Community Medicine & Health Education

Goel et al., J Community Med Health Educ 2012, 2:9

http://dx.doi.org/10.4172/2161-0711.1000176

Research Article

Open Access

A Cross Sectional Study on Prevalence of Acute Respiratory Infections

(ARI) in Under-Five Children of Meerut District, India
Kapil Goel1*, Sartaj Ahmad2, Gagan Agarwal3, Parul Goel4 and Vijay Kumar3
Department of Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India
Department of Medical Sociology, Subharti Medical College, Meerut, Uttar Pradesh, India
3
Department of Pediatrics, Subharti Medical College, Meerut, Uttar Pradesh, India
4
Department of Biochemistry, Subharti Medical College, Meerut, Uttar Pradesh, India
1
2

Abstract
Background: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in under-five children
worldwide. On an average, children below 5 years of age suffer about 5 episodes of ARI per child per year, thus
accounting for about 238 million attacks and about 13 million deaths every year in the world. Identification of modifiable
risk factors of ARI may help in reducing the burden of disease.
Objective: To study the social demographic factors and prevalence of ARI in under five children living in urban
and rural area of Meerut district.
Materials and methods: A cross sectional study covering 450 under-five children living in urban and rural area
of Meerut district from October 2011 to March 2012.
Results: Prevalence of ARI was found to be 52%. It was higher in children with lower socioeconomic status
(35.89%), illiterate mother (49.14%), overcrowded conditions (70.94%), inadequate ventilation (74.35%), and use of
smoky chullah (56.83%), malnutrition (26.49) and parental smoking (78.20%).
Conclusion: The present study found that low socioeconomic status, maternal illiteracy, poor nutritional status,
overcrowding, indoor air pollution and parental smoking behavior were the significant social and demographic risk
factors responsible for ARI in under-five children. These observations emphasize the need for research aimed at
health system to determine the most appropriate approaches to control acute respiratory infection and thus could be
utilized to strengthen the ARI control programme.

Keywords: Acute respiratory infections; Under-five children;

Mother illiteracy; Indoor air pollution; Parental smoking

Hence the present study was conducted to determine the prevalence

and important socio-demographic factors associated with ARI.

Introduction

Material and Methods

Acute respiratory infection (ARI) in under-five children is one

of the main public health problems in India. It is the major cause of
morbidity and mortality in infants and young children below age 5.
Every year ARI in young children is responsible for an estimated 3.9
million deaths worldwide. ARI contributes to 15-30% of all under-five
deaths in India and most of these deaths are preventable [1]. ARI is an
important cause of morbidity in the children. On an average, children
below 5 years of age suffer about 5 episodes of ARI per child per year,
thus accounting for about 238 million attacks. Hospital records from
states with high infant mortality rate shows that up to 13% of inpatient
deaths in pediatric wards are due to ARI. The proportion of death due
to ARI in the community is much higher as many children die at home.
In India in 2008, about 27.4 million cases of ARI were reported which
gives an incidence rate of about 2394 cases per lakh population [2].

A cross sectional study was carried out among 450 under-five

children living in urban and rural area of Meerut district during
October 2011 to March 2012.

Many risk factors for respiratory tract infections have been

identified which include not only the climatic conditions but also the
poverty, poor nutrition, poor housing conditions, indoor air pollution
such as parental smoking, absence of ventilation, overcrowding,
industrialization, social cultural values, overuse and misuse of
antibiotics, lack of basic health services and lack of awareness.
There are multiple social and environmental factors associated
with ARI morbidity and mortality in childhood. These include comorbid illnesses especially HIV, malnutrition, prematurity or measles,
environmental determinants particularly passive smoke exposure,
overcrowding or poor living conditions and social factors principally
poverty and poor access to both preventative (including immunization)
and curative health services.
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal

Clearance from the Subharti ethical committee was first obtained.

Out of 450 studied children, 225 children were selected from urban area,
Multan Nagar and 225 children were selected from rural area, Khajuri
under the field practice area of Department of Community Medicine,
Subharti Medical College, Meerut. Purposive sampling was used. A
pre-designed and pre-tested questionnaire was used for data collection.
The questionnaire included information regarding socio-demographic
profile, housing conditions, type of cooking fuel used, anthropometric
and clinical examination. House to house survey was done for data
collection. History of episodes of ARI during last one year was enquired
for calculating the prevalence of ARI among children under-five. Social

*Corresponding author: Kapil Goel, Assistant Professor, Department of

Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India,
E-mail: drkapil123@gmail.com
Received July 31, 2012; Accepted October 26, 2012; Published October 28,
2012
Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross
Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in UnderFive Children of Meerut District, India. J Community Med Health Educ 2:176.
doi:10.4172/2161-0711.1000176
Copyright: 2012 Goel K, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.

