the likelihood of development of ARI symptoms

Table 6.2: Summary statistics for individual and community variables used in statistical analysis of ARI symptoms by regions, NDHS 2003-2013 [percentage], NDHS 2003-2013(N=58,954)

Table 6.3: Results of the multilevel regression of the odds of ARI symptoms among young children, 2003-2013 NDHS (N=58,455)


LIST OF FIGURES

Figure 1: Distinguishing upper and lower ARI by site of infection

Figure 2: Mechanisms through which contextual factors could influence child health

Figure 3: Conceptual framework of predicting ARI symptoms

Figure 4. 1: Prevalence of acute respiratory tract infection (ARI) symptoms among individuals with the status of orphans and vulnerable children (OVC) by region

Figure 5: Nigeria’s smoking prevalence rate; The Tobacco Atlas

Figure 6: Global Adult Tobacco Survey

Figure 6.4: ARI symptoms prevalence within the six geopolitical regions between 2003 to 2013

REFRENCES
Acharya, P., Mishra, S. R., & Berg-Beckhoff, G. (2015). Solid fuel in kitchen and acute respiratory tract infection among under five children: evidence from Nepal demographic and health survey 2011. J Community Health, 40(3), 515-521. doi: 10.1007/s10900-014-9965-0
Adedini, S. A., Odimegwu, C., Imasiku, E. N., Ononokpono, D. N., & Ibisomi, L. (2015). Regional variations in infant and child mortality in Nigeria: a multilevel analysis. Journal of biosocial science, 47(02), 165-187.
Adefolalu, D. (1986). Further aspects of Sahelian drought as evident from rainfall regime of Nigeria. Archives for meteorology, geophysics, and bioclimatology, Series B, 36(3-4), 277-295.
Adekanmbi, V. T., Kandala, N.-B., Stranges, S., & Uthman, O. A. (2015). Contextual socioeconomic factors associated with childhood mortality in Nigeria: a multilevel analysis. Journal of epidemiology and community health, jech-2015-205457.
Adesanya, O. A., & Chiao, C. (2016). A multilevel analysis of lifestyle variations in symptoms of acute respiratory infection among young children under five in Nigeria. BMC Public Health, 16(1), 880.
Aiello, A. E., Larson, E. L., & Sedlak, R. (2008). Hidden heroes of the health revolution Sanitation and personal hygiene. American journal of infection control, 36(10), S128-S151.
Aigbe, G., & Zannu, A. (2012). Differentials in infant and child mortality rates in Nigeria: Evidence from the six Geopolitical Zones. International Journal of Humanities and Social Sciences, 2(16), 206-214.
Aigbokhan, B. E. (2000). Poverty, Growth, and Inequality in Nigeria: A case study (Vol. 102): Citeseer.
Ainsworth, M., & Semali, I. (2000). The impact of adult deaths on children's health in northwestern Tanzania (Vol. 2266): World Bank Publications.
Alleyne, G. A. O., Resources, P. A. H. O. D. o. H., Research, & Bureau, P. A. S. (1983). Acute Respiratory Infections in Children: Pan American Health Organization, Pan American Sanitary Bureau, Regional Office of the World Health Organization.
Amoako Johnson, F., Padmadas, S. S., & Smith, P. W. (2010). Orphanhood and vulnerability: a conduit to poor child health outcomes in Rwanda. AIDS care, 22(3), 314-323.
Amouzou, A., Kozuki, N., & Gwatkin, D. R. (2014). Where is the gap?: the contribution of disparities within developing countries to global inequalities in under-five mortality. BMC Public Health, 14(1), 216.
Amouzou, A., Velez, L., Tarekegn, H., & Young, M. (2016). One is too many: ending child deaths from pneumonia and diarrhoea.
Antai, D. (2009a). Faith and child survival: the role of religion in childhood immunization in Nigeria. Journal of biosocial science, 41(01), 57-76.
Antai, D. (2009b). Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants. BMC infectious diseases, 9(1), 181.
Antai, D. (2011). Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants. Popul Health Metr, 9, 6. doi: 10.1186/1478-7954-9-6
Antai, D., & Antai, J. (2009). Collective violence and attitudes of women toward intimate partner violence: Evidence from the Niger Delta. BMC international health and human rights, 9(1), 1.
