Acute Lower Respiratory Tract Infections and Associated Factors Among Under-five Children Visiting Wolaita Sodo University Teaching and Referral Hospital: A Cross-sectional Study

Acute Lower Respiratory Tract Infections and Associated Factors Among Under-five Children Visiting Wolaita Sodo University Teaching and Referral Hospital: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Acute Lower Respiratory Tract Infections and Associated Factors Among Under-five Children Visiting Wolaita Sodo University Teaching and Referral Hospital: A Cross-sectional Study Birhanu Wondimeneh Demissie, Esayas Aydiko Amele, Yibeltal Asmamaw Yitayew, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-73458/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Lower respiratory tract infections are a leading cause of morbidity and mortality worldwide, particularly in children younger than five years. Even if the burden of lower respiratory tract infections in children under-five years had decreased dramatically in the last ten years, it is still the main cause of morbidity and mortality in under five years old children in developing countries. So, this study was aimed to assess lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital. Methods: A cross-sectional study was conducted from April 1-30, 2019, among under-five children attended the Pediatrics outpatient department of Wolaita Sodo University Teaching and Referral Hospital. The data was collected using a semi-structured pre-tested interviewer guided questionnaire. Epi -info (version 7.1.2.0) was used for data entry, and Statistical Package for Social Sciences version 20 was used for analysis. Bivariate and multivariate logistic regression, crude and adjusted odds ratio with their 95% confidence interval were computed. Finally, p-value <0.05 was used to identify variables that had a significant association with acute lower respiratory tract infection. Result: The prevalence of acute lower respiratory tract infections among under-five children was 40.3% (95%CI: 35.7%- 44.9%). Unvaccinated children (AOR: 2, 95% CI, (1.27-3.16)), non-exclusive/replacement feeding (AOR: 1.85, 95% CI, (1.18-2.91)), households mainly used unclean fuel for cooking (AOR: 2.12, 95% CI, (1.07-4.19)), absence of separate kitchen (AOR: 1.7, 95% CI, (1.09-2.65)), and absence of window in the kitchen room (AOR: 1.69, 95% CI, (1.07-2.68)) showed significant association with acute lower respiratory tract infection. Conclusion: The prevalence of acute lower respiratory tract infections was 40.3%. Unvaccinated children, non-exclusive/replacement feeding, households mainly used unclean fuel for cooking, absence of a separate kitchen, and absence of window in the kitchen room showed significant association with acute lower respiratory tract infection. Therefore, special attention should be given for the environmental sanitation and family health component of the health extension packages. Pediatrics ALRTIs associated factors under-five WSUTRH Figures Figure 1 Figure 2 Introduction Acute lower respiratory tract infections (ALRTs) are any infections in the lungs or below the voice box, which include pneumonia, bronchitis, and bronchiolitis [ 1 ]. So far, pneumonia is the most common type of lower respiratory tract infection (LRTIs), and globally, 150 million new episodes of pneumonia are identified per year worldwide, and more than 90% of which occur in developing countries[ 2 , 3 ]. Viruses are the most common cause of pneumonia in infants and young children, and the most frequent symptoms and signs are coughs, increased respiratory rate, fever, breathing difficulty, runny nose, and chest wall indrawing in more severe disease [ 3 – 6 ]. Lower respiratory tract infections (LRTIs) are a leading cause of morbidity and mortality worldwide, particularly in children younger than five years[ 7 , 8 ]. Globally, LRTIs cause 704 000 deaths, and the highest under-five LRTI mortalities were in sub-Saharan Africa. Even if the burden of LRTIs in under five-children has decreased dramatically in the last ten years, it is still the main cause of death in developing countries [ 8 – 10 ]. Each year, more than 2 million under five-children died due to pneumonia in the developing world, and 43% of global under-five death of ALRTIs occurs in India, Nigeria, the Democratic Republic Congo and Ethiopia[ 11 ]. In Ethiopia in 2015, 25,970 under-five children were dead due to LRTIs, and 14,148.3 was caused by Pneumococcal pneumonia[ 8 ]. Different factors were identified for the increased risk of LRTIs in children. Of these, poverty, restricted family income, low parental education level, low birth weight, malnutrition, lack of breastfeeding, maternal literacy, smoking, cow dung use for fuel, low socio-demographic status, solid fuels for cooking and heating, immune impaired populations, improved toilet facilities, season, and residence [ 8 , 10 , 12 , 13 ]. Similarly, the risk of death from LRTIs will be determined by very severe pneumonia, age below two months, diagnosis of Pneumocystis Carinii, chronic underlying diseases including HIV/ AIDS, severe malnutrition, young maternal age, low maternal education, low socioeconomic status, second-hand smoke exposure, and indoor air pollution[ 14 ]. Widespread immunization against influenza, measles, bacilli Calmette-Guerin (BCG), and now pneumococcus have been related to the decline of the LRTIs in children [ 3 ]. Likewise, vaccines prevent an estimated 2.5 million deaths among children under five every year. Yet one child dies every 20 seconds from a disease that could have been prevented by a vaccine[ 15 ]. Ethiopian children suffer four to eight episodes of ARTI on average every year, with the highest occurrence in urban areas in overcrowded living conditions[ 7 ]. In Ethiopia, only 39% received all vaccinations at some time, and 22% were vaccinated by the appropriate age [ 16 ]. This low immunization coverage will result in an increased risk of LRTIs morbidity and mortality. Even if Ethiopia has achieved millennium development goals (MDG) 4 by 2013, LRIs are one of the most common causes of under-five children mortality [ 17 ]. Therefore, to achieve the sustainable development goal (SDG) 3 of ending preventable deaths of new-borns and under-five children by 2030, efforts to reduce deaths due to lower respiratory tract infection should remain a top priority[ 18 , 19 ]. So this study was aimed to assess lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital (WSUTRH), 2019. Methods Study design, area and period An institution-based cross-sectional study was conducted from April 1–30, 2019, at Wolaita Sodo University Teaching and Referral Hospital (WSUTRH). Wolaita Sodo University Teaching and Referral Hospital is found at Sodo town, which is located 157 Km from the regional capital city, Hawassa, and 327 Km from the capital city of Ethiopia, Addis Ababa. According to the Wolaita Zone Health Department information 2019, the estimated population of Wolaita Zone is about 2,020,386 from this, about 983,991 are males, and 1,030,396 are females. The hospital gives service to nearly 3 million peoples in the catchment area, had 350 inpatient beds, and 450–500 patients visited the hospital per-day[ 20 ]. Populations Source population All under five children/mother or caretaker pair visiting WSUTRH pediatric outpatient department (OPD) Study population Randomly selected under five-children/mother or caretaker pair visited WSUTRH pediatric outpatient department (OPD) from April 1–30, 2019 Sample size determination and procedure The sample size was calculated using a single population proportion formula with the assumption of 50% under-five prevalence of ALRTIs to get the largest sample size, with a 95% confidence interval and 5% marginal error. The sample size calculated as follows; N i = (Z ɑ /2 ) 2 × p (1 – p)/W 2 N i = (1.96) 2 × (0.5) × (0.5)/ (0.0025) = 384 Where : n i = initial sample size ɑ = confidence interval p = prevalence LRIs W = margin of error By considering a 10% none response rate, the final sample size was 422 child/mother pairs. The estimated number of child/mother or care taker pair visited under five OPD in the study period was 1050 based on the last six months of patient flow. Then participants were selected using a systematic random sampling technique (k = 2) until the required sample size was obtained. Data collection instrument A face-to-face interview was conducted using a structured questionnaire that was adopted and modified from previous researches [ 21 – 27 ]. The questionnaire comprises socio-demographic factors, maternal and child factors, environmental factors, and the outcome variable (ALRTIs). Length board (< 2 years) or portable stadiometer (≥ 2 years) and portable digital weight scale were used to measure the height and weight of the child, respectively. Data collection procedure and quality control The data were collected by four BSc nurses and supervised by two MSc paediatrics and child health nurse professionals. The training was given for data collectors and supervisors for two days, and a pre-test was conducted in 5% (21) of the final sample size in Sodo Christian hospital. Both supervisors and data collectors were closely followed for the data collection process, and all filled questionnaires were checked every day, and errors were corrected accordingly. The weight of the child was measured using a well-calibrated, portable digital weight scale without shoes and wearing light clothes. Moreover, the reliability of the weight scale was checked before each measurement. Data entry and analysis