Volume 2 Issue 9 1000176

Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in
Under-Five Children of Meerut District, India. J Community Med Health Educ 2:176. doi:10.4172/2161-0711.1000176
Page 2 of 4

classification is done on the basis of Modified Prasads classification

revised according to inflation rate in year 2007-2008. Data was entered
into SPSS package (version 16.0) and was analyzed by using chi-square
test and the results were expressed as proportions.

Results
Socio-demographic characteristics
Out of 450 children, the sex wise distribution was almost equal with
52% males and 48% females. In the study, about 47.55% (214) were
in between 1-4 yrs, 39.33% (177) were below age of 1 yr and 13.11%
(59) were in between 4-5 yrs of age. No major difference was found
in rural and urban area. Males were more in urban area (58.22%) and
females were more in rural area (54.22%). Majority were Hindus (76%)
followed by Muslims (21%). About one-fifth (19%) of children belonged
to upper social class (I, II) and remaining (79%) were in low social class
(III, IV, V). 42% of children were living in proper houses, it was more
in urban area (61%) as compared to rural area (23%). Overcrowding
was present in more than half of the houses (56%), it was more in rural
area (71%). Cross ventilation was present in 42% of houses, it was more
in urban (61%) as compare to rural area (23%). 34% children were from
households using smokeless fuel which is more in urban area (58%) as
compare to rural area (33%). 34% father and 52% mother of children
were illiterate (more in rural area 46%, 73% respectively). According to
occupational status of parents, 46% fathers were laborers, 71% mothers
were housewives, 16% were laborers. History of parental smoking
was present in 66% of houses, it was more in rural area (74%). About
29% were malnourished children (13% had grade-I, 11% had grade-II
and remaining had grade-III and IV), it was more in rural area (46%).
According to symptoms, about 71% of children having cough, 60%
nasal discharge, 30% fever, 16% fast breathing and 2% stopped feeding.

Prevalence of ARI
The overall prevalence of ARI was 52%. A total of 234 ARI cases
were found during the study. The mean number of episodes of ARI
was 2.25 per child per year. According to sex-wise 53.84% were males
and 46.15% were females. More ARI cases were seen in 1-4 years of age
group (46.15%) and in this age group 45.24% were males and 47.22%
were females (Table 1). According to social class, prevalence of ARI
was higher in low social class (in class III - 20.94%, class IV -32.9%, and
class V- 35.89% respectively) (Table 2). This difference was statistically
significant (x2=13.72, p<0.001). In social class IV and class V, prevalence
of ARI was more in rural area (34.43%, 37.77%) as compare to urban
area (30.12%, 32.53%). This difference was statistically significant
(x2=15.7, p<0.05) (Table 2).
Prevalence of ARI was highest in children of illiterate (49.14%)
and primary (34.43%) mothers. According to occupation of father,
prevalence of ARI was highest in children of fathers who were engaged
in agriculture (35.47%) and laborers (23.93%). Prevalence of ARI was
more in those children having history of parental smoking (78.20%) as
compared history of non-parental smoking (21.79%). Overcrowding
and inadequate ventilation has a direct relationship with prevalence
of ARI. ARI was higher in children (70.94%) who were living in
overcrowded houses as compare to no overcrowding (29.05%) and
inadequate ventilation was 74.35%. Prevalence of ARI was higher
in children of mothers who were using smoky chullhas (56.83%) as
compared to using smokeless chullhas (30.34%). Nutrition status of
children had also a direct bearing on childrens susceptibility to ARI. It
was more in Grade-I (26.49%), Grade-II (19.23%), Grade-III (15.38%)
and Grade-IV (09.82 %) respectively.
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal

Overcrowding has a direct relationship with prevalence of ARI;

it was higher (70.94%) in children who were living in overcrowded
houses as compare to no overcrowding (29.05%). This difference was
statistically highly significant (x2=13.28, p<0.001). Prevalence of ARI
was more in children living in houses with inadequate ventilation
(74.35%) as compared to houses with adequate ventilation (25.64%).
This difference was statistically significant (x2=12.23, p<0.001).
Prevalence of ARI was higher in children of mothers who were using
smoky chullhas (56.83%) as compared to using smokeless chullhas
(30.34%). This difference was statistically significant (x2=3.91,
p<0.001). According to exposure to type of fuel and types of ARI, ARI
cases were more seen in rural area (75.49%) as compared to urban area
(22.89%) where smoky fuel was used but difference was not statistically
significant (p>0.05). Nutritional status of child has direct bearing on
childrens susceptibility to ARI. Prevalence of ARI amongst children
who had no malnutrition was lowest (16.0%), while it was more in
Grade-I to IV malnutrition. This difference was statistically significant
(x2=37.83, p<0.001) (Table 2).