Antai, D., Ghilagaber, G., Wedrén, S., Macassa, G., & Moradi, T. (2009). Inequities in under-five mortality in Nigeria: differentials by religious affiliation of the mother. Journal of religion and health, 48(3), 290-304.
Aremu, O., Lawoko, S., Moradi, T., & Dalal, K. (2011). Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: A multilevel model. Ital J Pediatr, 37, 13.
Bautista, L. E., Correa, A., Baumgartner, J., Breysse, P., & Matanoski, G. M. (2009). Indoor charcoal smoke and acute respiratory infections in young children in the Dominican Republic. American journal of epidemiology, 169(5), 572-580.
Boerma, J. T., & Weir, S. S. (2005). Integrating demographic and epidemiological approaches to research on HIV/AIDS: the proximate-determinants framework. Journal of Infectious Diseases, 191(Supplement 1), S61-S67.
Bonjour, S., Adair-Rohani, H., Wolf, J., Bruce, N. G., Mehta, S., Pruss-Ustun, A., . . . Smith, K. R. (2013). Solid fuel use for household cooking: country and regional estimates for 1980-2010. Enviromental Health Perspective, 121(7), 784-790. doi: 10.1289/ehp.1205987
Borghi, J., Guinness, L., Ouedraogo, J., & Curtis, V. (2002). Is hygiene promotion cost‐effective? A case study in Burkina Faso. Tropical Medicine & International Health, 7(11), 960-969.
Boyle, M. H., Georgiades, K., Racine, Y., & Mustard, C. (2007). Neighborhood and family influences on educational attainment: Results from the Ontario Child Health Study Follow‐up 2001. Child development, 78(1), 168-189.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Bronfenbrenner, U. (1979). Contexts of child rearing: Problems and prospects. American Psychologist, 34(10), 844.
Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Mass: Harvard University Press.
Bronfenbrenner, U. (1994). Ecological models of human development. Readings on the development of children, 2, 37-43.
Bronfenbrenner U. (1994). Ecolological models of human development. In Bronfenbrenner U. (Ed.), International encyclopedia of Education (2nd ed., pp. 37-43). Oxford: Elsevier.
Bruce, N., Perez-Padilla, R., & Albalak, R. (2000). Indoor air pollution in developing countries: a major environmental and public health challenge. Bulletin of the World Health Organization, 78(9), 1078-1092.
Cairncross, S. (2003). Editorial: Handwashing with soap–a new way to prevent ARIs? Tropical Medicine & International Health, 8(8), 677-679.
Cairncross, S., Blumenthal, U., Kolsky, P., Moraes, L., & Tayeh, A. (1996). The public and domestic domains in the transmission of
disease. Tropical Medicine and International Health, 1(1), 27-34.
Canagarajah, S., & Thomas, S. (2001). Poverty in a wealthy economy: the case of Nigeria. Journal of African Economies, 10(2), 143-173.
Chen, B., Hong, C., Pandey, M. R., & Smith, K. R. (1989). Indoor air pollution in developing countries. World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales, 43(3), 127-138.
Chiao, C. (2016). Community vulnerability and symptoms of acute respiratory infection among preschool age children in the Democratic Republic of Congo, Malawi and Nigeria: evidence from Demographic and Health Surveys. Journal of epidemiology and community health, jech-2015-206605.
Chiao, C., Mishra, V., & Sambisa, W. (2009). Individual-and community-level determinants of social acceptance of people living with HIV in Kenya: results from a national population-based survey. Health & place, 15(3), 742-750.
Crook, N., & Malaker, C. (1992). Child mortality in new industrial localities and opportunities for change: a survey in an Indian steel town. Health Transition Review, 165-176.
Curtis, N., Finn, A., & Pollard, A. J. (2010). Hot Topics in Infection and Immunity in Children VII: Springer New York.
Curtis, V., & Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious Diseases, 3(5), 275-281.
D'souza, R. M. (1997). Housing and environmental factors and their effects on the health of children in the slums of Karachi, Pakistan. Journal of biosocial science, 29(03), 271-281.
Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm: Institute for future studies.
Dalen, N., Nakitende, A. J., & Musisi, S. (2009). " They don't care what happens to us." The situation of double orphans heading households in Rakai District, Uganda. BMC Public Health, 9(1), 1.
Davis, K., & Blake, J. (1956). Social structure and fertility: An analytic framework. Economic development and cultural change, 211-235.
De Francisco, A., Morris, J., Hall, A., Schellenberg, J. A., & Greenwood, B. (1993). Risk factors for mortality from acute lower respiratory tract infections in young Gambian children. International journal of epidemiology, 22(6), 1174-1182.
Dietert, R. R., Etzel, R. A., Chen, D., Halonen, M., Holladay, S. D., Jarabek, A. M., . . . Smialowicz, R. J. (2000). Workshop to identify critical windows of exposure for children's health: immune and respiratory systems work group summary. Environmental health perspectives, 108(Suppl 3), 483.
Diez, R. (2002). A glossary for multilevel analysis. Journal of epidemiology and community health, 56(8), 588.
Dlamini, B. N., & Chiao, C. (2015). Closing the health gap in a generation: exploring the association between household characteristics and schooling status among orphans and vulnerable children in Swaziland. AIDS care(ahead-of-print), 1-10.
Dongre, A. R., Deshmukh, P. R., & Garg, B. S. (2010). Health expenditure and care seeking on acute child morbidities in peri-urban Wardha: a prospective study. The Indian Journal of Pediatrics, 77(5), 503-507.
Erubami, M., & Young, I. (2003). Nigerian social and economic inequality in its global context. CHRRD Research Review(2).
Evans, G. W., & Kantrowitz, E. (2002). Socioeconomic status and health: the potential role of environmental risk exposure. Annual review of public health, 23(1), 303-331.
Ezeh, O. K., Agho, K. E., Dibley, M. J., Hall, J. J., & Page, A. N. (2014). The effect of solid fuel use on childhood mortality in Nigeria: evidence from the 2013 cross-sectional household survey. Environmental Health, 13(1), 113.
Ezzati, M., & Kammen, D. M. (2001). Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study. The Lancet, 358(9282), 619-624.
Favin, M. Y., May Bendahmane, Diane. (1999 ). Behavior first: a minimum package of environmental health behaviors to improve child health. In EHP Applied Study (Vol. 10). AID. EHP Applied Study (Vol. 10): AID.
Feachem, R., Mara, D. D., & Bradley, D. J. (1983). Sanitation and disease: John Wiley & Sons Washington DC, USA.
Feigin, R. D., & Cherry, J. D. (1998). Textbook of pediatric infectious diseases: Volume 1: WB saunders.
Fort, A. L., Kothari, M. T., & Abderrahim, N. (2008). Association between maternal birth and newborn characteristics and neonatal mortality in five Asian countries.
Fullerton, D. G., Bruce, N., & Gordon, S. B. (2008). Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(9), 843-851.
Gall, E. T., Carter, E. M., Matt Earnest, C., & Stephens, B. (2013). Indoor air pollution in developing countries: research and implementation needs for improvements in global public health. American journal of public health, 103(4), e67-e72.
Gee, G. C., & Payne-Sturges, D. C. (2004). Environmental health disparities: a framework integrating psychosocial and environmental concepts. Environmental health perspectives, 1645-1653.
Global Adult Tobacco Survey: Country Report. (2012). The Global Adult Tobacco Survey. In G. N. Report (Ed.).
Gordon, S. B., Bruce, N. G., Grigg, J., Hibberd, P. L., Kurmi, O. P., Lam, K.-b. H., . . . Balmes, J. (2014). Respiratory risks from household air pollution in low and middle income countries. The Lancet Respiratory Medicine, 2(10), 823-860.
Gwaltney, J. M., Moskalski, P. B., & Hendley, J. O. (1978). Hand-to-hand transmission of rhinovirus colds. Annals of Internal Medicine, 88(4), 463-467.
Harttgen, K., & Misselhorn, M. (2006). A multilevel approach to explain child mortality and undernutrition in South Asia and Sub-Saharan Africa: Discussion papers//Ibero America Institute for Economic Research.