The collected data were checked for completeness, consistency, and accuracy, then entered into EPI data version 3.1 and exported to Statistical Package for Social Sciences version (SPSS) 22.0 for data analysis. Descriptive statistics with percentages, frequency distributions, measures of central tendency, and dispersion were used to describing the data. Bivariate logistic regression was used to check variables having an association with ALRTIs, and those variables found to have a p-value of < 0.2 were further analyzed using multiple logistic regressions. Odds ratio (OR) with 95%CI was computed, and variables with a p-value < 0.05 were considered as a significant variable. The model fitness was checked with the Hosmer and Lemeshow goodness of fit test, which was p = 0.767. Operational definitions Acute lower respiratory tract infections A child presented with cough, fever, rapid or difficulty of breathing in the last two weeks and diagnosed as ALRTIs (pneumonia, acute bronchitis, and bronchiolitis) by the physician. Main cooking fuel: Unclean fuel using wood, animal dung, charcoal, crop wastes, kerosene stove and kerosene lamp [ 28 ] Clean fuel use of electricity, gas, ethanol, and solar [ 28 ] Breast feeding: Exclusive breast feeding infants receive only breast milk for the first six months or receive only breast milk until the time of assessment for infants < six months Non-exclusive/replacement feeding Giving food or fluid (milk) alone or in addition to breast milk for the infants < six months Immunization status: Immunized for age Took all vaccines appropriate for age based on the immunization schedule Incomplete defaulters or those who were not vaccinated based on the immunization schedule Not vaccinated a child who didn’t take the vaccine at all Result Socio demographic characteristics A total of 414 child/mother or caretaker pairs had participated in the study, which resulted in a 98.1% response rate. The mean age and standard deviation of children and mothers were 21.3±14.13 months and 29±5.8 years, respectively. Nearly half (46.4%) of children were age ≥24 months, the majority (54.6%) of children were male, and 59.4% were urban dwellers. Nearly half of the respondents (49%) were protestant in religion, 32.6% were unable to read and write, and 57.7% were housewives in occupation. Nearly all (93%) children’s parents lived together, and the average monthly income of the family was 2356 ± 1316 Ethiopian birr (Table 1). Table 1 Socio-demographic characteristics of acute lower respiratory tract infections among under-five children/mother or caretaker pair attended at WSUTRH, 2019(n=414) Variable N=414 Categories Frequency (N) Percent % Age of the child 2-5 months 44 10.6% 6-11 months 77 18.6% 12-23 months 101 24.4% 24-59 months 192 46.4% Sex of the child Male 226 54.6% Female 188 45.4% Age of the mother ≤24 85 20.5% 25-34 264 63.8% ≥35 65 15.7% Residence Urban 246 59.4% Rural 168 40.65 Religion of the respondent Protestant 203 49% Orthodox 122 29.5% Catholic 46 11.1% Muslim 43 10.4% Educational status of mother Unable to read and write 135 32.6% Able to write and read 130 31.4% Primary school 79 19.1% Secondary school 41 9.9% Diploma and above 29 7% Occupation of the mother House wife 293 57.7% Government employ 31 7.5% Private business 33 8% Student 3 0.7% Farmer 29 7% Daily labor 79 19.1% Does parents live together Yes 385 93% No 29 7% Family income ≤1999 ETB 149 36 2000-3499 ETB 189 45.7 ≥3500ETB 76 18.4 Maternal and child factors The mean and standard deviation of children’s weight and height were 10.2±2.9 kg and 78.4±12.4 cm, respectively. The majority (58.2%) of children didn’t have a history of upper respiratory tract infection (URTI), and 34.1% of children didn’t take immunization at all. Over two-thirds of children (70.5%) were exclusively breastfeed in the first six months, 29% of children took Vitamin A in the last months, and 4.1% of children had severe wasting. Only 3.4% of children had parents with chronic illness, 59.4% of mothers took iron folate, 64.5% of mothers took extra food during pregnancy, and 4.1% of mothers had sexually transmitted infections (STI) during pregnancy (Table 2). Table 2 Maternal and child factors of acute lower respiratory tract infections among under-five children attended at WSUTRH, 2019(n=414) Variable N=414 Categories Frequency (N) Percent % History of URTI within 2 weeks Yes 173 41.8% No 241 58.2% Immunization Immunized 232 56% Incomplete 41 9.9% Not vaccinated 141 34.1% Breast feeding in the first 6 months (current for <6 months) Exclusive breast feeding 292 70.5% Non-exclusive/ replacement feeding 122 29.5% Vitamin A supplementation Yes 120 29% No 250 60.4% Not eligible 44 10.6% Nutritional status of the child Sever acute malnutrition 17 4.1% Moderate acute malnutrition 30 7.2% Mild/normal 367 88.7% Parental chronic illness Yes 14 3.4% No 400 96.6% Maternal iron folate intake Yes 246 59.4% No 168 40.6% Take extra meal during pregnancy Yes 267 64.5% No 147 35.5% STI during pregnancy Yes 17 4.1% No 397 95.9% Environmental factors Half of the respondents (49.5%) had a family size of ≤4 people, there was a smoker in 6% of the households, and 82.4% of children were cared for by their mothers. The majority of households (67.4%) had a separate kitchen, 71% of cooking areas had windows, and 76.2% of households used unclean fuel for cooking (Table 3). Table 3 Environmental factors of acute lower respiratory tract infections among under-five children attended at WSUTRH, 2019(n=414) Variable N=414 Categories Frequency (N) Percent % Family size ≤4 205 49.5% ≥5 209 50.5% Is there smoker in the house Yes 25 6% No 389 94% Who give care for the child Mother 341 82.4% House maker 73 17.6% Is there separate kitchen Yes 279 67.4% No 135 32.6% Does the cooking area(kitchen) had window Yes 294 71% No 120 29% Main household fuel type Unclean fuel 357 76.2% Clean fuel 57 13.8% Prevalence of acute lower respiratory tract infections The prevalence of ALRTIs was 40.3% (95%CI: 35.7%-44.9%)., and pneumonia accounts for 90.4% of the diagnosis (Fig 1 & 2). Factors associated with acute lower respiratory tract infections In the bivariate analysis, parents living together, history of URTI, vaccination status, breastfeeding in the first six months, a person who cared for the child, main cooking fuel type, a smoker in the house, a separate kitchen, a window for the kitchen, and nutritional status of the child were factors those had a p-value <0.2. Variables that had a p-value of < 0.2 in the bivariate analysis were further analyzed using multivariate logistic regression. The result of this analysis showed that immunization status, breastfeeding in the first six months, main cooking fuel, separate kitchen, and window for the kitchen were significantly associated variables with ALRTIs. Unvaccinated children were 2 times more likely to be affected by ALRTIs compared with immunized children (p = 0.003, AOR = 2, 95%CI: 1.27-3.16). Non-exclusively/replacement feeding children were 1.85 times more likely to be affected by ALRTIs compared with exclusively breastfeeding children (p = 0.008, AOR = 1.85, 95%CI: 1.18-2.91). Similarly, children living in households mainly cooking with unclean fuel had 2.12 times higher odds of developing ALRTIs compared with children living in houses mainly cooking with clean fuel (p = 0.031, AOR = 2.12, 95%CI: 1.07-4.19). Additionally, the absence of a separate kitchen had 1.7 times higher odds of ALRTIs in children than having a separate kitchen (p = 0.021, AOR = 1.7, 95%CI: 1.09-2.65). Finally, children lived in households which had no window in the cooking room (kitchen) were 1.69 times more likely to be affected by ALRTIs compared with those children lived in houses which had a window in the cooking room (kitchen) (p = 0.025, AOR = 1.69, 95%CI: 1.07-2.68). Table 4 Factors associated with acute lower respiratory tract infections among under five children attended at WSUTRH, 2019(n=414) Variables Acute lower respiratory tract infection COR(95%CI) AOR(95%CI) P- value Yes No Parents live together Yes 151 (36.5%) 234 (56.5%) 1 1 No 16(3.9%) 13 (3.1%) 1.9(0.9, 4.1) 2.22(0.99-5.01) 0.054 History of URTI Yes 81 (19.6%) 92 (22.2%) 1.59(1.07,2.36) 1.44(0.94-2.21) 0.095 No 86 (20.8%) 155 (37.4%) 1 1 Immunization status Immunized for age 80 (19.3%) 152 (36.7%) 1 1 In completed 16(3.9%) 25 (6%) 1.22(0.61,2.41) 1.12(0.54-2.35) 0.762 Not vaccinated 71(17.1%) 70(16.9%) 1.93(1.26,2.95) 2(1.27-3.16)* 0.003 Breast feeding Exclusive BF 104 (25.1%) 188 (45.4%) 1 1 Non-exclusive BF/ replacement 63 (15.2%) 59 (14.3%) 1.93(1.26,2.96) 1.85(1.18-2.91)* 0.008 Who care for the child Mother 131(31.6%) 210(50.7%) 1 1 Home maker 36 (8.7%) 37 (8.9%) 1.56(0.94, 2.59) 1.64(0.95-2.84) 0.078 Main cooking fuel Unclean fuel 153 (36.9%) 204 (49.3%) 2.3(1.22-4.36) 2.12(1.07-4.19)* 0.031 Clean fuel 14 (3.4%) 43 (10.4%) 1 1 Smoker in the house Yes 14(3.4%) 11 (2.7%) 1.96(0.9, 4.44) 1.81(0.75-4.33) 0.185 No 153(36.9%) 236(57%) 1 1 Separate kitchen Yes 100 (24.2%) 179 (43.2%) 1 1 No 67 (16.2%) 68 (16.4%) 1.76(1.16,2.68) 1.7(1.09-2.65)* 0.021 Window for the kitchen Yes 104 (25.1%) 190 (45.9%) 1 No 63 (15.2%) 57 (13.8%) 2(1.3, 3.1) 1.69(1.07-2.68)* 0.025 Nutritional status SAM 10 (2.4%) 7 (1.7%) 1.7 (0.65, 4.57) 2.54(0.88-7.39) 0.087 MAM 12 (2.9%) 18 (4.3%) 1.17 (0.55,2.48) 1.15(0.5-2.61) 0.747 Mild/normal 145 (35%) 222 (53.6%) 1 1 Discussion This study showed that the prevalence of ALRTIs among children who attended at WSUTRH was 40.3% (95%CI: 35.7%-44.9%). The finding of this research is comparable with the demographic and health survey report of Congo (39.8%) and Gabon (38.1%)[ 12 ]. However, this finding is higher compared with studies conducted in South West, Ethiopia(28.1%)[ 22 ], Wondo Genet district, Ethiopia (33.5%)[ 21 ], the overall ALRTIs of sub-Saharan Africa (25.3)[ 12 ], the Rio Grande do Sul State, Brazil(23.9%)[ 29 ], Rwanda (5%)[ 13 ]. The possible reason might be the difference in the study setting and type of lower respiratory tract infection included. This study was conducted in a health facility and includes other ALRTIs in addition to pneumonia. But the above studies were conducted in a community setting or include only pneumonia, which will result in a lower prevalence. In this study, unvaccinated children were 2 times more likely to be affected by ALRTIs compared with vaccinated for age children. Widespread immunizations have been related to the decline of the LRTIs in children [ 3 , 30 , 31 ]. Similar findings were reported from studies in Gamo Gofa Zone, Ethiopia[ 22 ], Southern Ethiopia [ 23 ], and a systematic review and meta-analysis from the UK[ 32 ]. Non-exclusive breast/replacement feed children were 1.85 times more likely to be affected by ALRTIs compared with exclusively breastfeeding children. Breast milk contains antibodies that help children fight viruses and bacteria. Additionally, children who are breastfed exclusively for the first six months had a lower risk of acute otitis media, lower respiratory tract infections, gastroenteritis and diarrhea, and asthma [ 33 , 34 ]. Other studies conducted in Northwest Ethiopia[ 24 ], Achefer district, Ethiopia[ 35 ], Kersa district, Ethiopia[ 25 ], Gamo Gofa Zone, South West of Ethiopia[ 22 ], Southern Ethiopia[ 23 ], a systematic review and meta-analysis from UK[ 32 ] showed similar findings. Children living in households mainly cooking with unclean fuel had 2.12 times higher odds of developing ALRTIs compared with children living in houses mainly cooked with clean fuel. The use of unclean fuel might produce high levels of household air pollution, including small soot particles that will penetrate deep into the lungs. Deposited particulate matters may alter airway reactivity and will affect the ability of the lungs to fight pathogens. The exposure is high among women and young children, and as a result, it doubles the risk for childhood pneumonia [ 36 – 38 ]. Studies conducted in South West of Ethiopia[ 22 ], Gondar city of Ethiopia[ 26 ], Wolaita-Sodo, Ethiopia[ 27 ]and, Pakistan[ 39 ] had reported similar findings. The absence of a separate kitchen had 1.7 times higher odds of childhood ALRTIs compared with having a separate kitchen. Cooking in the household will result in a higher level of particulate matter concentration, and young children had increased vulnerability to household air pollution due to the longer indoor stay[ 39 ]. Similar findings were observed from the study conducted in Wondo Genet district, Ethiopia [ 21 ], South West of Ethiopia[ 22 ], and Pakistan[ 39 ]. Finally, children who lived in households that had no window in the cooking room (kitchen) were 1.69 times more likely to be affected with ALRTIs compared with those children who lived in houses that had a window in the cooking room. The kitchen without a window had limited ventilation, and it will increase the exposure of pollutants, particularly for young children who spend much of their time in the kitchen with their mother. This finding is supported by studies conducted in Wolaita Sodo, Ethiopia[ 27 ], Wondo Genet district, Ethiopia[ 21 ], Gondar, Ethiopia[ 26 ], and South West of Ethiopia[ 22 ]. Limitation Of The Study This study will be subjected to recall bias, didn’t consider seasonal variation, and the diagnosis for ALRTIs was made based on physician assessment. Conclusion The prevalence of ALRTIs among under-five children attended at WSUTRH was 40.3%. Unvaccinated children, non-exclusive/replacement feeding, households mainly cooking with unclean fuel, absence of a separate kitchen, and absence of window in the kitchen room showed significant association with ALRTIs. Therefore, strengthening the environmental sanitation (healthy home environment) and family health (child nutrition, immunization) component of the health extension packages will have a significant contribution to the reduction of under-five ALRTIs. List Of Abbreviations AOR: Adjusted odds ration; ALRTIs: acute lower respiratory tract infections; BSc: Bachelors of Science; COR: crude odds ratio; LRTI: lower respiratory tract infection; MDG: millennium development goal; MSc: Masters of Science; OPD: outpatient department; SDG: sustainable development goals; SPSS: Statistical Package for Social Sciences; WSUTRH: Wolaita Sodo University teaching and referral hospital Declarations Ethics approval and consent to participate Ethical clearance and approval were obtained from the Institutional Research Ethical and Review Committee of Wolaita Sodo University. An official letter was submitted, and permission was obtained from WSUTRH to conduct the research. Informed written consent was obtained from all study participants after explaining the objectives of the study in detail. Consent for publication Not applicable. Availability of data and materials Data will be available upon request from the corresponding author. Competing interests The authors declare that they have no competing interests. Funding Wolaita Sodo University had covered the cost for data collection, entry, and supervision. Authors’ contributions BW and EA were involved in the conception, design, analysis, interpretation, and report and manuscript writing. YA and ZM have participated in the design, analysis, interpretation, and report and manuscript writing. All authors have read and approved the final manuscript. Authors’ information Birhanu wondimeneh Demissie is an assistant professor in the Department of Paediatrics and Neonatal Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia Esayas Aydiko is a lecturer in the Department of Pediatrics and Neonatal Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia. Yibeltal Asmamaw Yitayew is a lecturer in the Department of Paediatrics and Child Health Nursing, College of Medicine and Health science, Wollo University, Dessie, Ethiopia Zemen Mengesha Yalew is a lecturer in the Department of Comprehensive Nursing, College of Medicine and Health science, Wollo University, Dessie, Ethiopia Acknowledgements The authors would like to thank Wolaita Sodo University for funding the study. Our gratitude also goes to the data collectors, supervisors, participants, and administrative staff of WSUTRH for their contribution to the completion of the research thesis. References MedicalNewsToday. Lower respiratory tract infections: symptoms, diagnosis, and treatment. Available at: https://www.medicalnewstoday.com/articles/324413 . Accessed in 2019. Biscevic-Tokic J, Tokic N, Musanovic A. Pneumonia as the most common lower respiratory tract infection. medical archives. 2013;67(6):442. 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WHO guidelines for indoor air quality: household fuel combustion: World Health Organization; 2014. Prietsch SO, Fischer GB, César JA, Lempek BS, Barbosa LV Jr, Zogbi L, et al. Acute lower respiratory illness in under-five children in Rio Grande, Rio Grande do Sul State, Brazil: prevalence and risk factors. Cadernos de saude publica. 2008;24:1429–38. Bianchini S, Argentiero A, Camilloni B, Silvestri E, Alunno A, Esposito S. Vaccination against paediatric respiratory pathogens. Vaccines. 2019;7(4):168. Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al. Disease control priorities in developing countries: The World Bank; 2006. Jackson S, Mathews KH, Pulanić D, Falconer R, Rudan I, Campbell H, et al. Risk factors for severe acute lower respiratory infections in children–a systematic review and meta-analysis. Croatian Med J. 2013;54(2):110–21. WebMD. Breastfeeding Overview. Available at: https://www.webmd.com/parenting/baby/nursing-basics#1 . Accessed in 2019. Salone LR, Vann WF Jr, Dee DL. Breastfeeding: an overview of oral and general health benefits. The Journal of the American Dental Association. 2013;144(2):143–51. Gedefaw M, Berhe R. Determinates of childhood pneumonia and diarrhea with special emphasis to exclusive breastfeeding in north Achefer district, northwest Ethiopia: a case control study. Open Journal of Epidemiology. 2015;5(02):107. Rahut DB, Ali A, Behera B. Domestic use of dirty energy and its effects on human health: empirical evidence from Bhutan. Int J Sustain Energ. 2017;36(10):983–93. Torres-Duque C, Maldonado D, Pérez-Padilla R, Ezzati M, Viegi G. Biomass fuels and respiratory diseases: a review of the evidence. Proceedings of the American Thoracic Society. 2008;5(5):577 – 90. WHO. Household air pollution and health. Available at: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health . accessed in 2019. Khan MSB, Lohano HD. Household air pollution from cooking fuel and respiratory health risks for children in Pakistan. Environ Sci Pollut Res. 2018;25(25):24778–86. