Determinants of Acute Respiratory Infection among Children in India: Evidence from the National Family Health Survey-5

Acute respiratory infection (ARI) is a leading cause of morbidity among children under five years of age in low- and middle-income countries, where household air pollution from polluting cooking fuels is a recognised risk factor. This study examines the association between cooking-fuel exposure and ARI among Indian children under five, with particular attention to rural–urban variation. Using cross-sectional data from the fifth round of the National Family Health Survey (NFHS-5), we applied survey-weighted methods to account for the complex sampling design. Descriptive and bivariate statistics characterised prevalence patterns, and survey-weighted multivariable logistic regression models estimated the association between cooking-fuel exposure and ARI while adjusting for child, maternal, and household characteristics. An interaction term between cooking fuel and place of residence was tested for effect modification. ARI was more prevalent among children exposed to polluting fuels than among those in clean-fuel households. In unadjusted models, both indoor and outdoor polluting fuels were associated with higher odds of ARI; however, these associations attenuated to non-significance after adjustment for socioeconomic and demographic factors, indicating substantial confounding. Child age, sex, household wealth, and household smoking emerged as strong correlates of ARI. The interaction analysis showed that the cooking-fuel association varied by residence, with outdoor polluting fuels associated with higher odds of ARI in rural but not urban households. Cooking-fuel exposure is associated with ARI in Indian children, but its apparent effect is conditional on socioeconomic and environmental context. Policies that promote clean-fuel adoption, reduce household smoke, and improve rural housing may help lower the ARI burden.