Acute respiratory infection (ARI) is an infectious illness caused by acute viral or bacterial infection of the breathing system, which is experienced by coughing, runny nose, sneezing, muscle pain, fever, and in the worst case may lead to shortness of breath and coughing up blood (1, 2). According to a 2018 World Health Organization (WHO) report, environmental exposures were contributing factors to a higher risk of respiratory problems, with indoor and ambient air pollution accounting for 7 million deaths of children under five globally (3). These exposures accounted for 210,777 disability-adjusted life years (DALYs) in 2015, with the highest DALYs per year in 1-year-old children (4). Approximately 1.3 million children die due to ARI annually (5).

Housing conditions have a substantial role in safeguarding people’s health (6). In the twenty-first century, most of society spends approximately 90% of their time at home, and the indoor housing condition correspondingly has a substantial influence on an inhabitant’s respiratory health (7). It is obvious that developing countries such as sub-Saharan African countries are increasing in urbanization rates. Such unintended rapid urbanization can lead to many slum dwellers, inadequate infrastructure and services, improper water and sanitation systems, and deteriorating air quality (8). In such countries, housing construction materials, accessing clean fuel, chimneys installation, number of windows, and having separate kitchens are all hidden by basic needs, drought, and many other man-made problems. However, such a housing environment influences the occurrence of ARIs by creating poor indoor air quality (2).

In particular, an innocuous and healthy living atmosphere contributes to youth growth and health (9). Because, children who have significant exposure to air pollutants at home, owing to their actively developing bodies, and tend to spend more time indoors. However, environmental factors continue to be a key risk factor that disturbs children’s health, which causes various short-and long-term impairments in children (10). Even if the problem is worldwide, environmental factors act as major risks to children’s respiratory disease among middle-and low-income countries (11).

The above issues indicated that housing conditions such as wall material, roof type, kitchen location, sanitation condition, and cooking fuel type are household-level predictors of acute respiratory disease among children under five years of age (12). Diseases of environmental origin in children can be prevented with the help of a combination of research to notice the environmental causes of disease together with science-based support (13).

Although the main studies are conducted internationally, there is still limited research on the impact of housing risk factors in the living environment on respiratory diseases among lower-developed countries. On the other hand, some include only one or a few environmental factors associated with acute respiratory symptoms (14, 15). At the same time, studies might also include limited study subjects and very specific study areas (16, 17), which are unable to show nationally representative evidence. Investigating the factors linked with acute respiratory symptoms, especially modifiable environmental risk factors, can decrease the morbidity of children due to acute respiratory disease.

Therefore, the aim of this study is to identify household-related environmental conditions affecting acute respiratory symptoms among children under five years of age in Ethiopia using the EDHS-2016 dataset. The study can provide substantial evidence to policymakers, health professionals, and other concerned stakeholders who are engaged in improving children’s health through enhanced housing conditions.

The aim of this study was to find neighbourhood environmental factors influencing the prevalence of acute respiratory symptoms among children under five years of age using the EDHS 2016. The study included 10,006 children younger than five years. Seven hundred and ninety-six (7.955% (7.397, 8.551%)) of the children experienced acute respiratory symptoms. The factor analysis of the findings of the study indicated that acute respiratory symptoms among children under five years of age were significantly associated with age, diarrhea status, residence, fuel type, stool disposal of youngest child, main wall material, and floor material.

This finding revealed that the prevalence of ARI symptoms was negatively linked with the age of the children. Younger children increased in experiencing acute respiratory symptoms compared to children near the age of five years. In reality, as their age increases, their immune system will be advanced to resist disease (23), they will advance in consciousness, and this is the time they get school where they are educated, including health and safety. This finding is in line with the studies performed in Bangladesh (24) and Nepal (25), which were conducted on ARI symptoms.

