Prevalence and associated risk factors of acute respiratory tract infections among under-five children in a tertiary hospital in Nigeria.

BACKGROUND: Acute respiratory tract infections (ARIs) remain a significant public health concern, contributing to childhood morbidity and mortality, particularly in low- and middle-income countries. This study aimed to determine the prevalence of ARI and identify associated risk factors, including home environmental exposures, among under-five children receiving care at a tertiary hospital in Nigeria. METHODS: A hospital-based cross-sectional study was conducted from August to November 2022 in the Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. A total of 251 children aged 2-59 months with ARI, diagnosed using Integrated Management of Childhood Illness (IMCI)/WHO criteria, were enrolled via systematic sampling. Inclusion required informed consent and caregiver reliability in reporting home conditions. Children were excluded if their caregivers could not provide environmental information or if ARI diagnosis was not confirmed. Data were collected through structured questionnaires and analyzed using SPSS v23. Descriptive statistics, chi-square tests, and multivariable logistic regression were applied to identify independent predictors (p < 0.05). RESULTS: The prevalence of ARI was 17.0% (95% CI: 12.8-21.9%). Significant associations were observed between ARI and several environmental factors, including type of cooking fuel, toilet facility, water supply, ventilation, kitchen location, and indoor kerosene lamp use (all p < 0.05). Socio-demographic factors such as socioeconomic status, parental education, maternal age, and household size, as well as child-related factors including age, low birth weight, breastfeeding practices, immunization status, daycare attendance, and comorbidities, were also significantly linked with ARI (p < 0.05). Independent predictors of ARI included indoor smoking (aOR = 4.34, p = 0.023), inbuilt kitchen location (aOR = 4.51, p = 0.034), unimproved water supply (aOR = 4.59, p = 0.025), poor ventilation (aOR = 3.78, p = 0.026), unimproved toilet facilities (aOR = 15.32, p = 0.007), and indoor mosquito coil use (aOR = 8.44, p = 0.024). CONCLUSION: This study highlights a high prevalence of ARI among U5, linked to modifiable household and environmental factors. Families should be encouraged to use clean cooking fuels, improve ventilation, and reduce indoor pollutants like mosquito coils and tobacco smoke. These findings support community education and further research to guide effective, child-focused public health interventions.