Table 2 Data extraction for included studies

[1] Ethiopia

To assess the magnitude of lower respiratory tract infections and associated factors among under five children visiting Wolaita Sodo University Teaching and Referral Hospital

Cross-sectional survey

Mothers and care-takers (Hospitalised sample)

414

40.3%

Unvaccinated children, non-exclusive breastfeeding or replacement breastfeeding, unclean fuel for cooking, absence of separate kitchen, absence of window in the kitchen room

[13] Dr. Congo

To evaluate viral co-infections and risk factors for lower respiratory tract infections in children under 5 years

cross-sectional study

Children under five – years (Hospitalised sample)

146

57.5%

Malnutrition, rural settings, low income and mother illiteracy were risk factors

[14] Nigeria

To evaluate risk Factors for Acute Respiratory Tract Infections in Under‑five Children

cross-sectional study

Children Under – 5 Years (Hospitalised sample)

436

Pneumonia (31.6%), Bronchiolitis (6.9%)

Undernourished, Inadequate breast feeding, poor immunisation, attendance to day care centres, large family size, poor parental educational status, parental smoking, living in urban areas and the use of biofuels were risk factors

[15] Cameroon

To determine the proportion of acute respiratory infections and the associated risk factors in children under 5 years visiting the Bamenda Regional Hospital in Cameroon

Cross-sectional survey

Children under five (Hospitalised sample)

512

Pneumonia (22.3%)

HIV infection, poor maternal education, exposure to wood smoke, passive smoking and contact with someone who has cough

[16] Ethiopia

To evaluate the prevalence of, and risk factors associated with, acute respiratory infection hospitalisation in under five years children hospitalised at the University of Gondar Comprehensive Specialized Hospital

Cross-sectional survey

Under five children (Hospitalised sample)

422

27.3%

Children < 2 years, younger maternal age, maternal age above 28 years, lack of awareness about handwashing, rural residence

[17] Mozambique

To examine respiratory syncytial and influenza viruses in children under 2 years

Cross-sectional survey

Under two-years (Hospitalised sample)

450

26.7

[18] Ethiopia

To evaluate association of acute respiratory infections with indoor air pollution from biomass fuel exposure among under five children

Cross sectional study

Under – 5 years (Community sample)

265

Pneumonia (13.2%), Bronchiolitis (1.9%)

Large family size and living in household with no separate kitchen

[19] Rwanda

To examine spatial inequalities and Socioeconomic Factors of Acute Respiratory Infections among Under five Children

Cross sectional study

Under – 5 Years (community sample)

7,311

11.6%

Children with a history of diarrhoea, children > 2 years and crowded homes

[20] Ethiopia

To evaluate respiratory symptoms and associated risk factors among under five children

Cross sectional survey

Under 5 Years (Community sample)

792

37.5%

Uterine irritability during pregnancy, physical exercise during pregnancy, using wood and coal for heating, cockroach infestation, presence of new carpets, damp stain, opening windows during cooking, living less than 100 m heavy traffic and living less than 100 m unpaved road or street are risk factors

[21] Kenya

To examine long-term PM2.5 exposure as associated with symptoms of acute respiratory infections among children under five years of age

Cross sectional survey

Children under 5 Years (community sample)

7,036

Exposure to high concentrations of PM_2.5 is a risk factor

[22] Zambia

To examine the trends and factors associated with respiratory tract infection in children under five years

cross-sectional study

Under-5 years (Community sample)

30,391

5%

Underweight children, and the use of charcoal and firewood was associated with high ALRTIs, children of mothers with no education, breastfeeding children and crowded homes were risk factors. Mothers < 20 years

[23] Ghana

To examine ecological zone and symptoms of acute respiratory infection among children under five

cross-sectional study

under five – years (Community sample)

3,393

22.0%

Mothers in rural areas

[24] Ghana

To examine urinary pesticide residual levels and acute respiratory infections in children under 5 years of age

cross-sectional study

Mothers/ caretakers and children under five (Community sample)

404

22.1%

The use of agro-chemicals is a risk factor

[25] Rwanda

To assess social, economic, and environmental factors associated with acute lower respiratory infections among children under five to inform potential further improvements in the health system

Cross-sectional study

Children under five (Community sample)

