{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:31:19Z","timestamp":1790573479568,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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\u20131.14; p = 0.04) and age 1 to &lt;3 years (adjusted PR: 1.18; 95% CI: 1.09\u20131.27; p &lt; 0.001) and 3 to &lt;5 years (adjusted PR: 1.14; 95% CI: 1.05\u20131.24; p = 0.001) were associated with higher prevalence compared with infants &lt;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.<\/jats:p>","DOI":"10.3390\/children12091242","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T14:31:41Z","timestamp":1758033101000},"page":"1242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Factors Associated with Acute Respiratory Infections in Children Under Five Years Old: Analysis of the Demographic and Family Health Survey"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5931-4924","authenticated-orcid":false,"given":"Diego A.","family":"Polo-Pucho","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Privada Norbert Wiener, Lima 15046, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier J.","family":"Gonzales-Carrillo","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Privada Norbert Wiener, Lima 15046, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A.","family":"Arce-Huamani","sequence":"additional","affiliation":[{"name":"Vicerrectorado de Investigaci\u00f3n, Universidad Privada Norbert Wiener, Lima 15046, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sarfo, J.O., Amoadu, M., Gyan, T.B., Osman, A.-G., Kordorwu, P.Y., Adams, A.K., Asiedu, I., Ansah, E.W., Amponsah-Manu, F., and Ofosu-Appiah, P. (2023). Acute Lower Respiratory Infections among Children under Five in Sub-Saharan Africa: A Scoping Review of Prevalence and Risk Factors. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-04033-x"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2333794X231156715","DOI":"10.1177\/2333794X231156715","article-title":"Differentials in the Prevalence of Acute Respiratory Infections Among Under-Five Children: An Analysis of 37 Sub-Saharan Countries","volume":"10","author":"Ekholuenetale","year":"2023","journal-title":"Glob. Pediatr. Health"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yaya, S., and Bishwajit, G. (2019). Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in Bangladesh. Trop. Med. Infect. Dis., 4.","DOI":"10.3390\/tropicalmed4010036"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Islam, M.A., Hasan, M.N., Ahammed, T., Anjum, A., Majumder, A., Siddiqui, M.N.-E.-A., Mukharjee, S.K., Sultana, K.F., Sultana, S., and Jakariya, M. (2022). Association of Household Fuel with Acute Respiratory Infection (ARI) under-Five Years Children in Bangladesh. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.985445"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Correia, W., Dorta-Guerra, R., Sanches, M., Almeida Semedo, C.d.J.B., Valladares, B., de Pina-Ara\u00fajo, I.I.M., and Carmelo, E. (2021). Study of the Etiology of Acute Respiratory Infections in Children Under 5 Years at the Dr. Agostinho Neto Hospital, Praia, Santiago Island, Cabo Verde. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.716351"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Gebrerufael, G.G., and Hagos, B.T. (2023). Prevalence and Predictors of Acute Respiratory Infection among Children Under-Five Years in Tigray Regional State, Northern Ethiopia: A Cross Sectional Study. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08701-2"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.ijid.2020.05.012","article-title":"Determinants of Acute Respiratory Infection (ARI) among under-Five Children in Rural Areas of Legambo District, South Wollo Zone, Ethiopia: A Matched Case\u2013Control Study","volume":"96","author":"Hassen","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Um, S., Vang, D., Pin, P., and Chau, D. (2023). Trends and Determinants of Acute Respiratory Infection Symptoms among Under-Five Children in Cambodia: Analysis of 2000 to 2014 Cambodia Demographic and Health Surveys. PLoS Glob. Public Health, 3.","DOI":"10.1371\/journal.pgph.0001440"},{"key":"ref_9","first-page":"17","article-title":"Acute Respiratory Infections among Under-Five Children Admitted in a Tertiary Hospital of Nepal: A Descriptive Cross-Sectional Study","volume":"60","author":"Bhurtel","year":"2022","journal-title":"JNMA J. Nepal. Med. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2147\/PHMT.S445908","article-title":"Prevalence and Outpatient Clinical Diagnostic Approaches for Common Acute Respiratory Tract Infections in Children Under Five Years of Age: A Cross-Sectional Study","volume":"15","author":"Turyasiima","year":"2024","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3961\/jpmph.22.470","article-title":"Associations Between Indoor Air Pollutants and Risk Factors for Acute Respiratory Infection Symptoms in Children Under 5: An Analysis of Data From the Indonesia Demographic Health Survey","volume":"56","author":"Santri","year":"2023","journal-title":"J. Prev. Med. Pub. Health"},{"key":"ref_12","unstructured":"World Health Organization (WHO) (2025, August 27). Pneumonia in Children. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/pneumonia."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tesema, G.A., Worku, M.G., Alamneh, T.S., Teshale, A.B., Yeshaw, Y., Alem, A.Z., Ayalew, H.G., Liyew, A.M., and Tessema, Z.T. (2022). Understanding the Rural\u2013Urban Disparity in Acute Respiratory Infection Symptoms among under-Five Children in Sub-Saharan Africa: A Multivariate Decomposition Analysis. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-14421-0"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"107019","DOI":"10.1016\/j.envint.2021.107019","article-title":"Ambient Air Pollution and Acute Respiratory Infection in Children Aged under 5 Years Living in 35 Developing Countries","volume":"159","author":"Odo","year":"2022","journal-title":"Environ. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1136\/jech-2023-220540","article-title":"Multidimensional Energy Poverty and Acute Respiratory Infection in Children under 5 Years of Age: Evidence from 22 Low-Income and Middle-Income Countries","volume":"77","author":"Stevens","year":"2023","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/S1473-3099(24)00176-2","article-title":"Global, Regional, and National Incidence and Mortality Burden of Non-COVID-19 Lower Respiratory Infections and Aetiologies, 1990\u20132021: A Systematic Analysis from the Global Burden of Disease Study 2021","volume":"24","author":"Bender","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_17","first-page":"e33425","article-title":"The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review","volume":"15","author":"Chelak","year":"2023","journal-title":"Cureus"},{"key":"ref_18","first-page":"e63143","article-title":"Behavior Change Theories and Models Within Health Belief Model Research: A Five-Decade Holistic Bibliometric Analysis","volume":"16","author":"Alamer","year":"2024","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/EDE.0000000000001544","article-title":"An Alternative Perspective on the Robust Poisson Method for Estimating Risk or Prevalence Ratios","volume":"34","author":"Talbot","year":"2023","journal-title":"Epidemiol. Camb. Mass."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yan, G., Ma, R., and Tariqul Hasan, M. (2019). A Joint Poisson State-Space Modelling Approach to Analysis of Binomial Series with Random Cluster Sizes. Int. J. Biostat., 15.","DOI":"10.1515\/ijb-2018-0090"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Petterle, R.R., Bonat, W.H., Kokonendji, C.C., Seganfredo, J.C., Moraes, A., and da Silva, M.G. (2019). Double Poisson-Tweedie Regression Models. Int. J. Biostat., 15.","DOI":"10.1515\/ijb-2018-0119"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/ije\/dyac220","article-title":"Reflection on Modern Methods: Risk Ratio Regression-Simple Concept yet Complex Computation","volume":"52","author":"Mittinty","year":"2023","journal-title":"Int. J. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Abdul Rahman, H., Noraidi, A.A., Hj Khalid, A.N., Mohamad-Adam, A.Z., Zahari, N.H., and Tuming, N.E. (2025). Practical Guide to Calculate Sample Size for Chi-Square Test in Biomedical Research. BMC Med. Res. Methodol., 25.","DOI":"10.1186\/s12874-025-02584-4"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s13643-022-01999-0","article-title":"Multivariate Meta-Analysis of Multiple Outcomes: Characteristics and Predictors of Borrowing of Strength from Cochrane Reviews","volume":"11","author":"Hattle","year":"2022","journal-title":"Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e000576","DOI":"10.1136\/bmjph-2023-000576","article-title":"Factors Associated with Acute Respiratory Infection and Healthcare-Seeking Behaviour among Primary Caregivers in Bangladesh: A Study Based on MICS 2019","volume":"2","author":"Fidah","year":"2024","journal-title":"BMJ Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e54","DOI":"10.1016\/j.pedn.2021.03.010","article-title":"Determinants of Acute Respiratory Infection Among Children Under-Five Years in Indonesia","volume":"60","author":"Windi","year":"2021","journal-title":"J. Pediatr. Nurs."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dagne, H., Andualem, Z., Dagnew, B., and Taddese, A.A. (2020). Acute Respiratory Infection and Its Associated Factors among Children Under-Five Years Attending Pediatrics Ward at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Institution-Based Cross-Sectional Study. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-1997-2"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ghimire, P., Gachhadar, R., Piya, N., Shrestha, K., and Shrestha, K. (2022). Prevalence and Factors Associated with Acute Respiratory Infection among Under-Five Children in Selected Tertiary Hospitals of Kathmandu Valley. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0265933"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Apanga, P.A., and Kumbeni, M.T. (2021). Factors Associated with Diarrhoea and Acute Respiratory Infection in Children Under-5\u2009Years Old in Ghana: An Analysis of a National Cross-Sectional Survey. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-02546-x"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"197","DOI":"10.11604\/pamj.2020.36.197.18799","article-title":"Trends and Factors Associated with Acute Respiratory Infection among under Five Children in Zambia: Evidence from Zambia\u2019s Demographic and Health Surveys (1996\u20132014)","volume":"36","author":"Mulambya","year":"2020","journal-title":"Pan Afr. Med. J."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/9\/1242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:30:59Z","timestamp":1763728259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/9\/1242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["children12091242"],"URL":"https:\/\/doi.org\/10.3390\/children12091242","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]}}}