Trends in acute respiratory infection and associated factors among under-5 children in Ethiopia

TL;DR

This study examines changes in acute respiratory infections among children under five in Ethiopia from 2000 to 2016 and identifies factors linked to these infections.

Contribution

This is the first nationwide trend analysis of acute respiratory infections in Ethiopia over 16 years.

Findings

The national prevalence of ARI in under-5 children decreased from 11.50% in 2000 to 9.37% in 2016.

Children aged 24–35 months were less likely to develop ARI compared to those under 12 months.

Wasted children were more likely to develop ARI than non-wasted children.

Abstract

Acute respiratory infections (ARI) are the leading cause of death in children under five. In 2021, an estimated five million children died before turning five. Sub-Saharan Africa and South Asian countries bear burdens of 56% and 26% of the global mortality, respectively. However, studies regarding trends in the prevalence of ARI and its associated factors over a wide period are scarce. Hence, we aimed to assess the trends and factors associated with the prevalence of ARI in Ethiopia over the past 16 years.

We used the 2000, 2005, 2011, and 2016 EDHS datasets. We conducted a trend analysis of the past 16 years and applied a multilevel logistics regression analysis to identify the individual-, household- and cluster-level factors affecting ARI among under-5 children.

At the national level, the prevalence of ARI in under-5 children in Ethiopia fell from 11.50% in 2000 to 9.37% in 2016. However, the temporal trend in the prevalence of ARI per region showed inconsistent patterns. From 2011 to 2016, the Benishangul-Gumuz, Gambela, Somali, Afar, and Amhara regions and Dire Dawa city administration showed a reduction in ARI prevalence, whereas the remaining regions and Addis Ababa city administration showed an increase in ARI prevalence. Our model, with individual-, household- and cluster-level factors, was found to be the best fitting model for exploring ARI prevalence-affecting factors. Compared with children aged < 12 months, children aged 24–35 months were less likely to develop ARI (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [CI]: 0.59–0.79, p < 0.001). Children who were wasted were more likely to develop ARI than those who were not wasted, with an AOR of 1.18 (95% CI: 1.00–1.39, p = 0.04).

This study identified inconsistent trends in the prevalence of ARI at the regional level of Ethiopia from 2000 to 2016. To the best of our knowledge, this is the first nationwide trend analysis of ARI in Ethiopia. Further research is warranted to identify the reasons for the substantial differences in the temporal trend of ARI by region in Ethiopia.

The online version contains supplementary material available at 10.1186/s12887-025-06100-x.

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