Hendley, J. O., Wenzel, R. P., & Gwaltney Jr, J. M. (1973). Transmission of rhinovirus colds by self-inoculation. New England Journal of Medicine, 288(26), 1361-1364.
Hosseinpoor, A. R., Mohammad, K., Majdzadeh, R., Naghavi, M., Abolhassani, F., Sousa, A., . . . Vega, J. (2005). Socioeconomic inequality in infant mortality in Iran and across its provinces. Bulletin of the World Health Organization, 83(11), 837-844.
Inter-agency Group for Child Mortality Estimation (UN IGME). (2015). Levels & Trends in Child Mortality Report 2015, . United Nations Children's Fund (UNICEF): United Nations Children's Fund (UNICEF).
International Centre for Energy Environment and Development. Prospects of clean cookstoves, by stakeholders. Retrieved from http://www.iceednigeria.org/news/prospects-of-clean-cookstoves-by-stakeholders/.
International Vaccine Access Center (IVAC). (2015). Pneumonia and diarrhea progress report 2015:sustainable Progress in
the Post-2015 Era., 42. http://www.jhsph.edu/research/centers-and-institutes/ivac/resources/IVAC-2015-Pneumonia-Diarrhea-Progress-Report.pdf
Isaacs, D., Dickson, H., O'Callaghan, C., Sheaves, R., Winter, A., & Moxon, E. R. (1991). Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus. Archives of disease in childhood, 66(2), 227-231.
IVAC, I. V. A. C. (2015). Pneumonia and Diarrhea Progress Report 2015. Johns Hopkins Bloomberg School of Public Health

IVAC, I. V. A. C. (2016). Pneumonia and Diarrhea Progress Report 2016. Johns Hopkins Bloomberg School of Public Health

Jamison, D. T., Breman, J. G., Measham, A. R., Alleyne, G., Claeson, M., Evans, D. B., . . . Musgrove, P. (2006). Disease control priorities in developing countries: World Bank Publications.
Jamison, D. T., Summers, L. H., Alleyne, G., Arrow, K. J., Berkley, S., Binagwaho, A., . . . Yamey, G. (2013). Global health 2035: a world converging within a generation. The Lancet, 382(9908), 1898-1955. doi: 10.1016/s0140-6736(13)62105-4
Jones, G., Steketee, R. W., Black, R. E., Bhutta, Z. A., Morris, S. S., & Group, B. C. S. S. (2003). How many child deaths can we prevent this year? The lancet, 362(9377), 65-71.
Kalipeni, E. (2000). Health and disease in southern Africa: a comparative and vulnerability perspective. Social Science & Medicine, 50(7), 965-983.
Kamath, K., Feldman, R., SUNDAR, P. R., & Webb, J. (1969). Infection and disease in a group of south Indian families. General morbidity patterns in families and family members. American Journal of Epidemiology, 89(4), 375-383.
Kandala, N.-B., Ji, C., Stallard, N., Stranges, S., & Cappuccio, F. P. (2007). Spatial analysis of risk factors for childhood morbidity in Nigeria. The American journal of tropical medicine and hygiene, 77(4), 770-779.
Kandala, N.-B., Ji, C., Stallard, N., Stranges, S., & Cappuccio, F. P. (2008). Morbidity from diarrhoea, cough and fever among young children in Nigeria. Annals of Tropical Medicine & Parasitology, 102(5), 427-445.
Kawachi, I., & Berkman, L. F. (2003). Neighborhoods and Health: Oxford University Press.
Kawachi, I., & Subramanian, S. (2007). Neighbourhood influences on health. Journal of epidemiology and community health, 61(1), 3-4.
Kilabuko, J. H., & Nakai, S. (2007). Effects of cooking fuels on acute respiratory infections in children in Tanzania. International journal of environmental research and public health, 4(4), 283-288.
Kirby, J. B., & Kaneda, T. (2005). Neighborhood socioeconomic disadvantage and access to health care. Journal of Health and Social Behavior, 46(1), 15-31.
Krieger, N. (2008). Proximal, distal, and the politics of causation: what's level got to do with it? American journal of public health, 98(2), 221-230.
