Background: Globally, Acute Respiratory Infections (ARI) remains the commonest cause of morbidity and mortality among under-five children and Ethiopia is no exception. Therefore, this study intended to assess the trend, prevalence, and associated factors of ARI among under-five years old children in Ethiopia.

Methods: This study used data from 2000, 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) collected from 9560, 9002,10808, and 10,006 children respectively for the trend analysis. Using the 2016 EDHS data, the study analyzed associated factors for ARI. Children having cough, short rapid breath, and problem in the chest and/or having a block or running nose symptoms were classified as having had ARI. For computing wealth index, composite variables were used. For analyzing factors associated with ARI, a total of 27 variables related to the index child and parent’s socio-demography were included in the bivariate model. To control for potential confounding effect, 17 variables with p-value < 0.2 in the bivariate model were included in the multivariate. Stata Version 16.1 was used for the analysis, a p-value of ≤ 0.05 with 95% CI was considered statistically significant.

Results: The trend data showed that a significant decrease in ARI prevalence from 24.4% in 2000, to 12.6% in 2005, to 7.0% in 2011, and 6.6% in 2016. The rate of change b/n 2000 and 2005 was 48.4%, while the rate of change between 2011 and 2016 was only 5.7%. Out of the 10,006 children studied in 2016, the prevalence of ARI was found to be 6.6%. Children born to a mother with primary education were 20% less likely to have ARI compared to children born to mothers with no education (AOR=0.80, 95%CI: 0.64–0.99), children from mothers with a partner having secondary education and higher education were  35% (AOR=0.64, 95% CI: 0.42–0.97) and 61%(AOR=0.39, 95% CI: 0.18–0.83) less likely to have ARI than those who have no education. Children whose mothers been employed were 1.3 (AOR=1.26, 95% CI: 1.05–1.51) times more likely to have ARI than those who were not. Children from a family with a wealth index in the lower quintile were 1.4 times  (AOR=1.37, 95% CI: 1.08–1.75) more likely to exhibit ARI symptoms than those form the poorest wealth quintile  Children aged 48 – 59 months were 36%(AOR=0.64, 95% CI: 0.45–0.90) less likely to have ARI symptoms than children aged 6-11 months.

Conclusion and Recommendations: There has been remarkable progress in reducing the ARI burden from 2000 to 2016 although the progress made in later years are much slower than in the earlier years. ARI remains a major public health challenge in Ethiopia. Associated factors have significant contribution which needs to be considered in national policies and strategies.  including a wealth index level. Age of children, Mother education level, Partner (Husband) education level, mothers working status were important variables. Therefore, governments, health-care workers should give emphasis to minimize ARI consequences associated with the disease.

Keywords: Acute respiratory infection, under-five, children, Ethiopia, Demographic and Health Survey, Trend, prevalence, factors