8,484

Children < 2 years, children with severe anaemia, children living in urban area and those who did not receive vitamin A, raining season

[26] Ethiopia

To examine spatial distribution and determinants of acute respiratory infection among under five children

cross-sectional study

Children Under five- years (Community sample)

10,006

History of diarrhoea, children > 3 years, working mothers and stunting were risk factors

[27] Uganda

To investigate the association between wood and charcoal domestic cooking, respiratory symptoms and acute respiratory infections among children aged under 5 years

Cross-Sectional study

Pre-school children (Community sample)

15,405

Wood fuel use

[28] Ethiopia

To assess the prevalence and association factors of pneumonia among children under five in peri-urban area

cross-sectional study

Under five – years (Community sample)

560

17.1%

Cooking in the living room, overcrowding, malnutrition and child and family history of ALRTIs

[6] Sub-Saharan Africa

To examine the prevalence and determinants of ALRIs among children under five years

Cross-sectional survey

Under-5 years (Community sample)

13,495

25.3%

Children aged 24–59 months and those who infected with intestinal parasite were at higher risk of ALRIs. Mothers who were employed and improved toilet facilities were protective factors

[29] Ethiopia

To determine the risk factors for acute respiratory infection among children under the age of five in Ethiopia

cross-sectional survey

Children under five (Community sample)

9,918

8.4%

Children with mothers with low education, not receiving vitamin A, history diarrhoea and unimproved drinking water

[30]

To determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia

Cross-sectional survey

Children under five (Community sample)

7,911

7.8%

Poor household, mothers no education, child has not received vitamin A, child with history diarrhoea, mothers not working, stunted and no improved water source

[31] Eswatini

To investigate the individual- and community-level factors associated with child ALRIs in Eswatini

Cross-sectional survey

Children under five (Community sample)

4,265

11.1%

Child born to women with no formal or primary education; history of diarrhoea; children from urban areas; children in households with low proportion of electricity

[32] Ethiopia

To assess the association of food cooking place with acute respiratory infections and the variability in households and surveys

Cross-sectional survey

Children under -five (Community sample)

30,895

11.9%

Cooking inside the house, solid biomass fuel, breastfeeding, low parental education, mothers who do not listen or watch television and low wealth

[33] Ethiopia

To investigate the spatiotemporal pattern of ALRI in Ethiopian administrative zones

Cross-sectional survey

Children under five (Community sample)

29,599

15%

Older children > 2, no formal parental education, children from poorer households, the use of unimproved water and toilet facilities, unclean fuel for cooking, underweight, stunted, history of diarrhoea

[34] Ethiopia

To investigate the prevalence of childhood acute respiratory infection and associated factors in Northwest Ethiopia

Cross-sectional survey

Children under-four (Community sample)

5,830

19.2%

Living in house with no chimney, eaves space, improved cookstove, cow dung fuel, child spending time near stove, indoor cooking events, frequent cooking of meals

[35] Ethiopia

To evaluate the association of biomass fuel use with acute respiratory infection in children under five years

Cross-sectional survey

Under-5 years (Community sample)

422

23.9%

Biomass, kerosine, Cigarette smoking, children who were held by their mothers while cooking, poor ventilation. Children who lived in male dominated home were less likely to be exposed to ALRTIs

[36] Gambia

To examine prevalence and determinants of acute respiratory infections among children under five years

Cross-sectional survey

Rural mothers with children Under 5 Years (Community sample)

1364

37.1%

Children with mothers with primary education, non-breastfed children and children whose fathers were unemployed

[37] Uganda

To analyse the risk factors of ARI disease symptoms among children under the age of 5 years in Uganda

Cross-sectional survey

Children under five (community sample)

13,493

Children < 2 years, one year child old, children whose mothers are teenagers and farm workers

[38] Nigeria

To examine whether lifestyle factors are associated with ARI risk among Nigerian children aged less than 5 years, taking individual-level and contextual-level risk factors into consideration

Cross-sectional survey

Children under five (community sample)

28,596

In-house biomass cooking, no hand washing, orphan or vulnerable children

[39] Nigeria

To investigate the specific regional determinants of overall and wealth-related inequality in children having ARI in Nigeria over a decade

Cross-sectional survey

Children under five (community sample)

No maternal education, having no vaccination card, having high birth order, short birth interval