Kurmi, O. P., Lam, K. B., & Ayres, J. G. (2012). Indoor air pollution and the lung in low- and medium-income countries. Eur Respir J, 40(1), 239-254. doi: 10.1183/09031936.00190211
Labonte, R., Polanyi, M., Muhajarine, N., Mcintosh, T., & Williams, A. (2005). Beyond the divides: Towards critical population health research. Critical Public Health, 15(1), 5-17.
Landrigan, P. J., & Etzel, R. A. (2013). Textbook of Children's Environmental Health: OUP USA.
Lang, T., Lafaix, C., Fassin, D., Arnaut, I., Salmon, B., Baudon, D., & Ezekiel, J. (1986). Acute respiratory infections: a longitudinal study of 151 children in Burkina-Faso. International Journal of Epidemiology, 15(4), 553-560.
Lawoyin, T. (2001). Risk factors for infant mortality in a rural community in Nigeria. The journal of the Royal Society for the Promotion of Health, 121(2), 114-118.
Li, J. S., Peat, J. K., Xuan, W., & Berry, G. (1999). Meta‐analysis on the association between environmental tobacco smoke (ETS) exposure and the prevalence of lower respiratory tract infection in early childhood. Pediatric pulmonology, 27(1), 5-13.
Lim, W. S. (2012). Acute Respiratory Infections: OUP Oxford.
Liu, L., Johnson, H. L., Cousens, S., Perin, J., Scott, S., Lawn, J. E., . . . Black, R. E. (2012). Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The Lancet, 379(9832), 2151-2161. doi: 10.1016/s0140-6736(12)60560-1
Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., . . . Black, R. E. (2015). Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet, 385(9966), 430-440. doi: 10.1016/s0140-6736(14)61698-6
Loughnan, L. C., Ram, P. K., & Luyendijk, R. (2015). Measurement of handwashing behaviour in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 1985–2008. Waterlines, 34(4), 296-313.
Luby, S. P., Agboatwalla, M., Feikin, D. R., Painter, J., Billhimer, W., Altaf, A., & Hoekstra, R. M. (2005). Effect of handwashing on child health: a randomised controlled trial. The Lancet, 366(9481), 225-233.
Lumley, T. (2004). Analysis of complex survey samples. Journal of Statistical Software, 9(1), 1-19.
Lynch, J., & Kaplan, G. (2000). Socioeconomic position: Social Epidemiology. New York: Oxford University Press.
Lynch, J. W., Smith, G. D., Kaplan, G. A., & House, J. S. (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ: British Medical Journal, 320(7243), 1200.
Macintyre, S., Ellaway, A., & Cummins, S. (2002). Place effects on health: how can we conceptualise, operationalise and measure them? Social science & medicine, 55(1), 125-139.
Mackay, J., Shafey, O., & American Cancer Society (2009). The Tobacco Atlas ((3rd ed., completely rev. and updated). ed.). American Cancer Society, Atlanta, Ga: American Cancer Society, Incorporated.
Madu, I. A. (2006). Spatial inequality in Nigeria: The imperative of geographic perspectives in the development process. Journal of Social and Economic Development, 8(2), 105.
Makris, A. T., Morgan, L., Gaber, D. J., Richter, A., & Rubino, J. R. (2000). Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. American journal of infection control, 28(1), 3-7.
Margolis, P. A., Greenberg, R., Keyes, L. L., LaVange, L. M., Chapman, R. S., Denny, F. W., . . . Boat, B. W. (1992). Lower respiratory illness in infants and low socioeconomic status. American journal of public health, 82(8), 1119-1126.
Marmot, M. (2010). Fair society, healthy lives : the Marmot Review : strategic review of health inequalities in England post-2010.
Marmot, M., & Bobak, M. (2000). International comparators and poverty and health in Europe. British medical journal, 321(7269), 1124.
Marmot, M., & Wilkinson, R. (2005). Social Determinants of Health: OUP Oxford.
Marmot, M. G., Kogevinas, M., & Elston, M. A. (1991). Socioeconomic status and disease. WHO Reg Publ Eur Ser, 37, 113-146.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377.