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-73458","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":2131579,"identity":"4b2312ea-2be8-44ee-a4c9-fc3bcd742a52","order_by":0,"name":"Birhanu Wondimeneh Demissie","email":"","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Birhanu","middleName":"Wondimeneh","lastName":"Demissie","suffix":""},{"id":2131580,"identity":"18228a17-25dd-4c13-b91f-26f5e500acc7","order_by":1,"name":"Esayas Aydiko Amele","email":"","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Esayas","middleName":"Aydiko","lastName":"Amele","suffix":""},{"id":2131581,"identity":"6089ab7b-2bc4-4368-b3bc-0ef541ad0004","order_by":2,"name":"Yibeltal Asmamaw Yitayew","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-4161-3500","institution":"Wollo University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yibeltal","middleName":"Asmamaw","lastName":"Yitayew","suffix":""},{"id":2131582,"identity":"e9db388f-8d8c-4948-9618-22bb73348715","order_by":3,"name":"Zemen Mengesha Yalew","email":"","orcid":"","institution":"Wollo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zemen","middleName":"Mengesha","lastName":"Yalew","suffix":""}],"badges":[],"createdAt":"2020-09-07 10:16:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-73458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-73458/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":2329712,"identity":"0ae4d987-22c3-4c21-9488-8801be2595c0","added_by":"auto","created_at":"2020-09-09 23:37:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":9756,"visible":true,"origin":"","legend":"Prevalence of acute lower respiratory tract infections among under-five children attended at WSUTRH, 2019(n=414)","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-73458/v1/fig1.png"},{"id":2329713,"identity":"c5ae8eee-d654-4dd2-85f7-27840eb08ac6","added_by":"auto","created_at":"2020-09-09 23:37:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13670,"visible":true,"origin":"","legend":"Diagnosis of acute lower respiratory tract infections among under-five children attended at WSUTRH, 2019(n=414)","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-73458/v1/fig2.png"},{"id":13590113,"identity":"1e3b4d35-0315-4abb-922e-05551f1de49e","added_by":"auto","created_at":"2021-09-17 05:03:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":579648,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-73458/v1/aab26fd4-389e-413d-a34b-cb96439cd753.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eAcute Lower Respiratory Tract Infections and Associated Factors Among Under-five Children Visiting Wolaita Sodo University Teaching and Referral Hospital: A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eAcute lower respiratory tract infections (ALRTs) are any infections in the lungs or below the voice box, which include pneumonia, bronchitis, and bronchiolitis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. So far, pneumonia is the most common type of lower respiratory tract infection (LRTIs), and globally, 150\u0026nbsp;million new episodes of pneumonia are identified per year worldwide, and more than 90% of which occur in developing countries[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Viruses are the most common cause of pneumonia in infants and young children, and the most frequent symptoms and signs are coughs, increased respiratory rate, fever, breathing difficulty, runny nose, and chest wall indrawing in more severe disease [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLower respiratory tract infections (LRTIs) are a leading cause of morbidity and mortality worldwide, particularly in children younger than five years[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Globally, LRTIs cause 704 000 deaths, and the highest under-five LRTI mortalities were in sub-Saharan Africa. Even if the burden of LRTIs in under five-children has decreased dramatically in the last ten years, it is still the main cause of death in developing countries [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Each year, more than 2\u0026nbsp;million under five-children died due to pneumonia in the developing world, and 43% of global under-five death of ALRTIs occurs in India, Nigeria, the Democratic Republic Congo and Ethiopia[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In Ethiopia in 2015, 25,970 under-five children were dead due to LRTIs, and 14,148.3 was caused by Pneumococcal pneumonia[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDifferent factors were identified for the increased risk of LRTIs in children. Of these, poverty, restricted family income, low parental education level, low birth weight, malnutrition, lack of breastfeeding, maternal literacy, smoking, cow dung use for fuel, low socio-demographic status, solid fuels for cooking and heating, immune impaired populations, improved toilet facilities, season, and residence [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, the risk of death from LRTIs will be determined by very severe pneumonia, age below two months, diagnosis of Pneumocystis Carinii, chronic underlying diseases including HIV/ AIDS, severe malnutrition, young maternal age, low maternal education, low socioeconomic status, second-hand smoke exposure, and indoor air pollution[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWidespread immunization against influenza, measles, bacilli Calmette-Guerin (BCG), and now pneumococcus have been related to the decline of the LRTIs in children [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Likewise, vaccines prevent an estimated 2.5\u0026nbsp;million deaths among children under five every year. Yet one child dies every 20 seconds from a disease that could have been prevented by a vaccine[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Ethiopian children suffer four to eight episodes of ARTI on average every year, with the highest occurrence in urban areas in overcrowded living conditions[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Ethiopia, only 39% received all vaccinations at some time, and 22% were vaccinated by the appropriate age [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This low immunization coverage will result in an increased risk of LRTIs morbidity and mortality.\u003c/p\u003e \u003cp\u003eEven if Ethiopia has achieved millennium development goals (MDG) 4 by 2013, LRIs are one of the most common causes of under-five children mortality [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, to achieve the sustainable development goal (SDG) 3 of ending preventable deaths of new-borns and under-five children by 2030, efforts to reduce deaths due to lower respiratory tract infection should remain a top priority[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. So this study was aimed to assess lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital (WSUTRH), 2019.\u003c/p\u003e "},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy design, area and period\u003c/h2\u003e\n\u003cp\u003eAn institution-based cross-sectional study was conducted from April 1\u0026ndash;30, 2019, at Wolaita Sodo University Teaching and Referral Hospital (WSUTRH). Wolaita Sodo University Teaching and Referral Hospital is found at Sodo town, which is located 157\u0026nbsp;Km from the regional capital city, Hawassa, and 327\u0026nbsp;Km from the capital city of Ethiopia, Addis Ababa. According to the Wolaita Zone Health Department information 2019, the estimated population of Wolaita Zone is about 2,020,386 from this, about 983,991 are males, and 1,030,396 are females. The hospital gives service to nearly 3\u0026nbsp;million peoples in the catchment area, had 350 inpatient beds, and 450\u0026ndash;500 patients visited the hospital per-day[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003ePopulations\u003c/h2\u003e\n\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n\u003ch2\u003eSource population\u003c/h2\u003e\n\u003cp\u003eAll under five children/mother or caretaker pair visiting WSUTRH pediatric outpatient department (OPD)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n\u003ch2\u003eStudy population\u003c/h2\u003e\n\u003cp\u003eRandomly selected under five-children/mother or caretaker pair visited WSUTRH pediatric outpatient department (OPD) from April 1\u0026ndash;30, 2019\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eSample size determination and procedure\u003c/h2\u003e\n\u003cp\u003eThe sample size was calculated using a single population proportion formula with the assumption of 50% under-five prevalence of ALRTIs to get the largest sample size, with a 95% confidence interval and 5% marginal error.\u003c/p\u003e\n\u003cp\u003eThe sample size calculated as follows;\u003c/p\u003e\n\u003cp\u003eN\u003csub\u003ei\u003c/sub\u003e = (Z \u003csub\u003eɑ /2\u003c/sub\u003e)\u003csup\u003e2\u003c/sup\u003e \u0026times; p (1 \u0026ndash; p)/W\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eN\u003csub\u003ei\u003c/sub\u003e= (1.96)\u003csup\u003e2\u003c/sup\u003e\u0026times; (0.5) \u0026times; (0.5)/ (0.0025)\u0026thinsp;=\u0026thinsp;384\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhere\u003c/em\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e \u003csub\u003e \u003cem\u003ei =\u003c/em\u003e \u003c/sub\u003e \u003cem\u003einitial sample size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eɑ = confidence interval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u0026thinsp;prevalence LRIs\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eW\u0026thinsp;=\u0026thinsp;margin of error\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBy considering a 10% none response rate, the final sample size was 422 child/mother pairs. The estimated number of child/mother or care taker pair visited under five OPD in the study period was 1050 based on the last six months of patient flow. Then participants were selected using a systematic random sampling technique (k\u0026thinsp;=\u0026thinsp;2) until the required sample size was obtained.