Water Facility Type and Acute Respiratory Infections in Under-Five Children: Insights From a Hospital-Based Case-Control Study.

Background and Aims: When predicting the risk of childhood acute respiratory infections (ARI) among under-five children, categorizing drinking water sources remains controversial in Bangladesh. The study aimed to assess the impact of main two drinking water sources on childhood ARI status. Methods: From January to April 2023, a hospital-based case-control study was carried out involving 216 cases and 216 controls among under-five children in Dhaka, Bangladesh. Children with ARI symptoms were considered as cases, while controls were without ARI symptoms. Piped water sources were categorized as improved sources, while tube well/boreholes as unimproved. Bivariate and multivariate logistic regression were performed to assess the relationship between two different water source categories and childhood ARI status. Results: Around 57% of households with cases had access to improved water sources while for controls it was 68.1%. Households with improved water sources had a 51% lower risk of having under-five children with ARIs (AOR: 0.5, 95% CI: 0.3-1.0, p = 0.039). Prematurity (AOR: 1.8, 95% CI: 1.1-3.0, p = 0.025), delayed initiation of breastfeeding (AOR: 3.0, 95% CI:1.8-4.8, p < 0.001), exposed to in-house smoking (AOR: 3.0, 95% CI: 1.9-5.0, p < 0.001) were associated with increased risk of childhood ARI. Older children had a lower risk of having ARI than infants. Conclusion: Piped drinking water sources are associated with a lower risk of ARI among under-five children in Bangladesh. Water purification practices may act as a protective mechanism against ARI in households with piped water sources. Water supply infrastructure and behavioral strategies programs in areas with unimproved water sources could reduce the burden of ARI.