Factors Associated with Acute Respiratory Infections in Children Under Five Years Old: Analysis of the Demographic and Family Health Survey

Abstract

Background/Objectives: Acute respiratory infections (ARIs) remain a leading cause of morbidity and mortality in children under five in low- and middle-income countries. This study aimed to estimate the prevalence of caregiver-reported ARI symptoms and identify independent risk factors among Peruvian children under five using a nationally representative survey. Methods: We conducted an analytical cross-sectional study using the 2022 Demographic and Family Health Survey (ENDES) of Peru. Children under five with complete data were included. ARI symptoms were defined from the standardized DHS/ENDES question asking whether the child had a cough in the preceding two weeks. Analyses accounted for the complex survey design (weights, strata, primary sampling units). Associations were evaluated using modified Poisson regression with robust standard errors to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Among 6299 children under five, the prevalence of caregiver-reported ARI symptoms was 38.5%. After multivariable adjustment, male sex (adjusted PR: 1.07; 95% CI: 1.00–1.14; p = 0.04) and age 1 to <3 years (adjusted PR: 1.18; 95% CI: 1.09–1.27; p < 0.001) and 3 to <5 years (adjusted PR: 1.14; 95% CI: 1.05–1.24; p = 0.001) were associated with higher prevalence compared with infants <1 year. Wealth quintile, maternal education, and low birth weight were not independently associated with ARI symptoms. Conclusions: Caregiver-reported ARI symptoms remain highly prevalent among Peruvian children under five. Sex- and age-specific differences highlight the need for context-sensitive prevention, caregiver education, and efficient resource allocation within nationally representative, survey-informed child-health strategies.