Multilevel Analysis of Lifestyle and Household Environment for Toddlers With Symptoms of Acute Respiratory Infection (ARI) in Indonesia in 2007, 2012, and 2017

Introduction. The morbidity and mortality rate of Acute Respiratory Tract Infection (ARI) in children under 5 is relatively high in Indonesia. Socio-demographic characteristic is considered one of the factors causing ARI in Indonesia. However, no study analyzed the prevalence of ARI among toddlers and the differences among the determinant factors in multiple periods. Thus, this study aimed to analyze the prevalence trends and determinant factors associated with ARI symptoms in children under 5 in Indonesia in 2007, 2012, and 2017. Methods. This study analyzed cross-sectional survey data from the Demographic and Health Survey (DHS) in Indonesia during 2007, 2012, and 2017. Bivariate and multivariate analysis with logistic regression was performed using Stata version 15. The final results were expressed in Adjusted Odds Ratio (AORs) and 95% Confidence Interval (CI). Results. The findings showed a progress in prevalence trends with a decrease in the percentage of children with ARI symptoms from 11.25% (2007), then 5.12% (2012) to 4.22% (2017). Risk factors for toddlers experiencing ARI symptoms were as follows: younger maternal age (OR: 1.13, 95% Cl 0.70-1.81 in 2007, OR: 1.72, 95% Cl 1.03-2.88 in 2012 and OR: 0.98, 95% Cl 0.48-1.97 in 2017), smoking habits of family members (OR: 1.12, 95% Cl 0.85-1.48 in 2012, OR: 1.23, 95% Cl in 2017), poor drinking water quality (OR: 1.12, 95% Cl 0.85-1.48 in 2012 and OR: 1.23, 95% Cl in 2017), unavailable toilet facilities (OR: 1.27, 95% Cl 1.04-1.56 in 2007, OR: 1.24, 95% Cl 0.95-1.63 in 2012 and OR: 1.28, 95% Cl 0.97-1.68 in 2017). Conclusion. There was a decrease in the prevalence of ARI symptoms among children in 2007, 2012, and 2017, with no prominent differences in other related factors. The lifestyle and household environmental factors such as the use of dirty fuel, the presence of smokers in the household, the poor quality of drinking water, unavailable toilet facilities in addition to the maternal age and child age were the determinant factors that must be prioritized and improved. Family self-awareness should also be enhanced for better prospects for toddler survival.