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection instrument\u003c/h2\u003e\n\u003cp\u003eA face-to-face interview was conducted using a structured questionnaire that was adopted and modified from previous researches [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. The questionnaire comprises socio-demographic factors, maternal and child factors, environmental factors, and the outcome variable (ALRTIs). Length board (\u0026lt;\u0026thinsp;2\u0026nbsp;years) or portable stadiometer (\u0026ge;\u0026thinsp;2\u0026nbsp;years) and portable digital weight scale were used to measure the height and weight of the child, respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection procedure and quality control\u003c/h2\u003e\n\u003cp\u003eThe data were collected by four BSc nurses and supervised by two MSc paediatrics and child health nurse professionals. The training was given for data collectors and supervisors for two days, and a pre-test was conducted in 5% (21) of the final sample size in Sodo Christian hospital. Both supervisors and data collectors were closely followed for the data collection process, and all filled questionnaires were checked every day, and errors were corrected accordingly. The weight of the child was measured using a well-calibrated, portable digital weight scale without shoes and wearing light clothes. Moreover, the reliability of the weight scale was checked before each measurement.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eData entry and analysis\u003c/h2\u003e\n\u003cp\u003eThe collected data were checked for completeness, consistency, and accuracy, then entered into EPI data version 3.1 and exported to Statistical Package for Social Sciences version (SPSS) 22.0 for data analysis. Descriptive statistics with percentages, frequency distributions, measures of central tendency, and dispersion were used to describing the data. Bivariate logistic regression was used to check variables having an association with ALRTIs, and those variables found to have a p-value of \u0026lt;\u0026thinsp;0.2 were further analyzed using multiple logistic regressions. Odds ratio (OR) with 95%CI was computed, and variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered as a significant variable. The model fitness was checked with the Hosmer and Lemeshow goodness of fit test, which was p\u0026thinsp;=\u0026thinsp;0.767.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eOperational definitions\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eAcute lower respiratory tract infections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eA child presented with cough, fever, rapid or difficulty of breathing in the last two weeks and diagnosed as ALRTIs (pneumonia, acute bronchitis, and bronchiolitis) by the physician.\u003c/em\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n\u003ch2\u003eMain cooking fuel:\u003c/h2\u003e\n\u003ch3\u003eUnclean fuel\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eusing wood, animal dung, charcoal, crop wastes, kerosene stove and kerosene lamp\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eClean fuel\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003euse of electricity, gas, ethanol, and solar\u003c/em\u003e[\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n\u003ch2\u003eBreast feeding:\u003c/h2\u003e\n\u003ch3\u003eExclusive breast feeding\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003einfants receive only breast milk for the first six months or receive only breast milk until the time of assessment for infants\u0026thinsp;\u0026lt;\u0026thinsp;six months\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eNon-exclusive/replacement feeding\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eGiving food or fluid (milk) alone or in addition to breast milk for the infants\u0026thinsp;\u0026lt;\u0026thinsp;six months\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n\u003ch2\u003eImmunization status:\u003c/h2\u003e\n\u003ch3\u003eImmunized for age\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eTook all vaccines appropriate for age based on the immunization schedule\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eIncomplete\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003edefaulters or those who were not vaccinated based on the immunization schedule\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eNot vaccinated\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003ea child who didn\u0026rsquo;t take the vaccine at all\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Result","content":"\u003ch2\u003eSocio demographic characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 414 child/mother or caretaker pairs had participated in the study, which resulted in a 98.1% response rate. The mean age and standard deviation of children and mothers were 21.3\u0026plusmn;14.13 months and 29\u0026plusmn;5.8 years, respectively. Nearly half (46.4%) of children were age \u0026ge;24 months, the majority (54.6%) of children were male, and 59.4% were urban dwellers. Nearly half of the respondents (49%) were protestant in religion, 32.6% were unable to read and write, and 57.7% were housewives in occupation. Nearly all (93%) children\u0026rsquo;s parents lived together, and the average monthly income of the family was 2356 \u0026plusmn; 1316 Ethiopian birr (Table 1).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSocio-demographic characteristics of acute lower respiratory tract infections among under-five children/mother or caretaker pair attended at WSUTRH, 2019(n=414)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable N=414\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCategories \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"34%\"\u003e\n\u003cp\u003eAge of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e2-5 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e10.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e6-11 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e18.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e12-23 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e24.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e24-59 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e46.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"34%\"\u003e\n\u003cp\u003eSex of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e226\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e54.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e45.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"34%\"\u003e\n\u003cp\u003eAge of the mother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e\u0026le;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e20.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e25-34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e264\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e63.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e\u0026ge;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e15.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"34%\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e246\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e59.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e40.65\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"34%\"\u003e\n\u003cp\u003eReligion of the respondent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eProtestant\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e49%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eOrthodox\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e29.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e11.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e10.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" width=\"34%\"\u003e\n\u003cp\u003eEducational status of mother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eUnable to read and write\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e32.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eAble to write and read\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e31.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003ePrimary school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e19.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eSecondary school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e9.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eDiploma and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" width=\"34%\"\u003e\n\u003cp\u003eOccupation of the mother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eHouse wife\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e293\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e57.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eGovernment employ\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e7.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003ePrivate business\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e0.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eFarmer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eDaily labor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e19.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"34%\"\u003e\n\u003cp\u003eDoes parents live together\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e385\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e93%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"34%\"\u003e\n\u003cp\u003eFamily income\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e\u0026le;1999 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e2000-3499 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e189\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e45.