Epidemiological and Clinical Determinants of Acute Respiratory Infections among Children Aged 0 - 14 Years in Kamina Health District, Democratic Republic of Congo

Background: Acute respiratory infections (ARIs) remain a leading cause of morbidity and mortality among children in low- and middle-income countries. Identifying their epidemiological, clinical, and environmental determinants is essential for designing effective prevention and control strategies. This study aimed to assess the prevalence, clinical characteristics, and determinants of ARIs among children aged 0 - 14 years in the Kamina health zone, Democratic Republic of Congo. Methods: A community-based cross-sectional analytical study was conducted among 384 children aged 0 - 14 years. Data were collected using a structured questionnaire covering socio-demographic characteristics, clinical symptoms, environmental exposures, nutritional status, vaccination history, and healthcare-seeking behaviors. Peak expiratory flow (PEF) measurements were performed among eligible children. Descriptive statistics and multivariable logistic regression analyses were used to identify factors associated with ARIs. Results: Children exhibiting active signs of ARI were 12.5 times more likely to have the infection in bivariate analysis (PR = 12.5, p < 0.001). Having a prior history of ARI significantly increased current infection risk (PR = 5.21, p < 0.001; AOR = 3.96, p < 0.001). Both symptoms are strong indicators of ARI. Persistent cough (PR = 4.25; AOR = 2.84) and fever (PR = 3.15; AOR = 2.21) both retained strong, statistically significant associations in the final model (p = 0.013). Acted as a significant determinant, increasing the odds of an ARI diagnosis by 78% in the multivariate model (aOR = 1.78, p = 0.041). Exposure to individuals with similar symptoms in the patient’s immediate circle significantly increased ARI risk (PR = 2.80, p = 0.003). It remains highly significant after adjustment (aOR = 2.49, p = 0.007), highlighting the communicable nature of the infection. There was no statistically significant difference in ARI prevalence between the rainy and dry seasons (PR = 1.08, p = 0.838). The presence of underlying chronic conditions significantly increased the risk of ARI (PR = 1.77, p < 0.001). This vulnerability is sustained in the multivariate analysis (aOR = 1.69, p = 0.017). Severe forms of ARI showed a borderline significant relationship in bivariate analysis ($PR = 2.1, p = 0.053) and remained non-significant after adjustment (aOR = 1.58, p = 0.078). The multivariate logistic regression isolates the true, independent drivers of ARI by controlling for confounding variables. Living in a High Prevalence Health Area (aOR = 1.32, p = 0.018) is a significant environmental factor. Conclusion: ARIs represent a substantial public health burden among children in the Kamina health zone, driven primarily by household transmission and individual susceptibility factors. The limited diagnostic contribution of PEF underscores the need for integrated approaches combining clinical, environmental, and functional assessments. Strengthening community awareness, improving environmental conditions, and enhancing early detection strategies are critical to reducing ARI burden in resource-limited settings.