Merlo, J., Chaix, B., Yang, M., Lynch, J., & Rastam, L. (2005). A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Community Health, 59(6), 443-449. doi: 10.1136/jech.2004.023473
Mishra, V. (2003). Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe. International journal of epidemiology, 32(5), 847-853. doi: 10.1093/ije/dyg240
Mishra, V., Smith, K. R., & Retherford, R. D. (2005). Effects of cooking smoke and environmental tobacco smoke on acute respiratory infections in young Indian children. Population and Environment, 26(5), 375-396.
Mishra, V. K., & Retherford, R. D. (1997). Cooking smoke increases the risk of acute respiratory infection in children. National Family Health Survey Bulletin(8), 1-4.
Moeller, D. W. (2011). Environmental Health: Harvard University Press.
Mosley, W. H., & Chen, L. C. (1984). An analytical framework for the study of child survival in developing countries. Population and development review, 25-45.
Moya, J., Bearer, C. F., & Etzel, R. A. (2004). Children’s behavior and physiology and how it affects exposure to environmental contaminants. Pediatrics, 113(Supplement 3), 996-1006.
National Population Commission Federal Republic of Nigeria. (2003). Final report on Nigeria Demographic and Health Survey. Calverton, Maryland, USA: ORC Macro.
National Population Commission Federal Republic of Nigeria. (2013). Final report on Nigeria Demographic and Health Survey. Rockville, Maryland, USA: ICF International; .
Nigeria Demographic and Health Survey. (2003). Final Report. Abuja, Nigeria. Retrieved from http://www.unicef.org/nigeria/ng_publications_Nigeria_DHS_2008_Final_Report.pdf.
Nigeria Demographic and Health Survey. (2008). Final Report. Abuja, Nigeria. Retrieved from http://www.unicef.org/nigeria/ng_publications_Nigeria_DHS_2008_Final_Report.pdf.
Nigeria Demographic and Health Survey. (2013). Final Report. Abuja, Nigeria. Retrieved from http://dhsprogram.com/publications/publication-fr293-dhs-final-reports.cfm.
Nigeria National Population Commission. (2003). Nigeria Demographic and Health Survey Preliminary Report, DHS Preliminary Reports. Calverton, MD: ICF International.
Nigeria National Population Commission. (2008). Nigeria Demographic and Health Survey Preliminary Report, DHS Preliminary Reports. Calverton, MD: ICF International.
Nigeria National Population Commission. (2013). Nigeria Demographic and Health Survey Preliminary Report, DHS Preliminary Reports. Calverton, MD: ICF International.
Nigeria National Population Commission. (2016). Trends in Child Health in Nigeria, 2003-2013 DHS Further Analysis Reports No. 103. Calverton, MD: ICF International.
Olaniyan, O., & Lawanson, A. O. (2010). Health expenditure and health status in Northern and Southern Nigeria: a comparative analysis using NHA framework. Paper presented at the CSAE conference held at St Catherine College, University of Oxford, Oxford, UK. Available online at www. csae. ox. ac. uk/conferences/2010-EDiA/.../451-Lawanson.
Ologunorisa, T., & Tamuno, T. (2003). Spatial and seasonal variations of sandstorms over Nigeria. Theoretical and applied climatology, 75(1-2), 55-63.
Ologunorisa, T. E. (2001). A review of the effects of gas flaring on the Niger Delta environment. The International Journal of Sustainable Development & World Ecology, 8(3), 249-255.
OWUSU BOADI, K., & KUITUNEN, M. (2006). Factors affecting the choice of cooking fuel, cooking place and respiratory health in the Accra metropolitan area, Ghana. Journal of biosocial science, 38(03), 403-412.
Oxford Poverty and Human Development Initiative. (2015). Human Development Initiative (OPHI)(2015). Country Briefing-India: Mulfi Dimension Poverty Index at a Glance.
Oyejide, C., & Osinusi, K. (1990). Acute respiratory tract infection in children in Idikan community, Ibadan, Nigeria: severity, risk factors, and frequency of occurrence. Review of Infectious Diseases, 12(Supplement 8), S1042-SI1046.
Pande, J. (2000). Respiratory medicine in the tropics: Oxford university press.
