Water Facility Type and Acute Respiratory Infections in Under-Five Children: Insights From a Hospital-Based...

When predicting the risk of childhood acute respiratory infections (ARI) among under-five children, categorizing drinking water sources remains controversial in Bangladesh. The study aimed to assess the impact of main two drinking water sources on childhood ARI status.

From January to April 2023, a hospital-based case-control study was carried out involving 216 cases and 216 controls among under-five children in Dhaka, Bangladesh. Children with ARI symptoms were considered as cases, while controls were without ARI symptoms. Piped water sources were categorized as improved sources, while tube well/boreholes as unimproved. Bivariate and multivariate logistic regression were performed to assess the relationship between two different water source categories and childhood ARI status.

Around 57% of households with cases had access to improved water sources while for controls it was 68.1%. Households with improved water sources had a 51% lower risk of having under-five children with ARIs (AOR: 0.5, 95% CI: 0.3-1.0, p = 0.039). Prematurity (AOR: 1.8, 95% CI: 1.1-3.0, p = 0.025), delayed initiation of breastfeeding (AOR: 3.0, 95% CI:1.8-4.8, p < 0.001), exposed to in-house smoking (AOR: 3.0, 95% CI: 1.9-5.0, p < 0.001) were associated with increased risk of childhood ARI. Older children had a lower risk of having ARI than infants.

Piped drinking water sources are associated with a lower risk of ARI among under-five children in Bangladesh. Water purification practices may act as a protective mechanism against ARI in households with piped water sources. Water supply infrastructure and behavioral strategies programs in areas with unimproved water sources could reduce the burden of ARI.