Background: Acute respiratory infections are a leading cause of morbidity andmortality across all ages, particularly in children under the age of five. The burden ismore sever in countries where biomass fuels are the primary sources of cookingenergy. In Ethiopia, ninety-three percent of households use some type of biomass fuelfor cooking. Although there is biological plausibility to draw an association betweenhousehold air pollution exposure and acute respiratory infection, existing evidence iseither lacking or conflicting. Therefore, this review aimed at estimating the pooledprevalence of acute respiratory infection and its association with biomass fuel use inEthiopia.

Objective: The main purpose of this paper is to estimate the pooled national evidenceon the magnitude of acute respiratory infection among under five children and itsassociation with biomass fuel use for cooking and other behavioral or housingcharacteristics in Ethiopia.

Method: PubMed, Google scholar, MEDLINE and Cochrane library weresystematically searched for studies which reported the association between biomassfuel use for domestic purpose and acute respiratory infection. Grey literatures andother sources of unpublished information which were subjected to the same extractionmethods and quality appraisal as published studies was done. A meta-analysis wasapplied to combine odds ratios and their confidence intervals from eligible studies.Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) qualityassessment tool. Funnel and Doi plot were used for detecting the potential publicationbias. All statistical analyses were performed using comprehensive meta-analysis (CMA2.0) and MetaXL version 5.3 software.

Result: The result of 21 (18 cross sectionals and 3 case control) eligible studies with29, 727 participants revealed that the overall pooled prevalence of acute respiratoryinfection among under five children was estimated to be 22% (95% CI: 17, 29%). In thesubgroup analysis by the residence of participant the highest prevalence was found inurban area 26% (95% CI: 24, 28%). Based on the two weeks before the interview data,a significant association was found between biomass fuel use and acute respiratoryinfection (OR = 2.6; 95% CI 2.05 - 3.30). In addition to biomass fuel use, being female(OR= 1.57, 95% CI; 1.06 - 2.33), absence of window in the kitchen (OR = 2.89, 95%CI; 2.11 – 3.96), being carried on mothers back or in lap during cooking (OR =2.76,95% CI; 1.96 - 3.89) and non-separated kitchen from the main house (OR=1.99, 95%CI; 1.49 - 2.68) were associated with acute respiratory infection.

Conclusion : This review result showed that acute respiratory infection among underfive children remains high. The paper also revealed that acute respiratory infection isassociated with biomass fuel use, child’s gender, absence of window in the kitchen,carried child during cooking and non-separated kitchen. Improved solid fuel stoves,advanced combustion designs, window or chimneys, separating kitchen from the mainhouse, are required to reduce acute respiratory infection.