Pandey, M., Neupane, R., Gautam, A., & Shrestha, I. (1989). Domestic smoke pollution and acute respiratory infections in a rural community of the hill region of Nepal. Environment International, 15(1), 337-340.
Pant, P. D. (1991). Effect of education and household characteristics on infant and child mortality in urban Nepal. Journal of biosocial science, 23(04), 437-443.
Perez-Padilla, R., Schilmann, A., & Riojas-Rodriguez, H. (2010). Respiratory health effects of indoor air pollution [Review article]. The International Journal of Tuberculosis and Lung Disease, 14(9), 1079-1086.
Po, J. Y., FitzGerald, J. M., & Carlsten, C. (2011). Respiratory disease associated with solid biomass fuel exposure in rural women and children: systematic review and meta-analysis. Thorax, 66(3), 232-239.
Putnam, S., & Galea, S. (2008). Epidemiology and the macrosocial determinants of health. Journal of public health policy, 29(3), 275-289.
Rabe-Hesketh, S., & Skrondal, A. (2008). Multilevel and Longitudinal Modeling Using Stata, Second Edition: Stata Press.
Rabie, T., & Curtis, V. (2006). Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health, 11(3), 258-267. doi: 10.1111/j.1365-3156.2006.01568.x
Rehfuess, E. (2006). Fuel for life: household energy and health.
Rehfuess, E., Mehta, S., & Prüss-Üstün, A. (2006). Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals. Environmental health perspectives, 114(3), 373-378. doi: 10.1289/ehp.8603
Robert, J., Geller,, Leslie., R., & Novdin, J. (2006). Safe and Healthy School Environments: Oxford University Press, USA.
Roux, A. V. D., Merkin, S. S., Arnett, D., Chambless, L., Massing, M., Nieto, F. J., . . . Watson, R. L. (2001). Neighborhood of residence and incidence of coronary heart disease. New England Journal of Medicine, 345(2), 99-106.
Rutstein, S. O., & Johnson, K. (2004). The DHS wealth index DHS Comparative Reports No. 6. Calverton, Maryland, USA: ORC Macro.
Sastry, N. (1996). Community characteristics, individual and household attributes, and child survival in Brazil. Demography, 33(2), 211-229.
Sellström, E., & Bremberg, S. (2006). Review Article: The significance of neighbourhood context to child and adolescent health and well-being: A systematic review of multilevel studies. Scandinavian journal of public health, 34(5), 544-554.
Shibata, T., Wilson, J. L., Watson, L. M., LeDuc, A., Meng, C., La Ane, R., . . . Maidin, A. (2014). Childhood acute respiratory infections and household environment in an Eastern Indonesian urban setting. International journal of environmental research and public health, 11(12), 12190-12203.
Siddiqi, A., Irwin, L. G., & Hertzman, C. (2007). Total environment assessment model for early child development. Evidence Report for the World Health Organization’s Commission on the Social Determinants of Health, OMS.
Smith, K. R., Samet, J. M., Romieu, I., & Bruce, N. (2000). Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax, 55(6), 518-532.
Sonego, M., Pellegrin, M. C., Becker, G., & Lazzerini, M. (2015). Risk Factors for Mortality from Acute Lower Respiratory Infections (ALRI) in Children under Five Years of Age in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies. PLoS ONE, 10(1).
Spengler, J. D., & Sexton, K. (1983). Indoor air pollution: a public health perspective. Science, 221(4605), 9-17.
Stanton, B. F., & Clemens, J. D. (1987). An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea. American Journal of Epidemiology, 125(2), 292-301.
StataCorp. (2013). Stata Statistical Software Release 13.0. College Station: Texas.: Stata Corporation.
Strachan, D. P., & Cook, D. G. (1997). Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood. Thorax, 52(10), 905-914.
