Factors Associated with Acute Respiratory Infection among Children Under 5 Years in India: Results from 2019 to 2021 National Family Health Survey

Of the 201,133 children under-five included in our sample, 2.85% [2.78-2.92%] experienced a recent respiratory infection. In multivariate analysis, children from northern and central regions had the highest odds of infection, while those from the southern region had the lowest. Healthcare accessibility, maternal smoking, caste, age (child), and birthweight were among additional variables associated with infections. Our study revealed significant regional differences in prevalence of acute respiratory infection symptoms. Notably, inability to access healthcare increased a child's risk of infection. Several states in southern India, which typically had lower ARI symptom rates, have adopted initiatives to strengthen public health infrastructure, including the WHO's Integrated Management of Neonatal and Childhood Illnesses program. Such initiatives could serve as models for broader health improvement efforts across regions. Furthermore, observed variability in disease burden suggests that with detailed and deliberate implementation of programs, advancements in under-five mortality due to ARI can be achieved.