Discussion
In the study overall prevalence of ARI was found to be 52%. Our
findings are similar to the findings of a study done by Rahman and
Rahman [3] in Bangladesh where prevalence of ARI was found to
be 58.7%. Our findings are in contrast to the findings of the studies
conducted by Prajapati et al. [4] in Gujrat where the prevalence of
ARI was found to be 22% and Gupta et al. [5] where the prevalence of
ARI was 4.5%. In present study 53.84% of ARI cases were males and
46.15% were females. This study showed that ARI was more prevalent
among male children and similar study conducted in London, United
Kingdom by Leeder et al. [6] had similar results showing male sex was
more prone as compared to female.
According to social class, prevalence of ARI was higher in low
social class. The present study found a significant association between
ARI and social class (p<0.001). Various studies like by Gupta et al. [5],
Deb et al. [7] and Mitra [8] found similar association.
According to area, Prevalence of ARI was lower in urban area
(36.89%) as compared to rural area (67.11%). Similar observations
were seen in study done by Deb [7].
The present study found no association between ARI and literacy
status of mothers (p>0.05). Similar findings observed in study done by
Mitra [8].
Prevalence of ARI was more in those children having history of
parental smoking (78.20%). Similar findings were observed in a study
by Rahman and Rahman [3] in Bangladesh. Studies done on exposure
of cigarette smoke in Australia and risk of parental smoking in UK
have increased risk of hospitalization with ARI [9,10].
Prevalence of ARI was higher in children of mothers who were
using smoky chullhas (56.83%). Similar study in rural areas of Australia
also showed increase risk of developing LRTI among those using wood
fuel [11].
Age group (yrs)

Male
No.

0-1

Female
(%)

No.

(%)

Total
No.

(%)

53

(42.06)

45

(41.66)

98

(41.88)

1-4

57

(45.24)

51

(47.22)

108

(46.15)

4-5

16

(12.69)

12

(11.11)

28

(11.96)

Total

126

(53.84)

108

234

(100.00)

(46.15)

Table 1: Distribution of ARI cases according to age and sex wise.

Volume 2 Issue 9 1000176

Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in
Under-Five Children of Meerut District, India. J Community Med Health Educ 2:176. doi:10.4172/2161-0711.1000176
Page 3 of 4
Urban (%)

Rural (%)

Total (%)

ARI Present

83

(36.89)

151

(67.11)

234 (52.00)

ARI Absent

142

(63.11)

74

(32.89)

216 (48.00)

Male

56

(67.46)

70

(46.36)

126 (53.84)

Female

27

(32.53)

81

(53.64)

108 (46.16)

Distribution of ARI cases according to gender

Distribution of ARI cases according to age wise

0-1 Yr

25

(30.12)

73 (48.34)

98 (41.88)

1-4 Yrs

42

(50.60)

66 (43.70)

108 (46.15)

4-5 Yrs

16

(19.27)

12 (07.94)

28 (11.96)
07 (02.99)

Distribution of ARI according to Social class

Social class I

06 (07.22)

01

(00.66)

Social class II

09 (10.84)

08

(05.29)

17 (07.26)

Social class III

16 (19.27)

33

(21.85)

49 (20.94)

Social class IV

25 (30.12)

52

(34.43)

77 (32.90)

Social class V

27 (32.53)

57

(37.74)

84 (35.89)

Illiterate

36 (43.37)

79 (52.31)

115 (49.14)

Primary

21 (25.30)

31 (20.52)

52

High school

12 (14.45)

22 (14.56)

34 (14.52)

Intermediate

08 (09.63)

11 (07.28)

19 (08.11)

Above Intermediate

06 (07.22)

08 (05.29)

14 (05.98)
56 (23.93)

Mothers education of ARI Children

(34.43)

Fathers occupation
Laborer

19 (22.89)

37 (24.50)

Pvt. Service

26 (31.32)

11 (07.28)

37 (15.81)

Agricultural

00 (00.00)

83 (54.96)

83

(35.47)

Business

32 (38.55)

16 (10.59)

48

(20.51)

Govt. Service

06 (07.22)

04 (02.64)

10

(04.27)

Yes

52

( 62.65)

131 (86.75)

183 (78.20)

No

31

(37.34)

20

51

Yes

47

(56.62)

119 (78.80)

