The current study aimed at evaluating the prevalence of, and risk factors associated with, AR in rural Ethiopia based on the Ethiopian Demographic and Health Survey data. In the study overall prevalence of ARI was found to be 7.8%. Our findings are comparable to those of a study conducted by
in Zambia, where the prevalence of ARI was reported to be 8% and 6.9% in Iraq by . In contrast to our findings, a study conducted in New Delhi slums estimated the overall prevalence of ARI among children under the age of five to be around 4.5 % for one month
. ARI affected 21.3 % of Bangladeshi children under the age of five in the two weeks before the survey . Differences in study populations, study sites, age categories investigated, the method used to assess the outcome variable, comorbidities, and variations in the study period and season could all contribute to the variation in ARI proportions.
The study showed that there is an enormous disparity in the distribution of ARIs in children across the different regional states of rural Ethiopia. According to the descriptive data analysis, the highest prevalence of ARI occurred in rural Oromia and rural Tigray at 12.8% and 12.7% respectively and the lowest, 2.4%, in rural Benishangul Gumuz region. It is in line with [34, 35]. There could be numerous reasons for the regional variations in illness distributions; high-risk areas for ARI were found in the northern and central parts of the country, particularly rural Tigray and rural Oromia. These were highland areas, implying a high prevalence of ARI among children under the age of five. Children are indoors for longer periods when the weather is cold, putting them in close contact with a variety of bacteria, fungi, and viruses. When the temperature drops, flu, viruses, and bacteria are more likely to remain stable in the air, forming respiratory droplets and causing damage to the airways, allowing bacteria to cause infections, most commonly ARI in the lungs. Another reason could be that many of the children in these areas were under the age of one year, and the majority of households in these areas relied on charcoal and cow dung as a source of fuel.
In this study, age of the child, wealth index of household, maternal education, received vitamin A supplement, had diarrhea recently, stunting, maternal occupation, source of drinking water, anemia status, the month of data collection, and region of the residence were found to be significantly associated with ARI symptoms. Children aged 48–59 months have a lower risk of developing ARI symptoms. This finding is consistent with studies undertaken in Ahmadabad city and other low- and middle-income nations
. The prevalence of ARI is particularly common among children aged 6–36 months, according to studies conducted in the People's Republic of China and South India [38, 39]. Compared to a child more than 48 months, the chances of the child at the earlier age experiencing acute respiratory infection symptoms are higher. It is obvious that as a child grows older, he or she will have greater resistance to diseases such as cough and diarrhea
. Because children's immunity develops as they grow older, they are more prepared to battle infection.
Children from the poorest families are more likely to contract ARI than those from wealthier households. These findings are supported by the study done in Bangladesh, residence in poor households conferred 1.3 times (95% CI 1.09–1.55) higher odds of ARI in young children . Under-five children those whose family were from the low socio-economic class was also significantly associated with ARI [40, 41, 42, 43]. This is due to wealthier households tend to afford better nourishment and health care for their children. Wealthier families can also minimize their children’s exposure to risk factors like unsanitary environments and contaminated water . These findings are supported by other studies which found that higher poverty levels increase the risk of ARI and diarrhea
Children whose mothers have no or only a primary education have a much higher risk of ARI than children whose mothers have a secondary or higher degree of education. This statement is consistent with earlier findings [47, 14]. This could be because education has improved mothers' ability to apply basic health knowledge and has facilitated their ability to manipulate their environment, including health care facilities, work more effectively with health professionals, follow treatment recommendations, and keep their environment clean. Furthermore, educated mothers have more power over their children's health decisions.
Children with stunted were shown to have a greater prevalence of ARI. This finding is also in line with studies conducted in India, specifically in Solapur and Gujarat, Ethiopia, and other developing countries [48, 36, 49, 43, 22, 39, 50]. This finding indicates that malnourished children have inadequate immunity and are susceptible to a variety of diseases, including ARI.
A kids who had not recently received vitamin A was 92.6 % more likely to develop ARI than a child who had recently received vitamin A. Promoting Vitamin A supplementation for all rural children could improve their health. Several studies backed up our conclusions
In this study, under-five children from rural areas with a history of diarrhea were more affected by ARI. This research backed up a study conducted in northeast Ethiopia's Oromia zone, which found that children with a history of diarrhea were three times more likely to get ARI than their peers
. Similar studies have been carried out in southwest Ethiopia and Ghana
. In addition, a study done in Bangladeshi found that children with a history of diarrhea were more likely to develop ARI . The reason is children who have a concomitant illness like diarrhea may have a lowered immunity, making them more susceptible to a disease like ARI. The reason for this is that children with a comorbid ailment, such as diarrhea, anemia may have decreased immunity, making them more vulnerable to diseases like ARI.
In rural Ethiopia, the source of drinking water is another key environmental element that influences the ARI of children under the age of five. This study found that children who drink water from an unprotected/unimproved source are more likely to have ARI symptoms than children who drink water from a protected/improved source. This result was supported by
. This was due to the fact that contaminated water was thought to be the leading cause of acute respiratory infection.
Mother’s occupation was found to be a significant factor of ARIs. Compared to children of mothers currently working those children whose mothers have no work in any sectors have a significantly lower risk of ARI. This means mothers to stays at home may keep their child in a good and clear environment. This result was supported by [14, 34]. The other explanation might be that, mothers who had work could be exposed to certain chemicals, pollutants, or toxic fumes within the working environment, thereby transmitting the infection to their children may be increased. Furthermore, because the majority of mothers in developing countries like Ethiopia work in the informal sector and lower-status occupations, the amount of income for these mothers is low and would be a significant effect on ARIs of under five children.
The odds of the child suffering from ARI were higher in January. Because this study was carried out during the peak of the dry season which is characterized by dry and dusty harmattan winds. It is consistent with the previous study done by
[56, 57, 58]
. Anemia or low hemoglobin status has also been stated as one of the risk factors of ARI. This finding was consistent with the studies conducted by . Similar significance was also shown in other studies like
. Because most healthy children can fight infection with their natural defenses, children with impaired immune systems are more susceptible to infection. Anemia amplifies this effect by reducing the body's natural defenses. So, when the current study was compared to previous similar studies, there was a strong link between anemia and ARI. As a result, preventing anemia and detecting anemia early can help to lower the incidence of acute respiratory tract infection.
Finally, ARI among under-five children was a significant association with regions. It revealed that the probability of children living in rural Tigray, rural Amhara, rural Oromia, and rural SNNPR regions have higher ARI symptoms before two weeks preceding the survey than children who living in rural Dire Dawa regions. It is consistent with a previous study done by . While, the odds of children living in rural Somali, rural Benishangul-Gumuz, rural Gambela, and rural Afar, being have ARI symptoms before two weeks are significantly not different from those living in rural Dire Dawa.
Strengths and weaknesses of the study
A strength of this study was that it assessed many important determinant factors including socioeconomic status, maternal and child nutrition, environmental, health, and other factors contributing to ARI in a cross-sectional study design. This study's findings should help policymakers better grasp this rapidly evolving health hazard and adopt appropriate legislative steps. Aside from our significant contributions, our research contains a number of flaws. First, the symptoms of ARIs were reported by mothers and were not the result of clinical examinations. Because the variables were self-reported, they are prone to reporting bias. Second, no data on household hygiene practices, which is a critical predictor of infectious diseases in people of all ages, was available. However, this gap is expected to be overcome, to a great extent, by the inclusion of sanitation variables. Finally, because the data was secondary, no causal inferences regarding the correlations could be drawn. Therefore, the reader of this article should take into account the above barriers.