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"29%\"\u003e\n\u003cp\u003e\u0026ge;3500ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e18.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eMaternal and child factors\u003c/h2\u003e\n\u003cp\u003eThe mean and standard deviation of children\u0026rsquo;s weight and height were 10.2\u0026plusmn;2.9 kg and 78.4\u0026plusmn;12.4 cm, respectively. The majority (58.2%) of children didn\u0026rsquo;t have a history of upper respiratory tract infection (URTI), and 34.1% of children didn\u0026rsquo;t take immunization at all. Over two-thirds of children (70.5%) were exclusively breastfeed in the first six months, 29% of children took Vitamin A in the last months, and 4.1% of children had severe wasting. Only 3.4% of children had parents with chronic illness, 59.4% of mothers took iron folate, 64.5% of mothers took extra food during pregnancy, and 4.1% of mothers had sexually transmitted infections (STI) during pregnancy (Table 2).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMaternal and child factors of acute lower respiratory tract infections among under-five children attended at WSUTRH, 2019(n=414)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"36%\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable N=414\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCategories \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"36%\"\u003e\n\u003cp\u003eHistory of URTI within 2 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e41.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e58.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"36%\"\u003e\n\u003cp\u003eImmunization\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eImmunized\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e232\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e56%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eIncomplete\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e9.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNot vaccinated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e34.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"36%\"\u003e\n\u003cp\u003eBreast feeding in the first 6 months (current for \u0026lt;6 months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eExclusive breast feeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e292\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e70.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNon-exclusive/ replacement feeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e29.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"36%\"\u003e\n\u003cp\u003eVitamin A supplementation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e29%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e60.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNot eligible\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e10.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"36%\"\u003e\n\u003cp\u003eNutritional status of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eSever acute malnutrition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e4.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eModerate acute malnutrition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e7.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eMild/normal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e367\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e88.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"36%\"\u003e\n\u003cp\u003eParental chronic illness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e3.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e96.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"36%\"\u003e\n\u003cp\u003eMaternal iron folate intake\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e246\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e59.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e40.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"36%\"\u003e\n\u003cp\u003eTake extra meal during pregnancy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e267\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e64.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e35.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"36%\"\u003e\n\u003cp\u003eSTI during pregnancy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e4.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e397\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003e95.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eEnvironmental factors\u003c/h2\u003e\n\u003cp\u003eHalf of the respondents (49.5%) had a family size of \u0026le;4 people, there was a smoker in 6% of the households, and 82.4% of children were cared for by their mothers. The majority of households (67.4%) had a separate kitchen, 71% of cooking areas had windows, and 76.2% of households used unclean fuel for cooking (Table 3).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eEnvironmental factors of acute lower respiratory tract infections among under-five children attended at WSUTRH, 2019(n=414)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"37%\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable N=414\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCategories \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"37%\"\u003e\n\u003cp\u003eFamily size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e\u0026le;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e49.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e\u0026ge;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e209\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e50.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"37%\"\u003e\n\u003cp\u003eIs there smoker in the house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e389\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e94%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"37%\"\u003e\n\u003cp\u003eWho give care for the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eMother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e341\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e82.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eHouse maker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e17.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"37%\"\u003e\n\u003cp\u003eIs there separate kitchen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e279\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e67.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e32.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"37%\"\u003e\n\u003cp\u003eDoes the cooking area(kitchen) had window\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e294\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e71%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e29%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"37%\"\u003e\n\u003cp\u003eMain household fuel type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eUnclean fuel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e357\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e76.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eClean fuel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e13.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003ePrevalence of acute lower respiratory tract infections\u003c/h2\u003e\n\u003cp\u003eThe prevalence of ALRTIs was 40.3% (95%CI: 35.7%-44.9%)., and pneumonia accounts for 90.4% of the diagnosis (Fig 1 \u0026amp; 2).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFactors associated with acute lower respiratory tract infections\u003c/h2\u003e\n\u003cp\u003eIn the bivariate analysis, parents living together, history of URTI, vaccination status, breastfeeding in the first six months, a person who cared for the child, main cooking fuel type, a smoker in the house, a separate kitchen, a window for the kitchen, and nutritional status of the child were factors those had a p-value \u0026lt;0.2. Variables that had a p-value of \u0026lt; 0.2 in the bivariate analysis were further analyzed using multivariate logistic regression. The result of this analysis showed that immunization status, breastfeeding in the first six months, main cooking fuel, separate kitchen, and window for the kitchen were significantly associated variables with ALRTIs.\u003c/p\u003e\n\u003cp\u003eUnvaccinated children were 2 times more likely to be affected by ALRTIs compared with immunized children (p = 0.003, AOR = 2, 95%CI: 1.27-3.16). Non-exclusively/replacement feeding children were 1.85 times more likely to be affected by ALRTIs compared with exclusively breastfeeding children (p = 0.008, AOR = 1.85, 95%CI: 1.18-2.91). Similarly, children living in households mainly cooking with unclean fuel had 2.12 times higher odds of developing ALRTIs compared with children living in houses mainly cooking with clean fuel (p = 0.031, AOR = 2.12, 95%CI: 1.07-4.19). Additionally, the absence of a separate kitchen had 1.7 times higher odds of ALRTIs in children than having a separate kitchen (p = 0.021, AOR = 1.7, 95%CI: 1.09-2.65). Finally, children lived in households which had no window in the cooking room (kitchen) were 1.69 times more likely to be affected by ALRTIs compared with those children lived in houses which had a window in the cooking room (kitchen) (p = 0.025, AOR = 1.69, 95%CI: 1.07-2.68).