THE WORLD BANK. (2015). Nigeria Mortality rate, under-5 (per 1,000). http://data.worldbank.org/indicator/SH.DYN.MORT
Torres-Duque, C., Maldonado, D., Perez-Padilla, R., Ezzati, M., Viegi, G., & Forum of International Respiratory Studies Task Force on Health Effects of Biomass, E. (2008). Biomass fuels and respiratory diseases: a review of the evidence. Proc Am Thorac Soc, 5(5), 577-590. doi: 10.1513/pats.200707-100RP
UNICEF, & World Health Organization. (2013). Ending preventable child deaths from pneumonia and diarrhoea by 2025: the integrated global action plan for pneumonia and diarrhoea (GAPPD): World Health Organization.
United Nations Children’s Fund (UNICEF). (2015). Commiting to Child Survival: A Promise Renewed Progress report 2015, 99. http://www.apromiserenewed.org/wp-content/uploads/2015/09/APR_2015_8_Sep_15.pdf
United States Agency for International Development (USAID). (2012). Demographic and Health Survey Sampling and Household Listing Manual, 109. http://www.dhsprogram.com/pubs/pdf/DHSM4/DHS6_Sampling_Manual_Sept2012_DHSM4.pdf
Van Norren, B., Boerma, J. T., & Sempebwa, E. K. (1989). Simplifying the evaluation of primary health care programmes. Social Science & Medicine, 28(10), 1091-1097.
van Norren, B., & van Vianen, H. (1986). The malnutrition-infections syndrome and its demographic outcome in developing countries: a new model and its application.
Victora, C. G., Smith, P., Vaughan, J., Nobre, L., Lombard, C., Teixeira, A., . . . Barros, F. (1988). Water supply, sanitation and housing in relation to the risk of infant mortality from diarrhoea. International journal of epidemiology, 17(3), 651-654.
Victora, C. G., Wagstaff, A., Schellenberg, J. A., Gwatkin, D., Claeson, M., & Habicht, J.-P. (2003). Applying an equity lens to child health and mortality: more of the same is not enough. The Lancet, 362(9379), 233-241.
Wagstaff, A., & Doorslaer, E. v. (2004). Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations. Health Econ, 13(3), 297-301. doi: 10.1002/hec.822
Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., . . . Black, R. E. (2013). Global burden of childhood pneumonia and diarrhoea. The Lancet, 381(9875), 1405-1416. doi: 10.1016/s0140-6736(13)60222-6
Wall, L. L. (1998). Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria. Studies in family planning, 341-359.
Wardlaw, T. M., Johansson, E. W., & Hodge, M. J. (2006). Pneumonia: the forgotten killer of children: UNICEF.
Watts, H., Gregson, S., Saito, S., Lopman, B., Beasley, M., & Monasch, R. (2007). Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe. Tropical Medicine & International Health, 12(5), 584-593.
Weber, M. W., Mulholland, E. K., & Greenwood, B. M. (1998). Respiratory syncytial virus infection in tropical and developing countries. Tropical Medicine & International Health, 3(4), 268-280.
WHO and United Nations Environment Programme. (2016). BreatheLife air pollution campaign.
Wilkinson, R. G. (2002). Unhealthy societies: the afflictions of inequality: Routledge.
Woldemicael, G. (2000). The effects of water supply and sanitation on childhood mortality in urban Eritrea. Journal of biosocial science, 32(02), 207-227.
World Health Organisation. (2015). Global Health Observatory (GHO) data; Child mortality and causes of death. http://www.who.int/gho/child_health/mortality/mortality_under_five_text/en/
World Health Organisation/United Nations Children's Fund. (2012). Countdown to 2015: Maternal, Newborn & Child Survival. http://www.countdown2015mnch.org/documents/2012Report/2012-part-1.pdf
World Health Organization. (2005). Effects of air pollution on children's health and development: a review of the evidence.
World Health Organization. (2007). Indoor air pollution: national burden of disease estimates.
World Health Organization, & UNICEF. (2013). Ending preventable child deaths from pneumonia and diarrhoea by 2025: the integrated global action plan for pneumonia and diarrhoea (GAPPD).
Worrall, G. (2006). There's a Lot of it about: Acute Respiratory Infections in Primary Care: Radcliffe Publishing.
角井, & 信弘. (2002). The prevalence of acute respiratory infections and the associated risk factors: a study of children under five years of age in Kibera Lindi village, Nairobi, Kenya. J. Natl. Inst. Public Health, 51, 1.