166 (70.94)

No

36

(43.37)

32

(21.19)

68 (29.05)

Inadequate ventilation

45

(54.21)

129 (85.43)

174 (74.35)

Adequate ventilation

38

(45.78)

22

(14.56)

60 (25.64)

Smoky Chullah

19

(22.89)

114 (75.49)

133 (56.83)

Smokeless Chullah

41

(49.39)

30

(19.86)

71 (30.34)

Others

23

(27.71)

07

(04.63)

30 (12.82)

Normal

15

(18.07)

53

(35.09)

68 (29.05)

Grade I

23

(27.71)

39

(25.82)

62 (26.49)

Grade II

19

(22.89)

26

(17.21)

45 (19.23)

Grade III

15

(18.07)

21

(13.90)

36 (15.38)

Grade IV

11

(13.25)

12

( 07.94)

23 (09.82)

History of Parental smoking

(13.24)

(21.79)

Overcrowding

Cross ventilation

Use of domestic fuel

Distribution of ARI cases according to Nutritional Status

Table 2: Social demographic factors and ARI cases in under five children of Meerut.

An another study conducted by Pore et al. [12] revealed that

significant association was found that between ARI and nutritional
status, immunization status, weaning, mothers literacy status in
pediatric ward of S.C.S.M. General Hospital, Solapur. A study
conducted by Gupta et al. [5] suggested that the factor analysis,
crowding, economic status, and sanitary conditions are important
associates of prevalence of ARI. The incidence of pneumonia was found
to be the highest in infant group. Lower socio-economic status and
malnourished had the greater risk of ARI episodes [13].
In a study done by Mitra [8] showed that low socio-economic
class, low birth weight, under-nutrition of the child, inadequate

J Community Med Health Educ

ISSN: 2161-0711 JCMHE, an open access journal

immunization, children not exclusively breastfed and indoor smoke

pollution were significantly associated with increasing number of
ARI episodes. A study conducted by Peat et al. [14] suggested that
between 500-2500 excess hospitalizations and between 1000 to 5000
excess diagnoses per 100,000 young children as result from respiratory
infections can be directly attributed to parental smoking.
A study by Singh and Nayar [15] discussed that the incidence of
ARI was found to be closely associated with nutritional status of the
child, socio-economic status of the family, maternal literacy status and
family size. Environmental factors like type of house, ventilation and
fuel used for cooking were found to influence the incidence of ARI.

Volume 2 Issue 9 1000176

Citation: Goel K, Ahmad S, Agarwal G, Goel P, Vijay Kumar (2012) A Cross Sectional Study on Prevalence of Acute Respiratory Infections (ARI) in
Under-Five Children of Meerut District, India. J Community Med Health Educ 2:176. doi:10.4172/2161-0711.1000176
Page 4 of 4

Chhabra et al. [16] reported that Lower respiratory infection was

more affected by adverse nutritional status than upper respiratory
infection. ARI incidence was also significantly lower among children
living in well-ventilated homes (1.79 episodes/child/year) than those
living in poorly ventilated homes (2.87 episodes/child/year).

4. Prajapati B, Talsania N, Sonaliya KN (2011) A Study On Prevalence Of Acute

Respiratory Tract Infections (ARI) In: Under Five Children in Urban And Rural
Communities Of Ahmadabad District, Gujarat. National Journal of Community
Medicine 2: 255-259.

Conclusion

6. Leeder SR, Corkhill R, Irwig LM, Holland WW, Colley JR (1976) Influences of
family factors on the incidence of lower respiratory illness during the first year
of life. Br J Prev Soc Med 30: 203212.

The present study found that low socioeconomic status, maternal

illiteracy, poor nutritional status, overcrowding, indoor air pollution
and parental smoking behaviour were the significant social and
demographic risk factors responsible for ARI in under-five children.
Based on the findings, occurrence of ARI could be reduced by improved
living, environmental conditions and nutrition of children. Raising
female literacy level and awareness regarding indoor pollution will
go a long way in prevention of morbidity amongst children in general
and ARI. These observations emphasize the need for research aimed at
health system to determine the most appropriate approaches to control
acute respiratory infection and thus could be utilized to strengthen the
ARI control programme.
Acknowledgement
Authors are thankful to Mr. Shiv Kumar, Mr. Anil Kumar and Mr. Praveen
Kumar (data entry operators), Zulfikar Ali (field volunteer) for their help and to the
parents of children who shared their valuable experiences, spent precious time and
for their participation.

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J Community Med Health Educ

ISSN: 2161-0711 JCMHE, an open access journal

Volume 2 Issue 9 1000176