The main construction materials of the house (wall and floor) were strongly associated with acute respiratory symptoms among children under five years of age. The probability of experiencing ARI symptoms among children under five years of age was higher among children who resided in a house with a natural main wall and floor materials. Such poor housing standards are due to lower socioeconomic status and cultural acceptance leading to poor ventilation, supporting growth molds, home dampness (26–28), and difficulty cleaning acting as the source of dust particles limiting healthy life, including ARI symptoms among children (29–32). According to the findings of the studies performed in Lao PDR (33), main wall and floor materials were significantly associated with ARI symptoms, which is in line with this study. However, this finding contradicts the study performed in Punjab, Pakistan, in the case of wall main construction material and ARI symptom association (31). However, roof construction materials were not a statistically significant predictor of ARI symptoms in the children. This could be due to the height where the children had not come into direct contact with the roof rather than the wall and floor. This was consistent with an earlier study performed in Punjab, Pakistan (31). Therefore, housing conditions are a determinant of children’s health, including acute respiratory infections (34–37).

This study also revealed that the children under five years of age who found where improper stool disposal of the youngest child took place were more likely to have acute respiratory symptoms than the children who lived where proper stool disposal of the youngest child took place. Improper or unsafe stool disposal includes being put/rinsed into drains or ditches, being thrown into garbage, being, being left open/not disposed of, which is related to housing environmental contamination and creating bad odours, especially for children.

The probabilities of ARI symptoms among children under five years of age were increased among children who experienced diarrhea compared to children not affected by diarrhea. A possible explanation for this finding is that diarrhea, especially acute diarrhea, might lead to the loss of micronutrients and dryness, suppress the immune system (38), and expose children to bad smells, which are associated with respiratory problems. The study confirms previous findings in Ghana and Brazil (38) and Pakistan (18).

This study found that the likelihood of acute respiratory symptoms among children under five years of age was higher among children who lived in rural areas than among children who lived in urban areas. People who live in urban areas have a higher chance of being educated, wealthy, and exposed to information on disease prevention, including respiratory problems and awards for childcare, and they are near health facilities as well or in general. The standard of living is better in urban areas. These and other reasons might cause such differences in acute respiratory symptoms among children. This finding was consistent with other past studies (39–41) in different parts of the world.

The other factor statistically associated with acute respiratory symptoms other than the children was the type of fuel used for cooking, holding other factors constant. Children under five years of age who were connected to solid fuel use were more likely to develop acute respiratory symptoms than children who used clean fuel for cooking. Solid fuels used for cooking are sources of different gases, such as CO2, NO2, CO, methylene chloride, dioxins and respirable particulate matter (PM2.5) (42–45), which are the most health-harmful indoor air pollutants (46) where children spend more of their time. This idea is consistent with previous studies revealing the impact of solid fuel use on childhood respiratory problems (12, 39, 47). Children lived in Tigray and in Oromia; regions were affected by ARI symptoms compared with the children found in Addis Ababa. The reason behind this difference could be that Addis Ababa is the capital city where most of the economy, health and other related infrastructures fulfilled and satisfied community needs. These economy, health and other related infrastructures also enable childcare, including preventing acute respiratory infections. On the other hand, children living in the Somalia, Benishangul, and Harari regions were lower in experiencing ARI symptoms than children residing in Addis Ababa. A possible explanation for this variation is that during data collection, more vulnerable children for acute respiratory infections might not be found since there are desert areas that are difficult to access. However, the children lived in towns and cities where good health and safety take place in the regions could have a higher chance of being part of the survey.

Based on factor analysis findings, acute respiratory infection symptoms among children under five years of age were significantly associated with age of child, diarrhea status, residence, region, fuel type, stool disposal of youngest child, main wall material, and floor material. Interventions should be targeted in reducing acute respiratory infection symptoms among children under five years of age through proper stool disposal of the youngest child, informing the health effects of poor housing conditions such as improving wall and floor construction material. Hence, NGOs conserving under five children and the regional and federal governments of Ethiopia should focus on improving living/housing conditions and fuel types used for cooking and reducing diarrheal disease to reduce the effect of acute respiratory problems in children under five years of age.

This study utilized secondary data from publicly available datasets, which can be accessed at (48).

JA: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Supervision, Validation, Writing – original draft, Writing – review & editing. FW: Investigation, Visualization, Writing – review & editing. AM: Conceptualization, Investigation, Methodology, Software, Supervision, Validation, Writing – review & editing.