[40] Senegal

To explore this association by using the satellite-detected tropospheric NO2 concentrations measured by Sentinel-5 Precursor and ARI symptoms in children under age five

Cross-sectional survey

Children under five (community sample)

4,220

High level of nitrogen dioxide

[41] Uganda

To evaluate household management of acute respiratory infections in children under five years

cross-sectional survey (Intervention study)

Mothers and caretakers of under five – years children (community sample)

200

Pneumonia (9%)

Appropriate use of medication is associated with decreased risk of ALRTIs, pneumonia symptoms and high level of education of caretaker

The management of ARIs among the under fives in Kampala is suboptimal with misuse of antibiotics, antimalarials, dexamethasone, herbal medicines and cough remedies common

[42] Uganda

To evaluate use of antibacterial in the management of symptoms of acute respiratory tract infections among children under five years

cross-sectional survey (Intervention study)

Children under five- years

865

60.2% prevalence of antibiotic usage

Getting treatment from a health facility, peri-urban area and child having cough

It was found that antibacterial use is more common in children who are taken to a health facility with symptoms of ARIs. We also observed that living in less remote (peri-urban) areas was associated with high frequency of antibacterial use compared to rural areas

[43] Uganda

To assess the secular trend in the prevalence of ARIs as well as their treatment seeking-behaviour among Ugandan infants

Cross-sectional survey (Intervention study)

Singleton infants 0–5 (Community sample)

26,974

32.7%

Children 2–5 years, high order birth, malnutrition, poor households, intendedness of the child; rural residency,

Treatment seeking behaviour has doubled since 1995

[44] Dr. Congo

To evaluate decreased number of hospitalised children with severe acute lower respiratory infection after introduction of the pneumococcal conjugate vaccine

Quantitative (modelling)

children under 5 Years (Hospitalised sample)

21,478

9.4%

Malnutrition

[45] Benin

To examine high acute lower respiratory infection levels in children under five linked to specific weather conditions

Quantitative (modelling)

Under – 5 years

232,214

High relative humidity in wet season, low relative humidity and low temperature during dry season and high temperature

[46] Niger

To improve the integrated management of childhood illness through identification of etiologies of respiratory infections for an adapted treatment and testing of a new strategy for post hospitalisation health monitoring

Cohort study (Intervention study)

Children under five (Hospitalised sample)

767

Pneumonia (59.2%)

Failure to receive the second dose of pentavalent vaccine

Multiple home visits for post hospitalisation health monitoring did not offer better prevention of morbidity and mortality compared to a single visit

[47] Ethiopia

To investigate the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove

R.C.T (Intervention Study)

Children under five years (Community sample)

5,508

19.1%

Children > 2 years, inhouse cooking, frequency of cooking

Improved baking stove intervention did not have significant effect on ALRTI

[48] Ethiopia

To evaluate determinant factors for ARI

Case control

Under-5 years (hospitalised sample)

417

Age of the mother/ caregiver > 35 years, housewife, unclean stove, carrying the child while preparing food, absence of windows in the house, and nutritional status of the child

[49] Nigeria

To examine the pattern of acute respiratory infections in hospitalised children under five

Case control study

Children Under – 5 years (Hospitalised sample)

113

Total prevalence of 39%

[50] Ethiopia

To assess risk factors of acute respiratory infection among under five children attending public hospitals in Southern Tigray, Ethiopia

Case control study

Under five children (hospitalised sample)

288

Malnutrition, cow dung fuel use, presence of smoker in the family, low maternal literacy

[51] Nigeria

To examine Indoor airborne microbial burden and risk of acute respiratory infections among children under five years

Case control study

Under-5 years (hospitalised sample)

132

Higher indoor bacterial counts

[52] Nigeria

To evaluate housing quality and risk of acute respiratory infections among hospitalised children under five

Case control study

Hospitalised Under – 5 years (Hospitalised sample)

132

Damp roof, mould growths on walls and high indoor air relative humidity were risk factors

[53] Ethiopia

To examine children under five from houses of unclean fuel sources and poorly ventilated houses have higher odds of suffering from acute respiratory infection

Case- control study

Children under – 5 years (hospitalised sample)

1144

Solid fuel for cooking, poor ventilated houses, large family size and carrying children whiles cooking