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFactors associated with acute lower respiratory tract infections among under five children attended at WSUTRH, 2019(n=414)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" width=\"226\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"180\"\u003e\n\u003cp\u003e\u003cstrong\u003eAcute lower respiratory tract infection\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003eCOR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003eAOR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eParents live together \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e151 (36.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e234 (56.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e16(3.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e13 (3.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.9(0.9, 4.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e2.22(0.99-5.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.054\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eHistory of URTI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e81 (19.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e92 (22.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.59(1.07,2.36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.44(0.94-2.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.095\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e86 (20.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e155 (37.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eImmunization status \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eImmunized for age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e80 (19.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e152 (36.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIn completed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;16(3.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e25 (6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.22(0.61,2.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.12(0.54-2.35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.762\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNot vaccinated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e71(17.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e70(16.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.93(1.26,2.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003e2(1.27-3.16)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eBreast feeding \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eExclusive BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e104 (25.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e188 (45.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNon-exclusive BF/ replacement\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e63 (15.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e59 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.93(1.26,2.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.85(1.18-2.91)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eWho care for the child \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eMother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e131(31.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e210(50.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eHome maker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e36 (8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e37 (8.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.56(0.94, 2.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.64(0.95-2.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.078\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eMain cooking fuel \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eUnclean fuel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e153 (36.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e204 (49.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e2.3(1.22-4.36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.12(1.07-4.19)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eClean fuel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e14 (3.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e43 (10.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmoker in the house \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e14(3.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e11 (2.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.96(0.9, 4.44)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.81(0.75-4.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.185\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e153(36.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e236(57%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eSeparate kitchen\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e100 (24.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e179 (43.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e67 (16.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e68 (16.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.76(1.16,2.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.7(1.09-2.65)*\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eWindow for the kitchen \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e104 (25.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e190 (45.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e63 (15.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e57 (13.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e2(1.3, 3.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.69(1.07-2.68)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eNutritional status \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eSAM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e10 (2.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e7 (1.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.7 (0.65, 4.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e2.54(0.88-7.39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.087\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eMAM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e12 (2.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e18 (4.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.17 (0.55,2.48)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.15(0.5-2.61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.747\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eMild/normal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e145 (35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e222 (53.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":" \u003cp\u003eThis study showed that the prevalence of ALRTIs among children who attended at WSUTRH was 40.3% (95%CI: 35.7%-44.9%). The finding of this research is comparable with the demographic and health survey report of Congo (39.8%) and Gabon (38.1%)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, this finding is higher compared with studies conducted in South West, Ethiopia(28.1%)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Wondo Genet district, Ethiopia (33.5%)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], the overall ALRTIs of sub-Saharan Africa (25.3)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the Rio Grande do Sul State, Brazil(23.9%)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Rwanda (5%)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The possible reason might be the difference in the study setting and type of lower respiratory tract infection included. This study was conducted in a health facility and includes other ALRTIs in addition to pneumonia. But the above studies were conducted in a community setting or include only pneumonia, which will result in a lower prevalence.\u003c/p\u003e \u003cp\u003eIn this study, unvaccinated children were 2 times more likely to be affected by ALRTIs compared with vaccinated for age children. Widespread immunizations have been related to the decline of the LRTIs in children [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similar findings were reported from studies in Gamo Gofa Zone, Ethiopia[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Southern Ethiopia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and a systematic review and meta-analysis from the UK[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNon-exclusive breast/replacement feed children were 1.85 times more likely to be affected by ALRTIs compared with exclusively breastfeeding children. Breast milk contains antibodies that help children fight viruses and bacteria. Additionally, children who are breastfed exclusively for the first six months had a lower risk of acute otitis media, lower respiratory tract infections, gastroenteritis and diarrhea, and asthma [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Other studies conducted in Northwest Ethiopia[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], Achefer district, Ethiopia[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], Kersa district, Ethiopia[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Gamo Gofa Zone, South West of Ethiopia[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Southern Ethiopia[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], a systematic review and meta-analysis from UK[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] showed similar findings.