Spatial Clustering and Factors Associated with Acute Respiratory Infection among Under-five Children in India: A District-level Perspective

Background: Acute Respiratory Infection (ARI) is one of the leading causes of death in children Under-five years (U5), especially in developing countries like India. Despite various efforts by international and national agencies, the prevalence of ARI among children in India has increased from 2016 to 2021. Therefore, the present study was conducted to estimate the prevalence and contextual factors associated with ARI among U5 children across districts in India. Methods: The study used data from the National Family Health Survey-5 conducted during 2019-21. We used spatial analysis software (ArcGIS and GeoDa) to demonstrate the spatial prevalence and clustering across districts in India. A multilevel logistic regression model was employed to identify the factors associated with ARI. Results: The study revealed that the prevalence of ARI in India is 2.8 percent. The clustering analysis (Moran's I=0.27) identified 58 hot-spot and 66 cold-spot districts across India. Most of the hot-spot districts are from Uttar Pradesh, Maharashtra, Panjab, Delhi, Jammu & Kashmir, Odisha and Assam. The study also found significant associations between the prevalence of ARI in India and exposure to smoking in the household (AOR:1.13; 95% CI: 1.06-1.19), mothers with respiratory illness/asthma (AOR:2.33; 95% CI: 1.93-2.8), mothers' smoking behaviour (AOR:1.34; 95% CI:1.2-1.5), child malnutrition (AOR:1.08; 95% CI: 1.02-1.18), and history of diarrhoea (AOR:3.76, 95% CI: 3.52-4.02). Conclusion: The study recommends that public health programs focus on the high prevalence and hotspot districts and implement a district and state-level policy to control the incidence and burden of childhood ARI in India.