Determinants of Acute Respiratory Infection Among Children in Ethiopia: A Multilevel Analysis from Ethiopian Demographic and Health Survey

Background: Acute respiratory infection (ARI) is one of the leading public health challenges among children in low- and middle-income countries. Child mortality due to ARI is disproportionately higher in African regions. In Ethiopia, an encouraging progress in the reduction of ARI was observed until 2010, however, since then the national prevalence is unchanged. There is limited information for the persistently higher prevalence of the infection. Therefore, the aim of this study was to determine regional variations and identify factors associated with the infection. Methods: This study used data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016. The analysis used information from 10,006 children. A two-level logistic regression analysis was used to consider the cluster random effect. Results: Out of 10,006 children included, 15.9%, 8.9%, and 8.8% reported cough, short rapid breaths, and chest complaint respectively two weeks before the survey, making the overall prevalence of ARI 8.8%. Children aged six to 11 years (adjusted odds ratio (AOR)=1.466, 95% CI: 1.143-1.881), and 12 to 23 (AOR=1.390, 95%CI: 1.109-1.742), small birth size (AOR=1.387, 95%CI), and animal dung as cooking fuel (AOR=1.904, 95%CI: 1.152-3.146) are significantly associated with higher odds of ARI in the final multilevel modeling. The AOR (95%CI) for ARI for differing levels of altitude were: 1000 to 2000, 1.805 (1.403-2.483); 2000 to 3000, 1.882 (1.427-2.483); above 3000, 2.24 (1.023-4.907). Conclusion: ARI is still a significant public health problem in Ethiopia among children underfive, with a huge variation in the burden across the regional states. Age of children, birth size, household cooking fuel, and altitude above sea level were important variables. Therefore, regional governments, health-care workers and concerned organizations should give emphasis to minimize ARI and the consequences associated with the disease.