\u003c/p\u003e \u003cp\u003eChildren living in households mainly cooking with unclean fuel had 2.12 times higher odds of developing ALRTIs compared with children living in houses mainly cooked with clean fuel. The use of unclean fuel might produce high levels of household air pollution, including small soot particles that will penetrate deep into the lungs. Deposited particulate matters may alter airway reactivity and will affect the ability of the lungs to fight pathogens. The exposure is high among women and young children, and as a result, it doubles the risk for childhood pneumonia [\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Studies conducted in South West of Ethiopia[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Gondar city of Ethiopia[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Wolaita-Sodo, Ethiopia[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]and, Pakistan[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] had reported similar findings.\u003c/p\u003e \u003cp\u003eThe absence of a separate kitchen had 1.7 times higher odds of childhood ALRTIs compared with having a separate kitchen. Cooking in the household will result in a higher level of particulate matter concentration, and young children had increased vulnerability to household air pollution due to the longer indoor stay[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Similar findings were observed from the study conducted in Wondo Genet district, Ethiopia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], South West of Ethiopia[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and Pakistan[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinally, children who lived in households that had no window in the cooking room (kitchen) were 1.69 times more likely to be affected with ALRTIs compared with those children who lived in houses that had a window in the cooking room. The kitchen without a window had limited ventilation, and it will increase the exposure of pollutants, particularly for young children who spend much of their time in the kitchen with their mother. This finding is supported by studies conducted in Wolaita Sodo, Ethiopia[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], Wondo Genet district, Ethiopia[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Gondar, Ethiopia[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and South West of Ethiopia[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e "},{"header":"Limitation Of The Study","content":" \u003cp\u003eThis study will be subjected to recall bias, didn\u0026rsquo;t consider seasonal variation, and the diagnosis for ALRTIs was made based on physician assessment.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eThe prevalence of ALRTIs among under-five children attended at WSUTRH was 40.3%. Unvaccinated children, non-exclusive/replacement feeding, households mainly cooking with unclean fuel, absence of a separate kitchen, and absence of window in the kitchen room showed significant association with ALRTIs. Therefore, strengthening the environmental sanitation (healthy home environment) and family health (child nutrition, immunization) component of the health extension packages will have a significant contribution to the reduction of under-five ALRTIs.\u003c/p\u003e "},{"header":"List Of Abbreviations","content":"\u003cp\u003eAOR: Adjusted odds ration; ALRTIs: acute lower respiratory tract infections; BSc: Bachelors of Science; COR: crude odds ratio; LRTI: lower respiratory tract infection; MDG: millennium development goal; MSc: Masters of Science; OPD: outpatient department; SDG: sustainable development goals; SPSS: Statistical Package for Social Sciences; WSUTRH: Wolaita Sodo University teaching and referral hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical clearance and approval were obtained from the Institutional Research Ethical and Review Committee of Wolaita Sodo University. An official letter was submitted, and permission was obtained from WSUTRH to conduct the research. Informed written consent was obtained from all study participants after explaining the objectives of the study in detail.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eData will be available upon request from the corresponding author.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eWolaita Sodo University had covered the cost for data collection, entry, and supervision.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eBW and EA were involved in the conception, design, analysis, interpretation, and report and manuscript writing. YA and ZM have participated in the design, analysis, interpretation, and report and manuscript writing. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; information\u003c/h2\u003e\n\u003cp\u003eBirhanu wondimeneh Demissie is an assistant professor in the Department of Paediatrics and Neonatal Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia\u003c/p\u003e\n\u003cp\u003eEsayas Aydiko is a lecturer in the Department of Pediatrics and Neonatal Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia.\u003c/p\u003e\n\u003cp\u003eYibeltal Asmamaw Yitayew is a lecturer in the Department of Paediatrics and Child Health Nursing, College of Medicine and Health science, Wollo University, Dessie, Ethiopia\u003c/p\u003e\n\u003cp\u003eZemen Mengesha Yalew is a lecturer in the Department of Comprehensive Nursing, College of Medicine and Health science, Wollo University, Dessie, Ethiopia\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank Wolaita Sodo University for funding the study. Our gratitude also goes to the data collectors, supervisors, participants, and administrative staff of WSUTRH for their contribution to the completion of the research thesis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMedicalNewsToday. Lower respiratory tract infections: symptoms, diagnosis, and treatment. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.medicalnewstoday.com/articles/324413\u003c/span\u003e\u003c/span\u003e. Accessed in 2019.\u003c/li\u003e\n\u003cli\u003eBiscevic-Tokic J, Tokic N, Musanovic A. Pneumonia as the most common lower respiratory tract infection. medical archives. 2013;67(6):442.\u003c/li\u003e\n\u003cli\u003eBoloursaz MR, Lotfian F, Aghahosseini F, Cheraghvandi A, Khalilzadeh S, Farjah A, et al. Epidemiology of lower respiratory tract infections in children. Journal of Comprehensive Pediatrics. 2013;4(2):93\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eMidlinePlus. 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Environ Sci Pollut Res. 2018;25(25):24778\u0026ndash;86.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ALRTIs, associated factors, under-five, WSUTRH ","lastPublishedDoi":"10.21203/rs.3.rs-73458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-73458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eLower respiratory tract infections are a leading cause of morbidity and mortality worldwide, particularly in children younger than five years. Even if the burden of lower respiratory tract infections in children under-five years had decreased dramatically in the last ten years, it is still the main cause of morbidity and mortality in under five years old children in developing countries. So, this study was aimed to assess lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was conducted from April 1-30, 2019, among under-five children attended the Pediatrics outpatient department of Wolaita Sodo University Teaching and Referral Hospital. The data was collected using a semi-structured pre-tested interviewer guided questionnaire. Epi -info (version 7.1.2.0) was used for data entry, and Statistical Package for Social Sciences version 20 was used for analysis. Bivariate and multivariate logistic regression, crude and adjusted odds ratio with their 95% confidence interval were computed. Finally, p-value \u0026lt;0.05 was used to identify variables that had a significant association with acute lower respiratory tract infection.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThe prevalence of acute lower respiratory tract infections among under-five children was 40.3% (95%CI: 35.7%- 44.9%). Unvaccinated children (AOR: 2, 95% CI, (1.27-3.16)), non-exclusive/replacement feeding (AOR: 1.85, 95% CI, (1.18-2.91)), households mainly used unclean fuel for cooking (AOR: 2.12, 95% CI, (1.07-4.19)), absence of separate kitchen (AOR: 1.7, 95% CI, (1.09-2.65)), and absence of window in the kitchen room (AOR: 1.69, 95% CI, (1.07-2.68)) showed significant association with acute lower respiratory tract infection.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The prevalence of acute lower respiratory tract infections was 40.3%. Unvaccinated children, non-exclusive/replacement feeding, households mainly used unclean fuel for cooking, absence of a separate kitchen, and absence of window in the kitchen room showed significant association with acute lower respiratory tract infection. Therefore, special attention should be given for the environmental sanitation and family health component of the health extension packages.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Acute Lower Respiratory Tract Infections and Associated Factors Among Under-five Children Visiting Wolaita Sodo University Teaching and Referral Hospital: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-09 23:37:04","doi":"10.21203/rs.3.rs-73458/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5cce3fc2-771d-4679-9ecf-e90195cd6d8e","owner":[],"postedDate":"September 9th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":470381,"name":"Pediatrics"}],"tags":[],"updatedAt":"2020-09-13T15:49:49+00:00","versionOfRecord":[],"versionCreatedAt":"2020-09-09 23:37:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-73458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-73458","identity":"rs-73458","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}